Effective Date: July 1st, 2008
Purpose of This Privacy Notice
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, initiate
payment, or conduct health care operations and for other purposes that are permitted or required by law. The medical practice reserves
the right to make changes in the Notice of Privacy Practices. The Notice describes your rights to access and control your protected
health information. “Protected health information” is information about you, including demographic information, that may identify you and
that relates to your past, present or future physical or mental health or condition and related health care services.
Who Will Follow This Notice:
This notice describes the privacy policies of our practice and that of:
• Any health care professional authorized to enter information into your medical record or have access to your information for purposes
of treatment, payment or health care operations
Our Pledge Regarding Medical Information
We understand that medical information about you and your health is personal, and we are committed to protecting it. A record of the care
and services you receive at this practice is created and maintained by the entities covered in this notice. This notice applies to all of those
records of your care.
We are required by law to:
• Make sure that medical information that identifies you is kept private
• Provide you this notice of our legal duties and privacy practices regarding your medical information
• Follow the terms of the notice that is currently in effect. We may change the terms of our notice at any time. The new notice will be
effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of
Privacy Practices. You may obtain a copy by calling our office and requesting that a revised copy be sent to you in the mail or asking for one
at the time of your next appointment.
How We May Use And Disclose Medical Information About You:
The following categories describe ways that we use and disclose medical information. Examples of each category are included. Not every
use or disclosure in each category is listed; however, all of the ways we are permitted to use and disclose information falls into one of
these categories:
• For Treatment: We may use medical information about you to provide, coordinate, or manage your medical treatment or services. We
may disclose medical information about you to other health care providers who are or will be involved in taking care of you. We would
disclose your protected health information, as necessary, to a home health agency that provides care to you. We would disclose your
protected health information, as necessary, to a physician or health care organization to which you have been referred to ensure that the
physician has the necessary information to diagnose or treat you.
• For Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed
to and payment may be collected from you, an insurance company, or a third party. We may also tell your health plan about a treatment you
are going to receive to obtain prior approval, to determine whether your plan will cover the treatment, and for undertaking utilization review
activities.
• For Health care Operations: We may use or disclose, as-needed, your protected health information in order to support the business
activities of our practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of
nutrition students, and conducting or arranging for other business activities. For example, we may disclose your protected health
information to nutrition students may work with patients at our office. We may call you by name in the waiting room when your dietitian is
ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
We may share your protected health information with third party “business associates” that perform various activities (e.g., billing,
transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or
disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your
protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or
other health-related benefits and services that may be of interest to you. For example, your name and address may be used to send you a
newsletter, a reminder card, or an email about our practice and the services we offer.
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise
permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that your
dietitian has taken an action in reliance on the use or disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the
use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure
of the protected health information, then your dietitian may, using professional judgment, determine whether the disclosure is in your best
interest. In this case, only the protected health information that is relevant to your health care will be disclosed.
Others Involved in Your Health care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other
person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable
to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest
based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member,
personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may
use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate
uses and disclosures to family or other individuals involved in your health care.
Emergencies: We may use or disclose your protected health information in an emergency treatment situation.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in the following situations without your consent or authorization. These situations
include:
Required By Law: We may use or disclose your protected health information to the extent that law requires the use or disclosure. The use
or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as
required by law, of any such uses or disclosures.
Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been
exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as
audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health
care system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports
of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse,
neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be
made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug
Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls;
to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to
an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a
subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law
enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited
information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a
result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the
Practice’s premises) and it is likely that a crime has occurred.
Workers’ Compensation: We may disclose your protected health information as authorized to comply with workers’ compensation laws
and other similar legally established programs.
Sale or Closure of the Practice: In the event that Nutrition at Best, Inc. is sold or acquired by another facility or group, your protected health
information will be disclosed to that group or entity.
Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department
of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500
YOUR RIGHTS
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise
these rights.
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected
health information about you that is contained in a designated record set for as long as we maintain the protected health information. A
“designated record set” contains medical and billing records and any other records that your dietitian and the practice use for making
decisions about you. Nutrition at Best, Inc. reserves the right to charge a reasonable fee for these services.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any
part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any
part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification
purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want
the restriction to apply.
Your dietitian is not required to agree to a restriction that you may request. If your dietitian believes it is in your best interest to permit use
and disclosure of your protected health information, your protected health information will not be restricted. If your dietitian does agree to the
requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to
provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your dietitian. You may request a
restriction by contacting and discussing the issue with us.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We
will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will
be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the
basis for the request. Please make this request in writing.
You may have the right to have your dietitian amend your protected health information. This means you may request an amendment of
protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may
deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us
and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact us to determine if you
have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right
applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice of Privacy
Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for
notification purposes. You have the right to receive specific information regarding these disclosures that occurred after July 1st, 2008. You
may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions and limitations.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we
already have about you as well as any information we receive in the future. We will post a copy of the current notice in the clinic. The notice
will contain on the first page, in the top right-hand corner, the effective date. In addition, you have the right to request a copy of the most
current notice in effect at any time.
COMPLAINTS OR QUESTIONS
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You
may file a complaint with us by notifying our privacy officer of your complaint. We will not retaliate against you for filing a complaint. You may
contact Nutrition at Best, Inc. Administration at (252) 757-0028 for further information about the complaint process.
Purpose of This Privacy Notice
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, initiate
payment, or conduct health care operations and for other purposes that are permitted or required by law. The medical practice reserves
the right to make changes in the Notice of Privacy Practices. The Notice describes your rights to access and control your protected
health information. “Protected health information” is information about you, including demographic information, that may identify you and
that relates to your past, present or future physical or mental health or condition and related health care services.
Who Will Follow This Notice:
This notice describes the privacy policies of our practice and that of:
• Any health care professional authorized to enter information into your medical record or have access to your information for purposes
of treatment, payment or health care operations
Our Pledge Regarding Medical Information
We understand that medical information about you and your health is personal, and we are committed to protecting it. A record of the care
and services you receive at this practice is created and maintained by the entities covered in this notice. This notice applies to all of those
records of your care.
We are required by law to:
• Make sure that medical information that identifies you is kept private
• Provide you this notice of our legal duties and privacy practices regarding your medical information
• Follow the terms of the notice that is currently in effect. We may change the terms of our notice at any time. The new notice will be
effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of
Privacy Practices. You may obtain a copy by calling our office and requesting that a revised copy be sent to you in the mail or asking for one
at the time of your next appointment.
How We May Use And Disclose Medical Information About You:
The following categories describe ways that we use and disclose medical information. Examples of each category are included. Not every
use or disclosure in each category is listed; however, all of the ways we are permitted to use and disclose information falls into one of
these categories:
• For Treatment: We may use medical information about you to provide, coordinate, or manage your medical treatment or services. We
may disclose medical information about you to other health care providers who are or will be involved in taking care of you. We would
disclose your protected health information, as necessary, to a home health agency that provides care to you. We would disclose your
protected health information, as necessary, to a physician or health care organization to which you have been referred to ensure that the
physician has the necessary information to diagnose or treat you.
• For Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed
to and payment may be collected from you, an insurance company, or a third party. We may also tell your health plan about a treatment you
are going to receive to obtain prior approval, to determine whether your plan will cover the treatment, and for undertaking utilization review
activities.
• For Health care Operations: We may use or disclose, as-needed, your protected health information in order to support the business
activities of our practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of
nutrition students, and conducting or arranging for other business activities. For example, we may disclose your protected health
information to nutrition students may work with patients at our office. We may call you by name in the waiting room when your dietitian is
ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
We may share your protected health information with third party “business associates” that perform various activities (e.g., billing,
transcription services) for the practice. Whenever an arrangement between our office and a business associate involves the use or
disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your
protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or
other health-related benefits and services that may be of interest to you. For example, your name and address may be used to send you a
newsletter, a reminder card, or an email about our practice and the services we offer.
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise
permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that your
dietitian has taken an action in reliance on the use or disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the
use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure
of the protected health information, then your dietitian may, using professional judgment, determine whether the disclosure is in your best
interest. In this case, only the protected health information that is relevant to your health care will be disclosed.
Others Involved in Your Health care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other
person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable
to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest
based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member,
personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may
use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate
uses and disclosures to family or other individuals involved in your health care.
Emergencies: We may use or disclose your protected health information in an emergency treatment situation.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in the following situations without your consent or authorization. These situations
include:
Required By Law: We may use or disclose your protected health information to the extent that law requires the use or disclosure. The use
or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as
required by law, of any such uses or disclosures.
Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been
exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as
audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health
care system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports
of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse,
neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be
made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug
Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls;
to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to
an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a
subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law
enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited
information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a
result of criminal conduct, (5) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the
Practice’s premises) and it is likely that a crime has occurred.
Workers’ Compensation: We may disclose your protected health information as authorized to comply with workers’ compensation laws
and other similar legally established programs.
Sale or Closure of the Practice: In the event that Nutrition at Best, Inc. is sold or acquired by another facility or group, your protected health
information will be disclosed to that group or entity.
Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department
of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500
YOUR RIGHTS
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise
these rights.
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected
health information about you that is contained in a designated record set for as long as we maintain the protected health information. A
“designated record set” contains medical and billing records and any other records that your dietitian and the practice use for making
decisions about you. Nutrition at Best, Inc. reserves the right to charge a reasonable fee for these services.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any
part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any
part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification
purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want
the restriction to apply.
Your dietitian is not required to agree to a restriction that you may request. If your dietitian believes it is in your best interest to permit use
and disclosure of your protected health information, your protected health information will not be restricted. If your dietitian does agree to the
requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to
provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your dietitian. You may request a
restriction by contacting and discussing the issue with us.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We
will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will
be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the
basis for the request. Please make this request in writing.
You may have the right to have your dietitian amend your protected health information. This means you may request an amendment of
protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may
deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us
and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact us to determine if you
have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right
applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice of Privacy
Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for
notification purposes. You have the right to receive specific information regarding these disclosures that occurred after July 1st, 2008. You
may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions and limitations.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we
already have about you as well as any information we receive in the future. We will post a copy of the current notice in the clinic. The notice
will contain on the first page, in the top right-hand corner, the effective date. In addition, you have the right to request a copy of the most
current notice in effect at any time.
COMPLAINTS OR QUESTIONS
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You
may file a complaint with us by notifying our privacy officer of your complaint. We will not retaliate against you for filing a complaint. You may
contact Nutrition at Best, Inc. Administration at (252) 757-0028 for further information about the complaint process.
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| NUTRITION AT BEST, INC. NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. If you have any questions about this notice, please contact: Nutrition at Best, Inc. Administration (252) 757-0028 |