THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective date: March, 2021
If you have any questions about this notice, please contact:
Dietgenics, Nutrition Consulting/Araceli Vázquez, MS, RDN, LD
1221 Abrams Rd, Suite 210, Walnut Abrams Plaza, Richardson, Texas 75081
At DietGenics, Nutrition Consulting our goal is to take appropriate steps to provide medical nutrition therapy and safeguard any medical or other personal information that is provided to us.
OUR PLEDGE REGARDING PROTECTED HEALTH INFORMATION:
We at DietGenics, Nutrition Consulting understand that protected health information about you and your health is personal. We are committed to protecting health information about you. This Notice applies to all of the records of your care generated by DietGenics, Nutrition Consulting.
This Notice will tell you about the ways in which we may use and disclose protected health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of protected health information. The law requires us to:
make sure that protected health information that identifies you is kept private;
notify you about how we protect protected health information about you;
explain how, when and why we use and disclose protected health information;
follow the terms of the Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU.
The following categories describe different ways that we use and disclose protected health information without your written authorization.
For Treatment. We may use protected health information about you to provide you with, coordinate or manage your medical treatment or services. We may disclose protected health information personnel who are involved in taking care of you.
For Payment for Services. We may use and disclose protected health information about you so that the treatment and services you receive at the DietGenics, Nutrition Consulting may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about nutrition services you received at DietGenics, Nutrition Consulting so your health plan will pay us or reimburse you for the service. We may also tell your health plan about the nutrition services you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
As Required by Law . All of our communication becomes a part of the clinical record. Adult records are disposed of seven years after the file is closed. Minor client’s records are disposed of seven years after the client’s 18th birthday.
Most of the information shared throughout treatment is confidential, however, there are limitations and exceptions that include: 1.) If I determine that you are a danger to yourself or others. 2.) If sexual contact with a health professional is disclosed. 3.) If abuse, neglect, or exploitation of a child, elderly, or disabled person is disclosed. 4.) If you have given DietGenics, Nutrition Consulting to release your records. 5.) If records are subpoenaed or are otherwise required by law to disclose information.
YOU CAN OBJECT TO CERTAIN USES AND DISCLOSURES
Unless you object, or request that only a limited amount or type of information be shared, we may use or disclose protected health information about you in the following circumstances:
We may share with a family member, relative, friend or other person identified by you protected health information directly relevant to that person’s involvement in your care or payment for your care. We may also share information to notify these individuals of your location, general condition or death.
If you would like to object to use and disclosure of protected health information in these circumstances, please present your request in writing and send to contact person listed on page 1 of this Notice.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU.
You have the following rights regarding protected health information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy protected health information that may be used to make decisions about your care. Usually, this includes medical and billing records.
To inspect and copy protected health information that may be used to make decisions about you, you must submit your request in writing DietGenics, Nutrition Consulting. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request, and we will respond to your request no later than 30 days after receiving it. There are certain situations in which we are not required to comply with your request. In these circumstances, we will respond to you in writing, stating why we will not grant your request and describe any rights you may have to request a review of our denial.
Right to Amend. If you feel that protected health information we have about you is incorrect or incomplete, you may ask us to amend or supplement the information.
To request an amendment, your request must be made in writing and submitted to DietGenics, Nutrition Consulting. In addition, you must provide a reason that supports your request. We will act on your request for an amendment no later than 60 days after receiving the request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request, and will provide a written denial to you. In addition, we may deny your request if you ask us to amend information that:
Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the protected health information kept by DietGenics, Nutrition Consulting
Is not part of the information which you would be permitted to inspect and copy; or
We believe is accurate and complete.
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of protected health information about you. To request this list or accounting of disclosures, you must submit your request in writing to DietGenics, Nutrition Consulting. You may ask for disclosures made up to six years before your request (not including disclosures made before April 14, 2003). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We are required to provide a listing of all disclosures except the following:
For your treatment
For billing and collection of payment for your treatment
For health care operations
Made to or request by you, or that you authorized
Occurring as a byproduct of permitted use and
disclosures
As part of a limited data set of information that does not contain information identifying you
Right to Request Restrictions. You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or health care operations or to persons involved in your care.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment; the disclosure is to the Secretary of the Department of Health and Human Services.
To request restrictions, you must make your request in writing to DietGenics, Nutrition Consulting.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at home, work or by mail.
To request confidential communications, you must make your request in writing to DietGenics, Nutrition Consulting. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice at any time by contacting Dietgenics, Nutrition Consulting,
OTHER USES AND DISCLOSURES
We will obtain your written authorization before using or disclosing your protected health information for purposes other than those provide for above (or as otherwise permitted or required by law). You may revoke this authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your information, except to the extent that we have already taken action in reliance on the authorization.
YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES If you believe your privacy rights have been violated, you may file a complaint with the DietGenics, Nutrition Consulting, LLC, 1221 Abrams Rd, Suite 210, Walnut Abrams Plaza, Richardson, Texas 75081 or file a written complaint with the Secretary of the Department of Health and Human Services. A complaint to the Secretary should be filed within 180 days of the occurrence or action that is the subject of the complaint.
If you file a complaint, we will not take any action against you or change our treatment of you in any way.