HIPAA 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.

1. Our Responsibilities

VitaLife Longevity Medicine is required by law to:

• Maintain the privacy of your protected health information (PHI)
• Provide you with this Notice of our legal duties and privacy practices regarding your health information
• Follow the terms of this Notice currently in effect
• Notify you if a breach of your unsecured health information occurs

2. How We May Use and Disclose Your Health Information

Treatment

We may use and share your health information with providers, nurses, and other healthcare professionals involved in your care. For example, your provider may share information with a specialist to whom you've been referred or with a laboratory performing tests related to your treatment.

Payment

We may use and share your health information for billing and payment activities. As a Direct Primary Care practice, we primarily collect payment directly from members. If you request a superbill for insurance reimbursement, relevant health information may be included.

Healthcare Operations

We may use and share your health information for practice operations including quality improvement, training, compliance activities, and business planning.

As Required by Law

We'll share your health information when required by federal, state, or local law.

Public Health Activities

We may share your health information for public health purposes such as reporting diseases, injuries, vital events, and FDA-regulated product issues.

Health Oversight Activities

We may share your health information with health oversight agencies for activities authorized by law, including audits, investigations, inspections, and licensure.

3. Your Rights Regarding Your Health Information

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your health information, including medical and billing records. To request access, submit a written request to our office. We may charge a reasonable fee for copying costs.

Right to Amend

If you believe your health information is incorrect or incomplete, you can request an amendment. Submit a written request explaining the reason for the amendment. We may deny your request in certain circumstances and will provide a written explanation.

Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures we've made of your health information. This doesn't include disclosures made for treatment, payment, or healthcare operations.

Right to Request Restrictions

You can request restrictions on how we use or share your health information for treatment, payment, or healthcare operations. We aren't required to agree to your request, but if we do, we'll honor it except in emergency situations.

Right to Request Confidential Communications

You can request that we contact you in a specific way or at a specific location. For example, you may ask that we only contact you by mail or at a specific phone number. We'll accommodate reasonable requests.

Right to a Copy of This Notice

You have the right to a paper copy of this Notice at any time, even if you previously agreed to receive it electronically. Contact our office to request a copy.

4. Changes to This Notice

We reserve the right to change this Notice and make the revised notice effective for health information we already have as well as any information we receive in the future. The current notice will always be available at our office and on our website.

5. Complaints

If you believe your privacy rights have been violated, you can file a complaint with VitaLife Longevity Medicine or with the U.S. Department of Health and Human Services Office for Civil Rights. We won't retaliate against you for filing a complaint.

To file a complaint with the U.S. Department of Health and Human Services, visit www.hhs.gov/hipaa/filing-a-complaint or call 1-877-696-6775.

6. Contact Information

For questions about this Notice or to exercise your rights, contact:

Privacy Officer: Courtney Contreras, PA-C
VitaLife Longevity Medicine
4461 S White Mountain Road, Suite D4
Show Low, AZ 85901
Phone: (928) 270-2515
Email: [email protected]