CENTER FOR METABOLIC AND BARIATRIC SURGERY
METABOLIC WEIGHT LOSS CENTERS, LLC
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.
Uses and Disclosures Treatment: Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members. Payment: Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of services, the services provided, and the medical conditions being treated. Health care operations: Your health information may be used as necessary to support the day to day activities and management of our medical and surgical companies. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality. Law Enforcement: Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting. Public health reporting: Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department. Abuse or Neglect: Our practice may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. This information will be disclosed only to the extent necessary to prevent a serious threat to your health or safety or that of others. Release of Information to Family/Friends: With prior written authorization, our practice may release your health information to a friend or a family member that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take their child to a pediatrician’s office for treatment of a cold. In this example, the babysitter may have access to this child’s medical information. Likewise, if a spouse is scheduling appointments for their family member, some medical information may be released, etc. Disclosure Required by Law: Our practice will use and disclose your health information when we are required to do so by federal, state, or local law. Lawsuits and Similar Proceedings: Our practice may use and disclose your health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain and order protecting the information the party has requested. Deceased Patients: Our practice may release your information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs. Organ and Tissue Donation: Our practice may release your health information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor. Research: Our practice may use and disclose your health information for research purposes in certain limited circumstances. We will obtain your written authorization to use your health information for research purposes except when an Internal Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following:- The use or disclosure involves no more than a minimal risk to your privacy based on the following:
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- An adequate plan to protect the identifiers from improper use and disclosures
- An adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifier or such retention is required by law)
- Adequate written assurances that the private health information will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use and disclosure would otherwise be permitted.
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- The research could not practicably be conducted without the waiver;
- The research could not practicably be conducted without access to and use of your health information.
- The right to request restrictions on the use and disclosure of your protected health information.
- The right to receive confidential communications concerning your medical condition and treatment.
- The right to inspect and copy your protected health information.
- The right to amend or submit corrections to your protected health information.
- The right to receive and accounting of how and to whom your protected health information has been disclosed.
- The right to receive a printed copy of this notice.
- 10475 Reading Road
- Suite 117
- Evendale, Ohio 45241
- 513-559-1222
