OUR PLEDGE REGARDING PROTECTED HEALTH INFORMATION

Go Light Bariatrics recognizes that your protected health information is personal. We are committed to safeguarding this information. This Notice applies to all records generated by Go Light Bariatrics, whether created by Go Light Bariatrics personnel or its affiliated doctors. It informs you about the ways in which we may use and disclose your protected health information. Additionally, we outline your rights and certain obligations we have regarding the use and disclosure of this information.

The law mandates that we:

• Ensure that your identifiable protected health information is kept private.
• Notify you about how we protect this information.
• Explain how, when, and why we use and disclose this information.
• Adhere to the terms of the currently effective Notice.
• We are obligated to follow the procedures outlined in this Notice.

We retain the right to modify the terms of this Notice and implement new provisions for all protected health information we maintain by providing copies of the revised Notice upon request or by posting the revised Notice on our website.

HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU

The following categories outline various ways we may use and disclose your protected health information without requiring your written authorization.

For Treatment: We may utilize your protected health information to offer, coordinate, or manage your medical treatment or services. Disclosure may be made to doctors, nurses, technicians, medical students, affiliates, or other personnel associated with Go Light Bariatrics who are actively engaged in your care. Go Light Bariatrics staff may share your protected health information to facilitate necessary elements of your treatment, such as prescriptions, lab work, and x-rays. Information about you may also be disclosed to external entities involved in your medical care. Additionally, we may collect, use, and disclose your protected health information to remind you of upcoming appointments at Go Light Bariatrics, provide you with your medical records, or to provide information about possible treatment options, alternatives, health-related benefits, or services.

For Payment for Services: Your protected health information may be used and disclosed to facilitate billing for the treatment and services you receive through Go Light Bariatrics. Payments may be collected from you, your insurance company, or a third party.

For Facilitating Operations: Protected health information about you may be used and disclosed for Go Light Bariatrics` facilitating operations. This includes activities such as quality assessment and improvement, case management, care coordination, business planning, customer services, and other necessary operations. These uses and disclosures are vital for the facility’s functioning, cost reduction, and ensuring all patients receive quality service. We may also analyze combined protected health information from multiple Go Light Bariatrics patients to determine necessary services, identify unnecessary services. Information may be disclosed to personnel, doctors, nurses, technicians, and medical students, for educational and review purposes. Any information identifying you may be removed to allow for studying healthcare and delivery without disclosing specific patient identities. In some limited situations, and subject to applicable state law, we may contact you as part of a fundraising effort. However, it’s important to note that some of the disclosed scenarios listed below may not occur at our facilities.

As Mandated by Legal Requirements: We will divulge protected health information about you when compelled to do so by federal, state, or local laws.

Research: Your Protected Health Information (PHI) may be disclosed to researchers if their research has received approval from an institutional review board or privacy board that has thoroughly examined the research proposal and established protocols ensuring the privacy of your information.

Health Risks: In situations where we reasonably believe you are a victim of abuse, neglect, or domestic violence, we may disclose your protected health information to a government authority. This type of information will only be disclosed to the extent required by law, with your consent, or if permitted by law and deemed necessary to prevent or mitigate a serious and imminent threat to you or another individual.

Judicial and Administrative Proceedings: If you are engaged in a lawsuit or dispute, your information may be disclosed in response to a court or administrative order. Health information about you may also be disclosed in response to a subpoena, discovery request, or other lawful processes initiated by another party involved in the dispute. However, such disclosures will only occur after efforts have been made, either by us or the requesting party, to inform you of the request or obtain an order protecting the requested information.

Business Associates: Information may be disclosed to business associates providing services on our behalf, such as billing companies. However, we mandate that they appropriately safeguard your information.

Public Health: In accordance with legal requirements, we may disclose your protected health information to public health or legal authorities tasked with preventing or controlling disease, injury, or disability.

To Prevent a Serious Threat to Health or Safety: We may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety or that of the public or another individual.
Health Oversight Activities: Health information may be disclosed to a health oversight agency for activities authorized by law, including audits, investigations, and inspections. These activities are necessary for licensure and government monitoring of the healthcare system, government programs, and compliance with civil rights laws.

Law Enforcement: Release of protected health information may occur as mandated by law, or in response to a court order, warrant, subpoena, or administrative request. Additionally, information may be disclosed in response to a request related to the identification or location of an individual, crime victims, decedents, or a crime occurring on the premises.

Organ and Tissue Donation: If you are an organ donor, we may release protected health information to organizations handling organ procurement, organ, eye, or tissue transplantation, or to an organ donation bank facilitating organ or tissue donation and transplantation.

Special Government Functions: If you are a member of the armed forces, we may disclose protected health information about you as it pertains to military and veterans’ activities. Additionally, your protected health information may be released for national security and intelligence purposes, protective services for the President, and medical suitability or determinations of the Department of State.

Coroners, Medical Examiners, and Funeral Directors: Release of protected health information may occur to a coroner or medical examiner, as necessary to identify a deceased person or determine the cause of death. Disclosure of protected health information to funeral directors, consistent with applicable law, may also be done to facilitate their duties.

Correctional Institutions and Other Law Enforcement Custodial Situations: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose protected health information about you to the correctional institution or law enforcement official as required for your or another person’s health and safety.

Worker’s Compensation: Information may be disclosed as necessary to comply with laws related to worker’s compensation or other similar programs established by law.

Food and Drug Administration: We may disclose protected health information to the FDA, or entities under the FDA’s jurisdiction, concerning adverse events related to drugs, foods, supplements, products, and product defects. This may include post-marketing surveillance information to facilitate product recalls, repairs, or replacements.

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU

You possess the following rights concerning the protected health information we hold about you:

Right to Inspect and Copy: You have the right to inspect and copy protected health information that might be used to make decisions about your care, typically involving medical and billing records. To review and copy protected health information relevant to your care decisions, submit a written request to Go Light Bariatrics. Charges may apply for copying, mailing, or other supplies associated with your request, and we will respond within 60 days of receiving it. There are instances where we are not obligated to fulfill your request. In such cases, we will respond in writing, explaining the reasons for denying your request and outlining any rights you have to request a review of our denial.

Right to Amend: If you believe that protected health information we possess about you is inaccurate or incomplete, you may request us to amend or supplement the information. Make a written request to Go Light Bariatrics, providing a reason supporting your request. We will address your request for an amendment within 60 days of receiving it. A written denial will be provided if your request is not in writing, lacks a reason, or seeks to amend information that was not created by us, is not part of the information you would be allowed 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,” a list of the disclosures made of protected health information about you. Submit a written request to Go Light Bariatrics, specifying the disclosures you want information about, covering up to six years before your request. The first list requested within a 12-month period will be free, while additional lists may incur charges for providing the information.

We are obligated to provide a listing of all disclosures, excluding those for your treatment, billing and collection of payment for your treatment, health care operations, made to or requested by you or authorized by you, occurring as a byproduct of permitted uses and disclosures, for national security or intelligence purposes, or to correctional institutions or law enforcement regarding inmates, or as part of a limited data set that does not identify you.

Right to Request Restrictions: You can 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 obligated to agree to your request, and if we do, we will comply unless the information is needed for emergency treatment, disclosure is to the Secretary of the Department of Health and Human Services, or for one of the purposes described on pages 4-5. Make your request in writing to Go Light Bariatrics.

Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a specific way or at a certain location, such as contacting you only at work or by mail. Make your request in writing to Go Light Bariatrics, and we will accommodate reasonable requests.

Right to a Paper Copy of This Notice: You can request a paper copy of this Notice at any time by contacting Go Light Bariatrics.

YOU MAY LODGE A COMPLAINT ABOUT OUR PRIVACY PRACTICES

If you believe that your privacy rights have been infringed upon, you can file a complaint with Go Light Bariatrics or submit a written complaint to the Secretary of the Department of Health and Human Services. A complaint to the Secretary should be lodged within 180 days of the occurrence of the complaint or violation. Filing a complaint will not result in any adverse action against you or alter our treatment of you in any way.