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.

Well & You Vein And Vascular, deemed as a covered entity under the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), will be referred to in this Notice of Privacy Practices (“Notice”) as “Well & You”. This Notice is created by Well & You to describe the ways in which Well & You may use and disclose your medical information (called “Protected Health Information” or “PHI”) and to notify you of your rights with respect to PHI in the possession of Well & You. Pursuant to the Regulations, and as outlined in this Notice, Well & You is permitted to use or disclose PHI to other parties. Below are categories describing these uses and disclosures, along with some examples to help you better understand each category.

Uses and Disclosures for Treatment, Payment and Health Care Operations: Well & You may use or disclose your PHI for the purposes of treatment, payment and health care operations, described in more detail below, without obtaining written authorization from you:

For Treatment: Well & You may use and disclose PHI in the course of providing, coordinating, or managing your medical treatment, including the disclosure of PHI for treatment activities of other health care providers. These uses and disclosures may take place between physicians, nurses, technicians, and other health care professionals who provide or are otherwise involved in your health care. For example, your primary care physician may share your PHI with a specialist physician whom he/she consults regarding your condition, or to their staff who are assisting in the provision or coordination of your care.

For Payment: Well & You may use and disclose PHI in order to bill and collect payment for health care services provided to you. For example, Well & You may need to give PHI to your health plan in order to be reimbursed for the services provided to you. Well & You may also disclose PHI to their business associates, such as billing companies, claims processing companies, and others that assist in processing health claims. Well & You may also disclose PHI to other health care providers and health plans for the payment activities of such providers or health plans.

For Health Care Operations: Well & You may use and disclose PHI as part of our health care operations, including: quality assessment and improvement, or evaluating the treatment and services you receive and the performance of its staff in caring for you. Other activities include provider training, compliance and risk management activities, planning and development, and management and administration. Well & You may disclose PHI to doctors, nurses, technicians, attorneys, consultants, accountants, and others for review purposes. These disclosures help ensure that Well & You is complying with all applicable laws, and are continuing to provide health care to patients at a high level of quality. Well & You may also disclose PHI to other health care providers and health plans for certain of their operations, including their quality assessment and improvement activities, credentialing and peer review or compliance activities.

Sharing PHI Among Well & You And Their Medical Staff: Well & You locations work together with the physicians and other health care providers on staff to provide medical services to you when you are a patient at a Well & You location. Well & You and the members of its staff will share PHI with each other as needed to perform their joint treatment, payment and health care operations activities

Other Uses and Disclosures for Which Authorization are Not Require:
In addition to using or disclosing PHI for treatment, payment and health care operations, Well & You may use and disclose PHI without your written authorization under the following circumstances:

As Required by Law and Law Enforcement: Well & You may use or disclose PHI when required by law. Well & You also may disclose PHI when ordered to in rare situations such as a judicial or administrative proceeding, in response to subpoenas or discovery requests, to identify or locate a suspect, fugitive, material witness, or missing person, about criminal conduct, to report a crime, its location or victims, or the identity, description or location of a person who committed a crime, or for other law enforcement purposes.

For Public Health Activities and Public Health Risks: Well & You may disclose PHI to government officials in charge of collecting healthcare information, such as reactions to medications or product defects, or to notify persons who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition.

For Health Oversight Activities: Well & You may disclose PHI to the government for oversight activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, and other activities necessary for monitoring health care or compliance with government programs or civil rights laws.

Research: Under certain circumstances, Well & You may use and disclose PHI for medical research purposes.

To Avoid a Serious Threat to Health or Safety: Well & You may use and disclose PHI to law enforcement or other appropriate persons, to prevent or lessen a serious threat to the health/safety of a person or the public.

Specialized Government Functions: Well & You may use and disclose PHI of military personnel and veterans under certain circumstances, and may also disclose PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities.

Appointment Reminders, Health-related Benefits and Services, Limited Marketing Activities: Well & You may use and disclose PHI to remind you of an appointment, or to inform you of treatment alternatives or other health-related benefits and services that may be of interest to you, such as disease management programs. Well & You may use and disclose your PHI to encourage you to purchase or use a product or service through face-to-face or written communication, or by giving you a promotional gift of nominal value.

Disclosures for HIPAA Compliance Investigations: Well & You may disclose your PHI when required to do so in connection with your rights of access to your PHI and to account for certain disclosures of your PHI. Well & You must disclose your PHI to the U.S. Department of HHS when requested by the Secretary in order to investigate compliance with privacy regulations issued under HIPAA.

Regulatory Requirements: Well & You is required by law to maintain the privacy of your PHI, to provide individuals with notice of their legal privacy practice duties with respect to PHI, and to abide by the terms described in this Notice. Well & You reserves the right to change the terms of this Notice or privacy policies, and to make changes applicable to all PHI it maintains. Well & You will acknowledge Notice changes and make available a revised copy of the Notice upon the patient’s request. A copy of the Notice will be posted in registration and waiting areas.

You Have The Following Rights Regarding Your PHI: You may request that Well & You restrict the use and disclosure of your PHI. Well & You is not required to agree to any restriction requests, but will be bound to restrictions to which we agree, except in emergency situations.

You have the right to request that communications of PHI to you from Well & You be made by alternative means or locations. You may request that Well & You can communicate with you by cell phone or via e-mail or to an alternate address. Well & You can accommodate your request through completion of the Well & You Communication Preferences and Message Agreement Form.

You have the right to inspect and copy your PHI in the possession of Well & You, if you make a request in writing to the Well & You Medical Records Director. Within thirty (30) days of receiving your request (unless extended by an additional thirty (30) days), Well & You will inform you of the extent to which your request has or has not been granted. Well & You may provide you a summary of the PHI you request if you agree in advance to such a summary. Well & You may impose a reasonable fee determined by state law to cover copying, postage, and related costs for copies or summaries of your PHI. If Well & You denies access to your PHI, it will explain the basis for denial. If Well & You does not maintain the PHI you request, and it knows where that PHI is located, we will tell you how to redirect your request.

You have the right to receive notifications whenever a breach of your unsecured PHI occurs. Well & You will provide notification through a written communication.

You have the right to restrict disclosure of information to your health plan(s) for services paid directly by you. You have the right to restrict the release of PHI for services for which you have paid for directly. Your written notification is required.

You have the right to designate personal representatives. You can designate specific individuals – other caregivers or personal representatives with whom Well & You may disclose your PHI. Please complete Well & You’s Patient Privacy and HIPPA Protection Form.

You have the right to request that Well & You amend, correct or supplement your PHI. Your request must be made in writing to the Well & You Medical Records Director and it must explain why you are requesting an amendment to your PHI. Within sixty (60) days of receiving your request (unless extended by an additional thirty (30) days), Well & You will inform you of the extent to which your request has or has not been granted. Well & You generally can deny your request if your request relates to PHI: (i) not created by the entity; (ii) that is not part of the records the entity maintains; (iii) that is not subject to being inspected by you; or (iv) that is accurate and complete. If your request is denied, Well & You will give you a written denial that explains the reason for the denial and your rights to: (i) file a statement disagreeing with the denial; (ii) if you do not file a statement of disagreement, submit a request that future disclosures of the relevant PHI be made with a copy of your request and the entity’s denial attached; and (iii) complain about the denial.

You have the right to request/receive a list of PHI disclosures Well & You has made during the six (6) years prior to your request (but not before April 14, 2003). The list will not include disclosures (i) for which you have provided a written authorization; (ii) for payment; (iii) made to you; (iv) to persons involved in your health care; (v) for national security or intelligence purposes; (vi) to law enforcement officials; or (vii) of a limited data set. You should submit any such request to the Privacy Officer, and within sixty (60) days of receiving your request (unless extended by an additional thirty (30) days), Well & You will respond to you regarding the status of your request. Well & You will provide you a list at no charge, but if you make more than one request in a year you will be charged a fee of $25.00 for each additional request.

You have the right to receive a paper copy of this notice upon request, even if you have agreed to receive this notice electronically. You can review and print a copy of this notice at any Well & You Web site via www.centerforvein.com or you may request a paper copy of this notice by contacting the Privacy Officer as described below.

You may complain to Well & You if you believe your privacy rights with respect to your PHI have been violated by contacting the Privacy Officer and submitting a written complaint, or contact the Well & You Hotline at 855-653-8346. Well & You will not retaliate against you for filing a complaint regarding their privacy practices. You also have the right to file a complaint with the Secretary of the Department of Health and Human Services.

If you have any questions about this notice, please contact the Well & You Privacy Officer by phone at 904-895-5400, by email at hello@wearewellandyou.com, or by mail at 15496 Max Leggett Parkway, Jacksonville, FL 32218.