HIPAA-Compliant Privacy Policy of Wellness Haven

This document details how your medical information may be used and disclosed. Also, how you can acquire access to this information. Please review this document carefully. For further information or if you have any questions regarding our HIPAA Compliant Privacy Policy, please Contact us at (818) 475-4555 or contact us by Email: admin@lawellnesshaven.com

Your Rights

You have the right to the following:

• Obtain a copy of your digital or physical medical record
• Make corrections to your digital or physical medical record
• Request confidential communication
• Request we limit the information we disclose
• Obtain a list with whom we've disclosed your information to
• Access a copy of this privacy disclosure document
• Delegate someone to act on your behalf
• File a complaint if you believe your privacy rights have been violated in accordance with what is detailed in this document

Your Choices

You have several choices regarding the way we use and disseminate information as we:

• Disclose information about your medical condition to family and/or friends
• Provide disaster relief
• Incorporate your information into a hospital directory
• Provide behavioral health and substance use disorder care
• Market our services digitally and/or physically, and vend your information
• Secure funding

Our Uses and Disclosures

We may use and share your information as we:

• Provide treatment to you
• Operate our organization
• Invoice for services rendered
• Assist with public health and safety issues
• Conduct research
• Comply with industry laws and regulations
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Confront workers' compensation, law enforcement, and other government requests
• Reply to lawsuits and legal actions taken against our organization

Detailed Rights Information

Obtain an electronic or physical copy of your medical record

Request access to a digital or physical copy of your medical record and/or other personal health information. A copy or summary of your health information will be provided to you upon request, usually within 30 business days. A reasonable fee may be charged upon request.

Request to revise your medical record

Personal health information you believe to be incorrect or incomplete can be corrected upon request. Your request may be denied, but a detailed explanation will be given within 60 business days.

Request access to confidential communications

A specific form of contact (e.g., mobile, work or home phone) can be requested or any changes to a mailing address. Any requests deemed unreasonable will be denied.

File a complaint if you feel your rights are violated

If you feel we have violated your rights, then you can file a formal complaint by using the contact information provided.

It is your right to file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by mailing a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.

There will be zero retaliatory measures taken against you if a complaint is filed.

Our Responsibilities

• Our organization is required by law to maintain the privacy and security of your protected personal health information.
• Our organization will promptly inform you of any breach that occurs that may compromise the privacy or security of your personal health information.
• Our organization must follow the regulations, duties and privacy practices detailed in this disclosure document and will provide you a digital and/or physical copy.
• Our organization will not use or disclose your personal health information for any purpose other than what is detailed in this document unless expressly authorized in written or verbal communication.

Changes to the Terms of this Document

Our organization can change the terms of this privacy document at any time and the revisions will apply to all your information. Upon request, the revised document will be readily available in our office(s) and accessible on our web site.