Notice of Privacy Practices
Effective August 18th, 2009
This notice describes how medical and personal information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.
Our pledge and responsibilities regarding your medical information.
We understand that Private Health Information (PHI) about you and your health is personal.
This Privacy Policy applies to all of the products, services, and website services offered by Weight Management, Inc ("WM"). PHI includes personal information such as name,
address, date of birth, social security number, and insurance information. We create a record of the services you receive at Weight Management, Inc ("WM").
We need this record to provide you with quality service and to comply with certain legal requirements. This notice applies to all of your records generated at or by WM,
whether made by WM personnel, your personal doctor, specialists involved in your treatment, or other caregivers. Other caregivers may have different
policies and notices regarding the use and disclosure of your medical information created in the respective caregivers office or clinic.
We are required by law to make sure that your Personal Health Information will be kept private at all times and provide you with a description of our privacy practices with respect to your medical information. We will abide by the terms of this notice.
Who will follow this notice.
This notice describes Weight Management, Inc's practices and those of: (1) any health care professional authorized to enter information into your WM chart; (2) all departments and units of WM; (3) all employees of WM.
All these entities follow the terms of this notice. In addition, these entities, practitioners and caregivers may share medical information with each other for services, payment, or health care operations purposes described in this notice.
How we may use and disclose medical information about you.
The following categories describe different ways that we use and disclose medical information.
For each category of uses or disclosures we explain what we mean and try to give some examples.
Not every use or disclose in a category will be listed.
However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Services. We may use medical information about you to provide you with services.
We may disclose medical information about you to doctors, nurses, technicians, medical students,
or other medical personnel whom you have designated as your Primary Care Physician ("PCP").
For example, a doctor treating you for high blood pressure may need to know about significant weight loss
so your medication can be adjusted appropriately. Different departments of WM may also share medical information about you in order to coordinate the different things you need.
For Payment. We may use and disclose medical information about you so that treatment and services you receive at
WM may be billed and payment may be collected from you, an insurance company or a third party.
For example, we may need to give your health plan information about services you received at WM so your
health plan will pay us or reimburse you for the services. We may also tell your health plan about
services you are going to receive to obtain prior approval or to determine whether your plan will cover the services.
For Health Care Operations. We may use and disclose medical information about you for WM operations. These uses and disclosures are necessary to run WM and make sure that all of our patients receive quality services. For example, we may use medical information to review our services and to evaluate the performance of our staff in providing these services for you. We may also combine medical information about many WM patients to decide what additional services WM should offer and what services are not needed. We may also disclose information to doctors, nurses, technicians, medical students, and other WM personnel for review and learning purposes.
Other Activities. We may also use and disclose your protected health information:
- To contact you as a reminder that you have an appointment for services at WM
- To tell you about or recommend possible service options or alternatives
- To inform you about health-related benefits and services that may be of interest to you
- To contact you as part of our fund-raising efforts
Business Associates. As part of our operations, we may disclose information about you to contractors that provide a service to our facility such as a photocopy services that is responsible for photocopying our health records requested by patients, attorneys, health care providers, insurance companies, or other agencies. For example, (1) we may disclose patient information to an external transcription company or coding service for purposes of retransmitting that data back to our facility's repository for inclusion in the patient health record, (2) we may disclose patient information to an external agency that has been given permission to assume care and services for a patient, or (3) we may disclose medical information to a utilization review/case management group contracted with the facility to perform utilization reports.
Research. Under certain circumstances, we may use and disclose medical information about you for research purposes.
For example, a research project may involve comparing the health and success of all patients who receive one service or product to those who receive another.
All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information,
trying to balance the research needs with patients' need for privacy of their medical information. Before we use or disclose medical information for research,
the project will have been approved through this research approval process. We may, however, disclose medical information about you to people preparing to conduct
a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave WM.
We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are,
or will be involved in your services at WM.
Marketing.
Occasionally, WM may request to use your name or photograph for reasons for promoting a particular product or service that encourages others to purchase
or use a particular product or service. An example would be to use your photograph in a promotional advertisement for a particular service we offer to the community.
We will obtain your permission for this prior to the use or disclosure of any of your information for marketing unless the marketing communication occurs in a
face-to-face meeting we have with you or concerns promotional gifts of nominal value we give you. If WM is to receive money from another party in connection with the
marketing communication with you, we will state that fact on the authorization we request from you.
As Required by Law. We will disclose medical or other information about you when required to do so and only to the extent required by law.
This may include but is not limited to:
- Public Health Authorities charged with preventing or controlling disease, injury or disability
- Authorities responsible for investigating suspected child or adult abuse or neglect
- Health Oversight Agencies authorized by law for licensing or other purposes
- Funeral Directors, Coroners and Medical Examiners
- County attorneys about what we believe may be criminal conduct
State Specific Requirements. Many states have separate privacy laws that may apply additional legal requirements.
In situations where the laws in New York are more stringent than federal privacy laws or where they give patients more rights, the state law preempts the federal law, and we must abide by the applicable state law.
Judicial and Administrative Proceedings. If you are involved in a lawsuit or a dispute, we may disclose information about you in response to a court or administrative order.
We may also disclose information about you in response to a subpoena, discovery request, or other legal process by someone else involved in the dispute,
but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may release limited personal information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons, or similar process (but only if efforts are made to obtain an order protecting the information requested);
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
- If we believe in good faith that it is evidence of criminal conduct that occurred on the premises of the hospital; and
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Military. If you are a member of the armed forces, we may release information about you as required by military command authorities.
We may also release information about foreign military personnel to the appropriate foreign military authority.
Worker's Compensation. We may release medical information about you for worker's compensation or similar programs which provide benefits for work-related injuries or illness.
Food and Drug Administration. We may release medical information about you to report reactions to medications or problems with products.
National Security and Intelligence Activities. We may release information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities as authorized by law.
Protection Services for the President and Others. We may disclose information about you to authorized federal officials so they may provide protection to the President,
other authorized persons or foreign heads of state or to conduct special investigations.
Uses and Disclosures That We May Make Unless You Object
Individuals Involved in Your Services or Payment for Your Services. We may release information about you to a friend or family member who is involved in your services.
We may also give your information to someone who helps pay for your care. You have the right to object, in writing, to the use and disclosure of your personal health information
to family or friends who are involved in your services or who help pay for your services and, if you do so, we will follow your wishes.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy. You have the right to inspect and copy medical information about you.
This includes medical and billing records. We may deny your request to inspect your records in certain very limited circumstances,
but you always have the right to a copy of the records. To inspect and copy or receive a copy of your medical information, you must
submit your request in writing to WM. State and federal laws permit WM to charge reasonable cost-based fees for photocopies of your
medical records requested by you or if you request a written summary of your records. State law limits the amount we may charge you
for photocopying your record to $.75 per page. You will be advised in advance of any such fees.
Right to Amend.
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as the information is kept by or for WM. To request an amendment,
your request must be made in writing and submitted to WM at the address listed at the bottom of the page of this notice.
We may deny your request for an amendment and if we do, you will be notified of the reason for the denial.
Right to an Accounting of Disclosures.
You have the right to request an "accounting of disclosures." This is a list of certain disclosures we made of medical information about you for reasons other than services,
payment, or our operations. To request this list, or accounting of disclosures, you must submit your request in writing to WM at the address shown at the bottom of the page
of this notice. Your request must state a time period, which may be no longer than six years and may not include dates before April 14, 2003. The first list you request within a
12-month period will be free of charge. For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may
choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for our services, payment,
or operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your services or the payment for your services,
like a family member or friend as described in the paragraph headed "Individuals Involved in Your Care or Payment for Your Care."
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or when required by law.
To request restrictions, you must make your request in writing to WM at the address shown at the bottom of the page of this notice.
In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply,
for example, disclosures to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or
at a certain location. For example, you can ask that we only contact you at work or by mail. We will accommodate all reasonable requests. To request confidential communications,
you must make your request in writing to the Privacy Officer at the address shown at the bottom of the page of this notice.
Your written request must also specify how or where you wish to be contacted in order to receive bills for services rendered by WM and any
related correspondence regarding payment for services. We reserve the right to contact you by other means and at other locations if you fail to respond to any communication
from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location.
Right to a Copy of this Notice. You have the right to receive a paper copy of this notice. You may ask us to give you a copy of this notice at any time. If you wish to receive a paper copy of this notice, you may contact the Privacy Officer by submitting your request in writing.
You may also obtain an electronic copy and/or printable copy of this notice at our website, https://www.wmforlife.com/privacy-policy.
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