Privacy Policy
Essentia Wellness, LLC. Inc.
Notice of Privacy Practices
(DBA: Essentia
Wellness, LLC. ™) (DBA: Essentia Wellness ™)
Last
updated: February 14, 2024
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.
I. Who We Are
This
Notice of Privacy Practices (“Notice”) describes the privacy practices of Essentia
Wellness, LLC. and its affiliates,
including certain affiliated professional entities and Asklepios, their
physicians, health care practitioners, and other personnel (“we” or “us”).
II. Our Privacy
Obligations
We are
required by law to maintain the privacy of your health information (“Protected Health
Information” or “PHI”) and
to provide you with this Notice of our legal duties and privacy practices with
respect to your PHI. We are also obligated to notify you following a Breach of
unsecured PHI. When we use or disclose your PHI, we are required to abide by
the terms of this Notice (or other notice in effect at the time of the use or
disclosure).
III. Permissible Uses and
Disclosures Without Your
Written Authorization
In
certain situations, which we describe in Section IV below, we must obtain your
written authorization in order to use and/or disclose your PHI. We do not need
any type of authorization, however, for the following uses and disclosures:
A. Uses and Disclosures For
Treatment, Payment and Health Care Operations. We may use and disclose
PHI, but not your “Highly Confidential Information” (defined in Section IV.B
below), in order to treat you, obtain payment for services provided to you, and
conduct our “Healthcare Operations” as detailed below:
Treatment. We may
use and disclose your PHI to provide treatment, for example, to diagnose and
treat your injury or illness. We may also disclose PHI to other health care
providers involved in your treatment.
Payment. In
most cases, we may use and disclose your PHI to obtain payment for services
that we provide to you.
Healthcare Operations. We may
use and disclose your PHI for our healthcare operations which include internal
administration and planning and various activities that improve the quality and
cost effectiveness of the care that we deliver to you. For example, we may use
PHI to evaluate the quality and competence of our physicians and other health
care practitioners. We may also disclose PHI in order to resolve any complaints
you may have.
We may
also disclose PHI to your other healthcare providers when such PHI is required
for them to treat you, receive payment for services they render to you, or
conduct certain healthcare operations, such as quality assessment and
improvement activities, reviewing the quality and competence of healthcare
professionals, or for health care fraud and abuse detection or compliance.
B. Disclosure to Relatives,
Close Friends and Other Caregivers. We may use or disclose
your PHI to a family member, other relative, a close personal friend, or any
other person identified by you when you are present for, or otherwise available
prior to the disclosure, if we (1) obtain your agreement; (2) provide you with
the opportunity to object to the disclosure and you do not object; or (3)
reasonably infer that you do not object to the disclosure.
If you
are not present, or the opportunity to agree or object to a use or disclosure
cannot practicably be provided because of your incapacity or an emergency
circumstance, we may exercise our professional judgment to determine whether a
disclosure is in your best interests. If we disclose information to a family
member, other relative or a close personal friend, we would disclose only
information that we believe is directly relevant to the person’s involvement
with your health care or payment related to your health care. We may also
disclose your PHI in order to notify (or assist in notifying) such persons of
your location, general condition, or death.
C. Public Health Activities. We may
disclose your PHI for the following public health activities: (1) to report
health information to public health authorities for the purpose of preventing
or controlling disease, injury or disability; (2) to report child abuse and
neglect to public health authorities or other government authorities authorized
by law to receive such reports; (3) to report information about products and
services under the jurisdiction of the U.S. Food and Drug Administration; (4)
to alert a person who may have been exposed to a communicable disease or may
otherwise be at risk of contracting or spreading a disease or condition; and
(5) to report information to your employer as required under laws addressing
work-related illnesses and injuries or workplace medical surveillance.
D. Victims of Abuse, Neglect
or Domestic Violence. If we reasonably believe you are a victim of abuse,
neglect or domestic violence, we may disclose your PHI to a governmental
authority, including a social service or protective services agency, authorized
by law to receive reports of such abuse, neglect, or domestic violence.
E. Health Oversight
Activities. We may disclose your PHI to a health oversight agency
that oversees the health care system and is charged with responsibility for
ensuring compliance with the rules of government health programs, such as
Medicare or Medicaid.
F. Judicial and
Administrative Proceedings. We may disclose your PHI in the
course of a judicial or administrative proceeding in response to a legal order
or other lawful process.
G. Law Enforcement Officers. We may
disclose your PHI to the police or other law enforcement officials as required
or permitted by law or in compliance with a court order or a grand jury or
administrative subpoena.
H. Decedents. We may
disclose your PHI to a coroner, medical examiner, or funeral director as
authorized by law.
I. Research. We may
use or disclose your PHI without your consent or authorization if an
Institutional Review Board or Privacy Board approves a waiver of authorization
for disclosure.
J. Health or Safety. We may
use or disclose your PHI to prevent or lessen a serious and imminent threat to
a person’s or the public’s health or safety.
K. Specialized Government
Functions. We may use and disclose your PHI to units of the
government with special functions, such as the U.S. military or the U.S.
Department of State under certain circumstances.
L. Workers’ Compensation. We may
disclose your PHI as authorized by and to the extent necessary to comply with
state law relating to workers’ compensation or other similar programs.
M. As Required By Law. We may
use and disclose your PHI when required to do so by any other law not already
referred to in the preceding categories.
IV. Uses and Disclosures
Requiring Your Written Authorization
A. Use or Disclosure with
Your Authorization. We must obtain your written authorization for uses and
disclosures of PHI for marketing purposes and disclosures that constitute the
sale of PHI. Additionally, other uses and disclosures of PHI not described in
this Notice will be made only when you give us your written permission on an
authorization form (“Your Authorization”). For instance, you will need to
complete and sign an authorization form before we can send your PHI to your
life insurance company or to the attorney representing the other party in a
lawsuit in which you are involved.
B. Uses and Disclosures of
Your Highly Confidential Information. Federal and state law
requires special privacy protections for certain highly confidential
information about you (“Highly Confidential Information”). This Highly
Confidential Information may include the subset of your PHI that: (1) is about
mental health and developmental disabilities services; (2) is about alcohol and
drug abuse prevention, treatment and referral; (3) is about HIV/AIDS testing,
diagnosis or treatment; (4) is about sexually-transmitted disease(s); (5) is
about genetic testing; (6) is about child abuse and neglect; (7) is about
domestic abuse of an adult with a disability; or (8) is about sexual assault.
In order for us to disclose your Highly Confidential Information for a purpose
other than those permitted by law, we must have Your Authorization.
C. Revocation of Your
Authorization. You may withdraw (revoke) your Authorization, or any
written authorization, regarding your Highly Confidential Information (except
to the extent that we have taken action in reliance upon it) by delivering a
written statement to the Privacy Officer identified below. A form of written
revocation is available upon request from the Privacy Officer.
V. Your Rights Regarding
Your Protected Health Information
A. For Further Information
and Complaints. If you would like more information about your privacy
rights, if you are concerned that we have violated your privacy rights, or if
you disagree with a decision that we made about access to your PHI, you may
contact our Compliance and Privacy Officer. Also, you may make a complaint by
calling our hotline at 1-833-422-6675. You may also file written complaints
with the Director, Office for Civil Rights of the U.S. Department of Health and
Human Services. Upon request, the Compliance and Privacy Officer will provide
you with the correct address for the Director. We will not retaliate against
you if you file a complaint with us or the Director.
B. Right to Request
Additional Restrictions. You have the right to request a
restriction on the uses and disclosures of your PHI (1) for treatment, payment
and health care operations purposes, and (2) to individuals (such as a family
member, other relative, close personal friend or any other person identified by
you) involved in your care or with payment related to your care. For example,
you have the right to request that we not disclose your PHI to a health plan
for payment or healthcare operations purposes, if that PHI pertains solely to a
health care item or service for which we have been involved and which has been
paid out of pocket in full. Unless otherwise required by law, we are required
to comply with your request for this type of restriction. For all other
requests for restrictions on use and disclosures of your PHI, we are not
required to agree to your request, but will attempt to accommodate reasonable
requests when appropriate. If you wish to request additional restrictions,
please obtain a request form from and return the form to our Compliance and
Privacy Officer. We will subsequently respond to your request with a written
response.
C. Right to Receive
Confidential Communications. You may request, and we will
accommodate, any reasonable written request for you to receive your PHI by
alternative means of communication or at alternative locations.
D. Right to Inspect and Copy
Your Health Information. You may request access to your
medical record file and billing records maintained by us in order to inspect
and request copies of the records. Under limited circumstances, we may deny you
access to a portion of your records. If you would like to access your records,
please request a Release of Information Form from the Privacy Officer and
submit the completed form to admin@essentiawellness.com. If you
request copies, we will charge you a cost-based fee that includes (1) labor for
copying the PHI; (2) supplies for creating the paper copy or electronic media
if you request an electronic copy on portable media; (3) our postage costs, if
you request that we mail the copies to you; and (4) if you agree in advance,
the cost of preparing an explanation or summary of the PHI.
E. Right to Request to Amend
Your Records. You have the right to request that we amend PHI
maintained in your medical record file or billing records. If you desire to
amend your records, please obtain an Amendment Request Form from the Compliance
and Privacy Officer and submit the completed form to admin@essentiawellness.com.
We will comply with your request unless we believe that the information that
would be amended is accurate and complete or other special circumstances apply.
F. Right to Receive An
Accounting of Disclosures. Upon request, you may obtain an
accounting of certain disclosures of your PHI made by us during any period of
time prior to the date of your request provided such period does not exceed six
years. If you request an accounting more than once during a twelve (12) month
period, we will charge you a reasonable fee for additional accountings of
disclosure, and will inform you in advance of any fee to provide you with an
opportunity to withdraw or modify the request.
G. Right to Receive A Copy of
this Notice. Upon request, you may obtain a copy of this Notice,
either by email or in paper format. Please submit your request to:
Essentia
Wellness, LLC.
ATTN: Compliance
601 Heritage Drive
Suite
227
Jupiter FL 33458
VI. Effective Date and
Duration of This Notice
A. Effective Date. This
Notice is effective on February 13, 2024
B. Right to Change Terms of
this Notice. We may change the terms of this Notice at any time. If we
change this Notice, we may make the new notice terms effective for all
Protected Health Information that we maintain, including any information created
or received prior to issuing the new notice. If we change this Notice, we will
post the new notice on our website at www.Essentiawellness.com You
also may obtain any new notice by contacting admin@essentiawellness.com
VII. Privacy Officer
You may
contact the Privacy Officer at:
Essentia
Wellness, LLC.
ATTN: Privacy Officer
601 Heritage Drive
Suite
227
Jupiter FL 33458
admin@essentiawellness.com