Notice of Privacy Practices

Introduction

This Notice describes how your protected health information (PHI) may be used and disclosed and how you can access this information. Please review it carefully.

I. Our Commitment to Your Privacy

We understand that your health information is personal. We are committed to protecting your privacy and maintaining the confidentiality of your PHI. We create a record of the care and services you receive to provide quality care and comply with legal requirements. This Notice applies to all records generated by ShapeUp Weight & Wellness, PLLC.

We are required by law to:

• Keep your PHI private.
• Provide you with this Notice describing our legal duties, privacy practices, and your rights.
• Follow the terms of this Notice while it is in effect.

We reserve the right to change our privacy practices and the terms of this Notice at any time. Updated Notices will be available upon request and on our website.

II. How We May Use and Disclose Your Health Information

We may use or disclose your PHI for the following purposes:

Treatment, Payment, and Health Care Operations

We may use and share your information to provide, coordinate, and manage your care, process payments, and conduct business operations. For example, we may consult with other healthcare providers about your treatment without needing your written authorization.

Legal Requirements and Lawsuits

We may disclose PHI in response to court orders, subpoenas, or legal processes, after making efforts to inform you or seek protective orders.

III. Uses and Disclosures That Require Your Authorization

Certain types of uses or disclosures require your written authorization, including but not limited to:

• Use of psychotherapy or session notes (except for certain exceptions such as treatment, supervision, legal defense, or investigations).
• Marketing communications.
• Sale of your PHI.

You may revoke your authorization at any time by notifying us in writing.

IV. Uses and Disclosures That Do Not Require Authorization

We may disclose your PHI without your authorization in certain situations, including:

• As required by law (e.g., reporting abuse, threats to safety).
• Public health activities.
• Health oversight activities (e.g., audits).
• Judicial and administrative proceedings.
• Law enforcement purposes.
• Coroners, medical examiners, or funeral directors.
• Research (under strict guidelines).
• Specialized government functions.
• Workers’ compensation.
• Appointment reminders and information about treatment alternatives or health-related benefits and services.

V. Disclosures to Family, Friends, or Others

We may share your PHI with family members, friends, or others involved in your care or payment unless you object. In emergencies, we may provide information without prior consent but will seek it as soon as possible.

VI. Your Rights Regarding Your PHI

You have the right to:

• Request Restrictions: Ask us to limit how we use or share your PHI for treatment, payment, or operations. We are not required to agree except for certain out-of-pocket payments.
• Request Confidential Communications: Ask that we contact you in a specific way or at a different location.
• Inspect and Copy: Obtain copies of your medical records (except psychotherapy notes), usually within 30 days. A reasonable fee may apply.
• Request an Accounting: Receive a list of disclosures we have made outside of treatment, payment, or operations within the last six years.
• Amend Your Records: Request corrections or additions to your PHI. We will respond within 60 days.
• Receive a Paper or Electronic Copy of This Notice: Even if you agree to receive it electronically, you may request a paper copy at any time.

VII. Contact Information and Complaints

If you have questions about this Notice or believe your privacy rights have been violated, please contact:

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.