Legal

HIPAA Notice of Privacy Practices

Celly Health Medical Group — Affiliated Covered Entity

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.

Your Rights Typical Uses of Your Info Your Choices Other Uses & Disclosures Sharing Preferences Our Responsibilities

Patient Rights

When It Comes to Your Health Information, You Have Certain Rights

Get a Copy of Your Medical Record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask Us to Correct Your Medical Record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say "no" to your request, but we'll tell you why in writing within 60 days.

Request Confidential Communications

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say "yes" to all reasonable requests.

Ask Us to Limit What We Use or Share

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your care.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.

Get a List of Those With Whom We've Shared Information

You can ask for a list (accounting) of the times we've shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all disclosures except those about treatment, payment, and health care operations. We'll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a Copy of This Privacy Notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose Someone to Act for You

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

File a Complaint

You can complain if you feel we have violated your rights by contacting us using the information at the bottom of this page.

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

Choices

You Have Some Choices in the Way We Use and Share Information

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us and we will follow your instructions.

You Have the Right and Choice to Tell Us To:

Share information with your family, close friends, or others involved in your care

Share information in a disaster relief situation

Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

We Never Share Your Information Unless You Give Written Permission For:

Marketing purposes

Sale of your information

Most sharing of psychotherapy notes

Fundraising

We may contact you for fundraising efforts, but you can tell us not to contact you again.

Typical Uses

How Do We Typically Use or Share Your Health Information?

Treat You

We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run Our Organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

Bill for Your Services

We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.

Other Uses

How Else Can We Use or Share Your Health Information?

We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

Public Health & Safety

Preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse or neglect, preventing or reducing a serious threat to anyone's health or safety.

Research

We can use or share your information for health research.

Comply with the Law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.

Organ & Tissue Donation

We can share health information about you with organ procurement organizations.

Medical Examiner / Funeral Director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Workers' Comp & Government

For workers' compensation claims, law enforcement purposes, health oversight agencies, and special government functions such as military, national security, and presidential protective services.

Lawsuits & Legal Actions

We can share health information about you in response to a court or administrative order, or in response to a subpoena.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/

Responsibilities

Our Responsibilities

We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

We must follow the duties and privacy practices described in this notice and give you a copy of it.

We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Questions About This Notice?

Email: legal@cellyhealth.com

Phone: 844-CELLYMD (844-235-5963)

Mail: Celly Health, Inc., Attn: Legal, 10850 E Traverse Hwy, STE 1155, Traverse City, MI 49684