Notice of Privacy Practices

Beloved Menopause, LLC, doing business as Beloved Menopause Clinic (“Beloved Menopause”) is committed to protecting the privacy and security of protected health information (PHI) and complies with all applicable Federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA) and Utah privacy laws. 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

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper 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 about you. Ask us how to do this. We will provide a copy or a summary of your health information, 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. Ask us how to do this. We may say “no” to your request but will 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 health care operations. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we share your 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 the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will 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 us 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.

Our services are intended only for individuals age 18 and older, and we do not knowingly provide services to minors. If we receive health information concerning a minor, we will handle that information in accordance with applicable law.

Utah Privacy Rights

We will use and disclose your protected health information in accordance with applicable federal and Utah law. Certain Utah laws may provide additional confidentiality protections for specific types of health information or records. Where applicable, we will comply with those requirements. You may have rights under federal or Utah law concerning access to, use of, and disclosure of your health information.

File a complaint if you feel your rights are violated

We value the relationships we develop with our patients, our patients’ privacy, and the trust our patients have in us. As such, we make every effort to remedy any issues or concerns you have. You may submit any complaint regarding your privacy rights to:

You may also file a complaint with the secretary of the U.S. Department of Health and Human Services Office for Civil Rights by:

• Sending a letter to
  Office for Civil Rights
  U.S. Department of Health and Human Services
  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.

Your Choices

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. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both 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.

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.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes.
• Sale of your information.
• Most sharing of psychotherapy notes.

Our Uses and Disclosures

We typically use or share your health information in the following ways (or as specifically described in this Privacy Notice):

Treat you

We can use your health information and share it with other professionals who are treating you. Example: A healthcare provider treating you for an injury asks another healthcare provider 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 as necessary to obtain and process payment for the services we provide to you. Our practice is cash-pay and does not bill health insurance plans for services. Example: We may use information about the services you receive to process your payment or address a billing question.

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 must meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues

We can share health information about you for certain situations such as:

• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do 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.

Respond to organ and tissue donation requests

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

Work with a medical examiner or funeral director

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

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

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

Specially Protected Information

Certain records (such as HIV/AIDS status, mental health records, substance use treatment records, genetic testing information, and other specially protected information) may be subject to additional state and federal protections and generally will not be disclosed without specific authorization except as permitted by law.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will notify you of any breach of your medical information without unreasonable delay and in accordance with federal and Utah law.
• 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.
• You may revoke a written authorization at any time by notifying us in writing.

Changes to the Terms of This Notice

We reserve the right to change this Notice and to make the revised Notice effective for health information we already have about you, as well as information we receive in the future. If we make a material change to this Notice, we will post the revised Notice on our website, including its effective date.