Lifeforce Medical Notice of Privacy

Last updated: October 26, 2023

Notice of Privacy Practices

THIS NOTICE OF PRIVACY PRACTICES (THIS “NOTICE”) DESCRIBES HOW YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED BY VAN MAELE MEDICAL, P.C., LIFEFORCE MEDICAL NJ, P.C., LIFEFORCE MEDICAL KS, P.A., AND LIFEFORCE MEDICAL, P.A. (COLLECTIVELY, “LIFEFORCE MEDICAL,” “WE” OR “US”), AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE NOTICE CAREFULLY.

The Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (“HIPAA”), requires Covered Entities (as defined therein)(each a “CE”) to ask patients to acknowledge receipt of a document similar to this Notice, which is published on the Lifeforce website.

By clicking on the “I Acknowledge Receipt of the NPP” check box to sign this Notice, You acknowledge receipt of the Notice. You can receive a copy of the Notice by asking for one from Lifeforce Medical, or by printing one from our website at any time.

Lifeforce Medical takes the privacy and security of your data seriously, whether or not we are engaging in standard transactions as defined at 45 CFR § 160.103, i.e., whether or not we are subject to HIPAA or qualify as a CE.

CE Responsibilities

Under HIPAA, CEs must take steps to protect the privacy of your Protected Health Information (“PHI”). PHI includes information that we have created or received regarding your health or payment for services related to your health. It includes both your medical records and personal information such as your name, social security number, financial information, address, and phone number.

Under federal law, CEs are required to:

Uses and Disclosures of Your Protected Health Information That Do Not Require Your Authorization

Lifeforce Medical and discloses PHI in a number of ways connected to your treatment, payment for your care, and our healthcare operations. Some examples of how we may use or disclose your PHI without your authorization are listed below.

TREATMENT

PAYMENT

HEALTHCARE OPERATIONS

OTHER

We may use or disclose your PHI without your authorization for legal and/or governmental purposes in the following circumstances:

We may also use or disclose your PHI without your authorization in the following miscellaneous circumstances:

Uses and Disclosures of Your Protected Health Information That Require Us to Obtain Your Authorization

Except in the situations listed in the sections above, we will use and disclose your PHI only with your written authorization. This means we will not use your PHI in the following cases, unless you give us written permission:

In some situations, federal and state laws provide special protections for specific kinds of PHI and require authorization from you before we can disclose that specially protected PHI. For example, additional protections may apply in some states to genetic, mental health, drug and alcohol abuse, rape and sexual assault, sexually transmitted disease and/or HIV/AIDS-related information, and/or to the use of your PHI in certain review and disciplinary proceedings of healthcare professionals by state authorities. In these situations, we will comply with the more stringent state laws pertaining to such use or disclosure. If you have questions about these laws, please contact the Privacy Officer at 1-213-325-2213 or privacy@lifeforce.com.

Your Rights Regarding Your Protected Health Information

You have the right to:

Communication Platforms

We may also use PHI to send you appointment reminders and other communications relating to your care and treatment, or let you know about treatment alternatives or other health related services or benefits that may be of interest to you, via email, phone call, or text message.

We may make certain PHI, such as information about care or treatment, appointment histories and medication records, accessible to you through secured online tools such as your Lifeforce patient account.

If you choose to communicate with us via emails, texts or chats, you acknowledge that we may exchange PHI with you via email, text or chat, that email, text and certain chat functionality may not be a secure method of communication, and that you agree to the security risks of such communication. If you would prefer not to exchange PHI via email, text or chat, you can choose not to communicate with us via those means, and you can notify us at privacy@lifeforce.com.

Changes to Privacy Practices

Lifeforce Medical may modify this Notice from time to time. The revised Notice will apply to all PHI that we maintain. We will make any such changes to this Notice by posting the revised Notice on our website. The date of the last update will be clearly indicated at the top of this Notice. Please review this Notice from time to time to ensure you are familiar with our privacy practices.

Questions and Complaints

If you have any questions about this Notice or would like an additional copy, please contact our Privacy Officer at 1-213-325-2213 or privacy@mylifeforce.com.

If you think that we may have violated your privacy rights or you disagree with a decision we made about access to your PHI, you may send a written complaint to the Privacy Officer at Lifeforce Medical, 1920 Olympic Blvd., Santa Monica, CA 90404.

By clicking on the “I Acknowledge Receipt of the Notice of Privacy Practices” check box to sign this Notice, You acknowledge receipt of the Notice.