(Effective Date: September 12, 2012)

Russell Nutrition LLC is committed to protecting the privacy and security of your protected health information (PHI). This notice explains your rights regarding your health information and our legal duties related to the use and disclosure of that information.

We do not sell or market your personal health information.

YOUR RIGHTS

You have the right to:

Receive a copy of your medical record

You may request an electronic or paper copy of your medical record and other health information we maintain about you.

We will generally provide a copy or summary within 30 days of your request. A reasonable fee may apply as permitted by law.

Request corrections to your medical record

If you believe information in your record is incorrect or incomplete, you may request that we amend it.

We may deny the request in certain circumstances, but we will explain the reason in writing.

Request confidential communications

You may request that we contact you in a specific way or at a specific location.

For example, you may request communication by email only, phone only, or at a particular mailing address.

We will accommodate reasonable requests whenever possible.

Request restrictions on certain uses or disclosures

You may request that we limit how we use or disclose your health information for treatment, payment, or healthcare operations.

While we will consider all requests, we are not required to agree to restrictions that could affect your care or legal obligations.

If you pay for services completely out of pocket, you may request that information related to those services not be disclosed to your health insurance company. We will honor such requests when required by law.

Receive an accounting of disclosures

You may request a list of certain disclosures of your health information made during the previous six years.

This list will not include disclosures made for treatment, payment, healthcare operations, or disclosures that you authorized.

One accounting per year is available at no charge. Additional requests may be subject to a reasonable fee.

Receive a copy of this notice

You may request a paper copy of this Notice of Privacy Practices at any time, even if you previously agreed to receive it electronically.

Choose someone to act on your behalf

If you have given another person medical power of attorney or if a person is your legal guardian, that individual may exercise your rights and make decisions regarding your health information, as permitted by law.

File a complaint

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services.

You will not be penalized or retaliated against for filing a complaint.

YOUR CHOICES

In certain situations, you have the right to tell us how you would like us to share your information.

Examples include:

  • Sharing information with family members, caregivers, or others involved in your care
  • Sharing information during disaster relief efforts

If you are unable to communicate your wishes, we may share information if we believe it is in your best interest or necessary to prevent a serious threat to health or safety.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

Treatment

We may use and disclose your health information to provide, coordinate, or manage your care.

For example, we may communicate with your physician regarding your nutrition treatment plan or medical condition.

Payment

We may use and disclose health information to bill and collect payment from health insurance plans or other responsible parties.

For example, we may submit claims to your insurance company for nutrition counseling services.

Healthcare Operations

We may use health information to operate our practice, improve services, maintain records, conduct quality improvement activities, and communicate with you regarding your care.

Coordination of Care

We may communicate with your physicians, specialists, therapists, or other healthcare providers when necessary to coordinate care or verify medical information.

OTHER USES AND DISCLOSURES PERMITTED BY LAW

We may use or disclose health information without your written authorization in circumstances permitted or required by law, including:

Public Health Activities

  • Preventing or controlling disease
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence

Health Oversight Activities

  • Audits
  • Investigations
  • Licensing activities
  • Regulatory oversight

Legal Proceedings

  • Court orders
  • Subpoenas
  • Legal processes as required by law

Law Enforcement

  • Certain law enforcement requests
  • Reporting crimes occurring on the premises

Research

We may use or disclose information for approved research activities when permitted by law.

Workers’ Compensation

We may disclose information as necessary to comply with workers’ compensation laws.

Public Safety

We may disclose information to prevent or lessen a serious threat to the health or safety of a person or the public.

Coroners, Medical Examiners, and Funeral Directors

We may disclose information when required after an individual’s death.

Military and National Security Activities

We may disclose information as required for authorized government functions.

OUR RESPONSIBILITIES

Russell Nutrition LLC is required by law to:

  • Maintain the privacy and security of your protected health information
  • Provide you with this Notice of Privacy Practices
  • Follow the terms of this notice currently in effect
  • Notify you if a breach occurs that may compromise the privacy or security of your information

We will not use or disclose your information in ways not described in this notice without your written authorization unless permitted or required by law.

You may revoke an authorization at any time in writing, except to the extent that action has already been taken based upon that authorization.

CHANGES TO THIS NOTICE

We reserve the right to change the terms of this Notice of Privacy Practices.

Any changes will apply to all health information maintained by Russell Nutrition LLC.

Updated versions will be available upon request and through our client portal.

CONTACT INFORMATION

Russell Nutrition LLC

Caitlin Russell, MS, RD, LD

1000 Johnson Ferry Road
Suite D125
Marietta, GA 30068

Fax: (404) 924-7357

Website: www.russellnutrition.com

TO FILE A PRIVACY COMPLAINT

You may contact Russell Nutrition LLC using the information above.

You may also file a complaint with:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue SW
Washington, DC 20201

Phone: 1-877-696-6775

Website: https://www.hhs.gov/ocr

Russell Nutrition LLC will not retaliate against you for filing a complaint.