Notice of Privacy Practices

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.

Counsel flagThis is a HIPAA Notice of Privacy Practices template. Final version must be reviewed and customized by legal counsel familiar with HIPAA, the HITECH Act, Virginia state privacy law, and Empower Med’s specific operational practices (EHR vendors, lab partners, pharmacy partners, etc.). First-patient-encounter presentation is a HIPAA requirement — must be provided before first treatment encounter.

Our commitment to your privacy

Empower Med, PLLC ("Empower Med," "we," "us") is committed to protecting the privacy of your Protected Health Information ("PHI"). We are required by law to maintain the privacy of your PHI, provide you with this Notice of our legal duties and privacy practices with respect to PHI, and follow the terms of this Notice currently in effect.

How we may use and disclose your PHI

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services. This includes sharing PHI with other healthcare providers involved in your care, laboratory services, and pharmacy partners who dispense your medications.

Payment

We may use and disclose your PHI to obtain payment for services we provide. This includes activities such as billing, claims management, and collection activities.

Healthcare operations

We may use and disclose your PHI for healthcare operations necessary to run our practice, including quality assessment, care coordination, business planning, and legal compliance.

Other uses and disclosures without authorization

We may use or disclose your PHI without your authorization for purposes including: required by law; public health activities; health oversight; judicial and administrative proceedings; law enforcement; coroners and medical examiners; organ donation; serious threat to health or safety; specialized government functions; worker’s compensation; research (with appropriate safeguards); and as otherwise permitted by HIPAA.

Uses and disclosures requiring your written authorization

We will obtain your written authorization before using or disclosing your PHI for any purpose not described above, including: marketing communications (other than face-to-face communications), sale of PHI, and most uses or disclosures of psychotherapy notes.

Your rights regarding your PHI

You have the following rights with respect to your PHI:

Right to inspect and copy your PHI in our designated record set.
Right to request an amendment if you believe your PHI is incorrect or incomplete.
Right to an accounting of certain disclosures we have made of your PHI.
Right to request restrictions on certain uses and disclosures.
Right to request confidential communications at alternative locations or by alternative means.
Right to receive notification of a breach of your unsecured PHI.
Right to obtain a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

Our responsibilities

We are required to maintain the privacy of your PHI, provide you with this Notice, abide by the terms of this Notice currently in effect, and notify you following a breach of unsecured PHI.

Changes to this Notice

We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have about you, as well as any PHI we receive in the future. The revised Notice will be available on our website and at our practice.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

To file a complaint with Empower Med or to exercise any of the rights described above, contact:

Empower Med, PLLC
[Mailing address to be provided]
Email: info@empowermed.us
Phone: (571) 293-6244

To file a complaint with the federal government, contact the U.S. Department of Health and Human Services, Office for Civil Rights at hhs.gov/ocr.

Counsel flagBefore first patient encounter, counsel should: (1) review this Notice for HIPAA compliance; (2) confirm acknowledgment-of-receipt process; (3) confirm storage of signed acknowledgments; (4) align Business Associate Agreements with all vendors touching PHI (CharmHealth, Quest, pharmacy partners, any website-form processor, etc.); (5) document the designated Privacy Officer.