Privacy & Compliance
Notice of Privacy Practices & Authorization for Use and Disclosure of Protected Health Information
Effective Date: January 1, 2025
Organization: Healix360 Mobile Wound Care Specialists
This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
You can ask to see or get a copy of your medical record and other health information we have about you.
You can ask us to correct health information about you that you think is incorrect or incomplete.
You can ask us to contact you in a specific way or at a certain location.
You can ask us not to use or share certain health information for treatment, payment, or operations.
You can ask for a list of times we've shared your health information in the past six years.
You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically.
You can complain if you feel we have violated your rights by contacting us or the U.S. Department of Health and Human Services Office for Civil Rights.
We typically use or share your health information in the following ways:
We can use your health information and share it with other professionals who are treating you.
Example: We share information about you with your primary care physician or specialists to coordinate your wound care treatment.
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We submit claims to your health insurance company that include information about your wound and treatment provided so we can receive payment.
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use your health information to manage your treatment and services, train staff, or improve our quality of care.
We can share health information with family members, friends, or others you identify who are involved in your care, unless you object.
Example: We can discuss your treatment with a family member or caregiver if you give us permission or if you are present and don't object.
We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as:
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 by letting us know in writing.
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 and on our website.
To exercise your rights described in this notice, please contact us:
Submit a written request to:
Privacy Officer
Healix360 Mobile Wound Care
[Your Address]
If you believe your privacy rights have been violated, you can file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights.
Contact our Privacy Officer at 877-545-1300
U.S. Department of Health and Human Services
Office for Civil Rights
We will not retaliate against you for filing a complaint. You will not be penalized or treated differently for exercising your privacy rights.
I have received a copy of this Notice of Privacy Practices
I have been given an opportunity to review it and ask questions
I understand how my health information may be used and disclosed
I understand my rights regarding my health information
I consent to the use and disclosure of my health information as described in this notice
This form will be signed during your first appointment.
A physical or electronic signature will be obtained at that
time.
If you have any questions about this Notice of Privacy Practices or need clarification about how we protect your health information, please don't hesitate to contact us.