Notice of Privacy Practices
This notice describes how health information about you may be used and disclosed, and how you can get access to this data
Effective January 2024
Lifestyle Medly Terms
Last Updated: January 26, 2024
Lifestyle Medly LLC, conducting business in New Jersey as Lifestyle Medly, is committed to complying with the Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”), to maintain the privacy and security of your protected health information (PHI) and to provide you with a notice of Lifestyle Medly’s legal duties and privacy practices with respect to protected health information that Lifestyle Medly may collect and maintain about you.
Protected Health Information (“PHI”) is any information that identifies you or may be used to identify you (e.g., basic demographic information); that is created or received by a health care provider, health plan, employer or health care clearinghouse; and that relates to your past, present or future physical or mental health or condition and related health care services, or provision of or payment for health care. This protection extends to any PHI whether in oral, written, or electronic format. This Notice of Health Information Privacy Practices (“Notice”) describes how we may use and disclose your PHI to carry out treatment, payment, or health care operations and for other specified purposes that are permitted or required by law.
The Notice also describes your choices and rights with respect to your PHI when in the hands of Lifestyle Medly and its business associates, which are vendors that may assist us in providing services to you.
We are required by law to maintain the privacy and security of your PHI, abide by the terms of this Notice, and give you a copy of this Notice. We will not use or disclose your PHI without your prior written authorization, except as permitted or required by law and described in this Notice. Please note that if other federal, state, or local laws, rules or regulations restrict or limit the use and disclosure of your PHI in ways that are permitted under this Notice, Lifestyle Medly will only use or disclose your PHI in compliance with the stricter law, rule, or regulation. We will, as required by HIPAA, let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We strongly urge you to read this Notice carefully and thoroughly so that you will understand both our commitment to protecting the privacy and security of your PHI and how you can participate in the protection of this information.
What PHI We Collect
We collect PHI for the purposes providing treatment, obtaining payment, and performing health care operations. This may include personal details, medical history, diagnosis, treatment, provider identification, financial responsibility, health insurance coverage, and payment information.
How We May Use and Disclose PHI About You WITHOUT YOUR CONSENT
With the exception of information that may qualify for special protection under state and/or federal law, the following categories describe different ways that we use and disclose your PHI. Not every possible use or disclosure in a category is listed below. However, all of the ways in which we are permitted to use and disclose PHI will fall within one of the categories below. Also, Lifestyle Medly must limit its uses, disclosures, or requests for your PHI to the “minimum necessary” to accomplish the intended purpose of such use, disclosure, or request, except as permitted by law. Please note that, for purposes of this Notice, any references to “we” or “Lifestyle Medly” include all business associates we may engage.
We follow state and federal laws in using and disclosing PHI. Categories include:
Treatment. Providing and coordinating treatment and services. We may use and disclose PHI to inform you about treatment alternatives and health-related benefits.
Payment. Submitting claims for payment or reimbursement.
Health Care Operations. Supporting business operations, ensuring quality care, and contacting you when necessary.
Communications. Disclosing relevant PHI to individuals involved in your care or payment.
Business Associates. We may engage business associates for services, and PHI may be disclosed to them under specified agreements to safeguard your information.
Address workers’ compensation, law enforcement, and other government requests. We can use or share health information about you for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services. PHI may be used or disclosed for workers’ compensation claims.
Public Health and Safety. Disclosure may occur uncertain 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 else’s health or safety.
Comply with the Law. We will share information about you if state or federal laws or regulations 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 Lawsuits and Legal Actions. We may use or disclose PHI in response to court or administrative orders or subpoenas.
Research. Under certain circumstances, PHI may be used for research purposes with appropriate authorization or conditions.
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.
Respond to organ and tissue donation requests. We can share health information about you with organ procurement organizations.
Your Choices – 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.
Include your information in a hospital directory. 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.
In the case of fundraising: We may contact you for fundraising efforts, but you can tell us not to contact you again.
Use and Disclosure of PHI (WITH YOUR CONSENT)
For purposes beyond this notice, your written authorization is required, and you may revoke it at any time in writing.
Your Rights
You have rights regarding your PHI, including the right to access, request restrictions, request amendments, receive an accounting of disclosures, and choose someone to act for 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 we have 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 we’ll 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 our operations with your health insurer. We will say “yes” unless a law or regulation requires us to share that information. Get a list of those with whom we’ve shared 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’ll 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 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.
File a complaint if you feel your rights are violated. You can complain if you feel we have violated your rights by contacting us using the information on page 5.
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 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.
Security Measures
We employ physical, technical, and procedural safeguards to protect PHI against unauthorized use and disclosure.
Complaints/Objections.
Submit written complaints to Lifestyle Medly's Privacy Officer, at support@lifestylemedly.com respecting your confidentiality rights.
Contact Information
For inquiries or to exercise your rights, contact us by mail, email, or telephone using the provided details:
By Mail:
To Lifestyle Medly, LLC
441 US Highway 130
East Windsor, NJ 08520
Attn: Hassan Shahid, MD
By Telephone: 201-844-9062
By Email: support@lifestylemedly.com
Changes to Notice
Lifestyle Medly reserves the right to change practices and this notice, The changes will apply to all information we have about you. Changes becoming effective without prior notice. The new notice will be available upon request, in our office, and on our web site.
Obtaining a Copy of this Notice
You can access and print this Notice on our website www.lifestylemedly.com, or request a copy of this notice from Lifestyle Medly's Privacy Officer, at support@lifestylemedly.com.
Effective Date
This revised notice is effective as of 01-26-24.
