MyWellnessMD Effective Date: June 2025
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.
MyWellnessMD (“we,” “us,” or “our practice”) is required by the federal Health Insurance Portability and Accountability Act (“HIPAA”) and the California Confidentiality of Medical Information Act (“CMIA”) to maintain the privacy of your Protected Health Information (“PHI”), to provide you with this Notice describing our legal duties and privacy practices with respect to your PHI, and to notify affected individuals following a breach of unsecured PHI.
We are required to abide by the terms of the Notice currently in effect.
We may use and disclose your PHI without your written authorization for the following purposes:
We use and disclose PHI to provide, coordinate, or manage your healthcare. For example, we may share information with other providers, specialists, laboratories, pharmacies, or hospitals involved in your care. If you receive telehealth services, PHI may be transmitted through a secure telehealth platform.
We use and disclose PHI to obtain payment for healthcare services. For example, we may share information with your health plan, insurance carrier, or billing service to determine coverage, submit claims, and collect payment.
We use and disclose PHI in the ordinary operation of our practice, including quality assessment, staff training and evaluation, credentialing, accreditation, legal and auditing services, and business planning.
We may share PHI with third parties (“Business Associates”) that perform services for us — such as electronic health record vendors, telehealth platforms, billing services, transcription services, IT support, and legal counsel. All Business Associates are contractually required to safeguard your PHI.
We will disclose PHI when required by federal, state, or local law.
We may disclose PHI for public health purposes, including reporting disease, injury, births, deaths, and adverse events; conducting public health investigations; and reporting to the U.S. Food and Drug Administration.
We may disclose PHI to appropriate authorities if we reasonably believe you are a victim of abuse, neglect, or domestic violence, as permitted or required by law.
We may disclose PHI to health oversight agencies for audits, investigations, inspections, and licensure activities.
We may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process, subject to applicable legal protections.
We may disclose PHI to law enforcement officials as required by law, in response to a valid legal process, to identify or locate a suspect or missing person, or in other limited circumstances permitted by law.
We may disclose PHI to coroners, medical examiners, and funeral directors as necessary to carry out their duties.
If you are an organ donor, we may disclose PHI to organizations that handle organ procurement, transplantation, or donation.
We may use and disclose PHI for research purposes under limited circumstances, subject to appropriate approvals, waivers, or de-identification.
We may disclose PHI to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
We may disclose PHI for specialized government functions, including military and veterans’ activities, national security, and correctional institution or law enforcement custodial situations.
We may disclose PHI as authorized by, and to the extent necessary to comply with, workers’ compensation laws.
Unless you object, we may:
You may object to any of these uses at any time by notifying us in writing at info@mywellnessmd.com.
The following uses and disclosures require your specific written authorization. You may revoke your authorization in writing at any time, except to the extent we have already acted in reliance on it.
Additional California protections. Under CMIA and California law, additional written authorization is required for the disclosure of PHI relating to HIV/AIDS status and testing, mental health treatment, substance use disorder treatment, genetic testing, and reproductive health services. We will not disclose these categories of information without your specific written authorization unless required by law.
You have the following rights with respect to your PHI:
You have the right to inspect and obtain a copy of your PHI held in our designated record set, in the form and format you request if readily producible (including electronic copies). We may charge a reasonable, cost-based fee as permitted by law. We may deny access in limited circumstances; if we deny access, we will provide a written explanation and your right to review.
You have the right to request that we amend PHI you believe is inaccurate or incomplete. Requests must be made in writing and include a reason for the request. We may deny the request in certain circumstances and will provide a written explanation.
You have the right to receive an accounting of certain disclosures of your PHI made by us during the six years prior to your request, excluding disclosures for treatment, payment, healthcare operations, and certain other categories. The first accounting in any 12-month period is free; additional accountings may be subject to a reasonable, cost-based fee.
You have the right to request restrictions on our use or disclosure of your PHI for treatment, payment, or healthcare operations, or to persons involved in your care. We are not required to agree to your request, except that we must agree to restrict disclosures to a health plan for payment or healthcare operations if the PHI relates solely to a service you have paid for out of pocket in full.
You have the right to request that we communicate with you about your PHI by alternative means or at alternative locations (for example, only by mail to a specific address, or only by phone). We will accommodate reasonable requests.
You have the right to be notified in the event of a breach of your unsecured PHI, as required by law.
You have the right to a paper copy of this Notice, even if you have agreed to receive it electronically. You may request a copy at any time by contacting our office.
If we maintain your PHI electronically, you may request an electronic copy in a form and format that is readily producible.
How to exercise your rights. All requests should be submitted in writing to our Privacy Officer at the contact information below.
We are required by law to:
We reserve the right to change this Notice at any time and to make the revised Notice effective for PHI we already have about you as well as any PHI we receive in the future. We will post the revised Notice at our office locations and on this website and provide a copy on request.
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. We will not retaliate against you for filing a complaint.
To file a complaint with us: MyWellnessMD — Privacy Officer Email: info@mywellnessmd.com
To file a complaint with HHS: U.S. Department of Health and Human Services, Office for Civil Rights 200 Independence Avenue, S.W., Washington, D.C. 20201 1-877-696-6775 · www.hhs.gov/ocr/privacy/hipaa/complaints/
To file a complaint with California authorities: California Department of Public Health, Office of Health Information Integrity, or the California Attorney General’s Office.
For questions about this Notice or to exercise any of your rights, please contact:
MyWellnessMD — Privacy Officer Email: info@mywellnessmd.com Website: https://mywellnessmd.com Serving patients in Beverly Hills, Santa Monica, and throughout California via telehealth.
Please also review our Privacy Policy, Terms of Use, and Medical Disclaimer.
