Privacy Policy

NEW DAWN WEIGHT LOSS, LLC

NOTICE OF PRIVACY PRACTICES 

Effective Date: 5-16-2025
This  Notice describes how your medical information may be used and  disclosed, and how you can access this information. Please review it  carefully.
1. Our Legal Responsibilities
We are required by law to:

• Maintain the privacy of your protected health information (“PHI”);
• Provide you with this Notice of Privacy Practices;
• Abide by the terms of the Notice currently in effect; and
• Notify you in the event of a breach of your unsecured PHI.

We  reserve the right to change the terms of this Notice at any time and to  make the new terms effective for all PHI we maintain, including PHI  created or received prior to the change. If we change our privacy  practices, we will:

• Post the revised Notice in our office and on our website; and
• Make a copy available to you upon request.

2. How We May Use and Disclose Your PHI Without Written Authorization
The  following categories describe ways we may use or disclose your PHI  without your written authorization. Not every example is listed, but all  uses and disclosures will fall within one of these categories:
A. Treatment
We  may use and disclose your PHI to provide, coordinate, or manage your  healthcare and related services. For example, we may share PHI with  another provider involved in your care, such as a specialist, pharmacy,  or laboratory.
B. Payment
We may use and disclose your PHI to bill  for and collect payment for services provided to you. For example,  providing necessary PHI to an insurance company for pre-authorization or  claims processing.
C. Healthcare Operations
We may use and  disclose your PHI for administrative, operational, and quality  improvement activities. Examples include reviewing cases for quality  assurance, training personnel, licensing, accreditation, and contacting  you with appointment reminders.
D. Business Associates
We may  share your PHI with third-party contractors (“business associates”) who  perform services on our behalf, such as billing or transcription,  provided they have signed an agreement requiring them to safeguard your  PHI.
E. Marketing
We may use your PHI to inform you about  health-related services or products we offer. You have the right to opt  out of receiving such communications at any time.
F. Fulfillment and Shipping Vendors
We  may disclose limited PHI (such as your name, address, and necessary  order details) to third-party vendors, suppliers, or fulfillment  companies in order to provide you with products, medical devices, tools,  or supplies related to your care. These vendors may ship items directly  to your address. When required by law, such vendors will enter into a  written agreement with us to safeguard your PHI. We will disclose only  the minimum information necessary to complete the order and delivery.
3. Other Uses and Disclosures Permitted or Required by Law
We may also use or disclose your PHI without your authorization in the following situations:

• As Required by Law – When required to do so by federal, state, or local law.
• Public  Health Activities – For purposes such as preventing or controlling  disease, reporting adverse events, and product recalls.
• Health Oversight Activities – For audits, inspections, investigations, or licensing.
• Judicial and Administrative Proceedings – In response to court orders, subpoenas, or similar processes.
• Law Enforcement Purposes – In limited situations, such as to comply with legal process.
• Workers’ Compensation – To comply with laws relating to workers’ compensation or similar programs.
• Organ and Tissue Donation – If you are an organ donor, to organizations involved in procurement or transplantation.
• To  Avert a Serious Threat to Health or Safety – To prevent or lessen a  serious and imminent threat to the health or safety of a person or the  public.
• Specialized Government Functions – Such as military, national security, or protective services activities.

4. Uses and Disclosures Requiring Your Written Authorization
Any  other use or disclosure of your PHI not described in this Notice will  be made only with your written authorization. You may revoke an  authorization in writing at any time, except to the extent that we have  already acted in reliance on it.
5. Your Rights Regarding Your PHI
You have the right to:

1. Access  and Copies – Inspect and obtain a paper or electronic copy of your  medical record. We may charge a reasonable fee for copying, mailing, or  other supplies associated with your request.
2. Amendments –  Request that we amend your PHI if you believe it is inaccurate or  incomplete. Your request must be in writing and include a reason for the  amendment. We may deny your request in certain circumstances, in which  case you have the right to submit a written statement of disagreement.
3. Accounting  of Disclosures – Receive a list of certain disclosures of your PHI made  in the six (6) years prior to your request, excluding disclosures for  treatment, payment, or healthcare operations.
4. Restrictions –  Request a restriction on the use or disclosure of your PHI. We are not  required to agree to a requested restriction except where the disclosure  is to a health plan for payment or operations purposes and the PHI  pertains solely to a healthcare item or service for which you have paid  in full out-of-pocket.
5. Confidential Communications – Request  that we communicate with you in a specific way or at a specific  location. We will accommodate reasonable requests.
6. Paper Copy – Request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.

6. Filing a Complaint
If  you believe your privacy rights have been violated, you may file a  complaint with our Privacy Officer or with the U.S. Department of Health  and Human Services, Office for Civil Rights.
You will not be retaliated against for filing a complaint.
Contact Person/Privacy Officer:New Dawn Weight Loss, LLC 

Email: Dr.Moore@NewDawn-WeightLoss.comPhone: 808-378-7639
7. Acknowledgment of Receipt
I acknowledge that I have received a copy of the Notice of Privacy Practices from New Dawn Weight Loss, LLC.
Patient Name: ____________________________________Patient Signature: _________________________________ Date: ____________