Legal
Notice of Privacy Practices (HIPAA)
Notice of Privacy Practices (HIPAA)
Effective Date
Sunshine Mobile Wellness
This Notice of Privacy Practices describes how your protected health information (“PHI”) may be used and disclosed, and how you may access your medical information.
Please review this notice carefully.
Our Commitment to Your Privacy
At Sunshine Mobile Wellness, we understand that your health information is personal and confidential.
Protecting your privacy is one of our highest priorities. We are committed to safeguarding your protected health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA), applicable California privacy laws, and professional standards of nursing practice.
We maintain physical, electronic, and administrative safeguards designed to protect your personal information from unauthorized access or disclosure.
What Is Protected Health Information?
Protected Health Information (PHI) includes information that identifies you and relates to your:
- Medical history
- Health conditions
- Wellness assessments
- Treatments received
- Medications
- Payment information
- Appointment history
- Laboratory results (when applicable)
- Communications regarding your care
This information may exist in electronic, written, photographic, or verbal form.
How We May Use and Disclose Your Information
Sunshine Mobile Wellness may use or disclose your health information without additional authorization for the following purposes:
Treatment
To provide safe and effective wellness services.
Examples include:
- Reviewing your health history
- Consulting with our supervising Medical Director
- Coordinating care with telehealth providers
- Determining treatment eligibility
- Documenting your wellness services
Payment
To receive payment for services provided.
Examples include:
- Processing credit card payments
- Providing receipts
- Collecting outstanding balances
- Verifying payment information
Healthcare Operations
To improve the quality and safety of our services.
Examples include:
- Quality assurance
- Staff education
- Compliance reviews
- Risk management
- Medical record audits
- Business operations
When Required by Law
We may disclose information when required by federal, state, or local law, including:
- Court orders
- Public health reporting
- Law enforcement requests authorized by law
- Prevention of serious threats to health or safety
Communications
We may contact you regarding:
- Appointment reminders
- Follow-up recommendations
- Scheduling changes
- Billing questions
- Important updates regarding your care
Communication may occur through:
- Telephone
- Text message
- Secure electronic communication platforms
Reasonable safeguards are used; however, no electronic communication method can be guaranteed to be completely secure.
Uses Requiring Your Authorization
We will obtain your written authorization before using or disclosing your information for purposes not otherwise permitted by law, including:
- Marketing unrelated to your care
- Media use
- Release of records to third parties (unless otherwise required by law)
You may revoke your authorization at any time in writing, except where we have already relied upon it.
Your Rights
As our client, you have the right to:
Access Your Records
Request access to your medical records as permitted by law.
Request Corrections
Request amendments to your medical information if you believe it is inaccurate or incomplete.
Request Restrictions
Ask us to limit certain uses or disclosures of your health information.
Although we are not required to agree to every request, we will carefully consider each one.
Confidential Communications
Request that we communicate with you using alternative methods or at alternative locations whenever reasonably possible.
Accounting of Disclosures
Request a record of certain disclosures of your health information as provided by law.
Paper Copy
Receive a paper or electronic copy of this Notice of Privacy Practices at any time.
Our Responsibilities
Sunshine Mobile Wellness is required to:
- Maintain the privacy of your protected health information.
- Provide this Notice of Privacy Practices.
- Abide by the terms of this notice.
- Notify affected individuals if a breach of unsecured protected health information occurs, as required by law.
Questions or Complaints
If you have questions about this Notice or believe your privacy rights have been violated, please contact:
You also have the right to file a complaint with the U.S. Department of Health and Human Services. Filing a complaint will not affect the quality of care you receive.
Changes to This Notice
Sunshine Mobile Wellness reserves the right to revise this Notice of Privacy Practices at any time.
Updated versions will apply to all protected health information maintained by our practice and will be made available through our website or upon request.
Acknowledgment
By signing the HIPAA Acknowledgment Form, you acknowledge that you have been provided access to this Notice of Privacy Practices. Your signature does not waive any of your privacy rights.
HIPAA Acknowledgment of Receipt
Notice of Privacy Practices
Sunshine Mobile Wellness
Acknowledgment
I acknowledge that I have been provided access to the Sunshine Mobile Wellness Notice of Privacy Practices, which explains how my protected health information may be used and disclosed, as well as my rights regarding that information under the Health Insurance Portability and Accountability Act (HIPAA).
I understand that I may request a paper or electronic copy of the Notice of Privacy Practices at any time.
I understand that Sunshine Mobile Wellness reserves the right to revise its Notice of Privacy Practices in accordance with applicable federal and state laws.
My signature acknowledges receipt of or access to this Notice. It does not indicate that I waive any of my privacy rights.
Electronic Acknowledgment
- ☐ I acknowledge that I have received or been provided access to the Sunshine Mobile Wellness Notice of Privacy Practices.
- ☐ I understand my privacy rights as described in the Notice of Privacy Practices.
- ☐ I understand that I may request a copy of the Notice of Privacy Practices at any time.
- ☐ I understand that Sunshine Mobile Wellness may update its Notice of Privacy Practices and that updated versions will be made available upon request or through its website.
Client Information
Full Name: _______________________________________
Date of Birth: ____________________________________
Electronic Signature
Signature: ________________________________________
Date: _____________________________________________
For Office Use Only
If the client declines to acknowledge receipt of the Notice of Privacy Practices, Sunshine Mobile Wellness will make a good-faith effort to document that the Notice was provided.
Reason acknowledgment was not obtained (if applicable):
Staff Member: ____________________________
Date: ______________________
Questions? Return to the full policies page.