HIPAA Notice of Privacy Practices

Effective Date: [Date]

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.

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Our Commitment to Your Privacy

At Key T Wellness, we are committed to protecting your medical information. This Notice applies to all of the records of your care generated or maintained by our clinic, whether made by our staff or other health care providers.

 

Your Rights

You have the right to:

• Get a copy of your medical record

• Correct your medical record

• Request confidential communication

• Ask us to limit the information we share

• Get a list of those with whom we’ve shared your information

• Get a copy of this privacy notice

• Choose someone to act for you

• File a complaint if you believe your privacy rights have been violated

To exercise these rights, please contact our Privacy Officer at the contact information below.

 

Our Uses and Disclosures

We may use and share your information:

For Treatment

To provide, coordinate, or manage your healthcare and related services.

For Payment

To bill and collect payment from you, your insurance company, or a third party.

For Healthcare Operations

To run our practice, improve your care, and contact you when necessary.

Other Permitted Uses and Disclosures

We may also use or disclose your information for:

• Public health and safety issues (e.g., disease reporting)

• Health oversight activities

• Legal requirements (e.g., court orders or law enforcement)

• Workers’ compensation claims

• Research (under strict conditions)

• Organ and tissue donation requests

• Medical examiner or funeral director requirements

We will never share your information for marketing, sales, or fundraising purposes without your explicit written permission.

 

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information (PHI).

• We must notify you 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 provide you with a copy.

• We will not use or share your information other than as described here unless you tell us we can in writing.

 

Changes to This Notice

We reserve the right to change this Notice at any time. The new notice will apply to all protected health information we maintain and will be available in our office and on our website.

 

Contact Us

If you have questions about this Notice or want to file a complaint, contact:

Privacy Officer
Key T Wellness
📍 [Insert Address]
📧 [Insert Email]
📞 [Insert Phone Number]

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.