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.
Essenza Wellness (“Essenza,” “we,” “us,” or “our”) is required by federal law — the Health Insurance Portability and Accountability Act of 1996 (HIPAA) — and by California state law to maintain the privacy of your protected health information (PHI), to provide you with this Notice of our legal duties and privacy practices with respect to PHI, and to follow the terms of the Notice currently in effect.
This Notice applies to all of the medical records of your care generated by our physicians and staff, whether maintained in our offices, in our electronic health record system, or by business associates acting on our behalf.
The following categories describe the ways we may use and disclose your PHI without your written authorization. Not every permitted use or disclosure will be listed, but every use or disclosure we make will fall within one of these categories.
We may use and disclose your PHI to provide, coordinate, or manage your medical care. For example, our physicians may share your information with one another — across our Longevity, Women’s Health, Neurology, and Psychiatry practices — to ensure your care is coordinated. We may also share information with outside providers, laboratories, pharmacies, imaging centers, or specialists involved in your treatment.
We may use and disclose your PHI as needed to obtain payment for our services. For example, we may share information with your health plan to verify coverage, obtain prior authorization, or process a claim — or with you directly to bill for services under our concierge membership.
We may use and disclose your PHI to support the business activities of our practice. These activities include quality assessment and improvement, physician credentialing and peer review, training, business planning, customer service, internal audits, and general administrative functions.
We may also use or disclose your PHI without your authorization in the following circumstances:
Most uses and disclosures of PHI beyond those described above require your written authorization. In particular, the following uses and disclosures will be made only with your written authorization:
You may revoke any written authorization at any time by submitting a written revocation to our Privacy Officer. The revocation will be effective except to the extent we have already acted in reliance on the authorization.
You have the following rights with respect to your PHI. To exercise any of these rights, please submit a written request to our Privacy Officer using the contact information at the end of this Notice.
You have the right to inspect and obtain a copy of your medical and billing records, with limited exceptions. We may charge a reasonable fee for the cost of copying as permitted by law. We will respond to your request within the time frames required by law.
If you believe information in your record is incorrect or incomplete, you may request that we amend it. We may deny your request under certain circumstances, but will provide a written explanation if we do.
You have the right to request a list of disclosures we have made of your PHI for purposes other than treatment, payment, healthcare operations, and certain other excluded disclosures, for up to six years prior to your request.
You have the right to request a restriction on the uses and disclosures of your PHI. We are not required to agree to your request, but if we do, we will honor it (with limited exceptions). You also have the right to restrict disclosure of PHI to a health plan for services you have paid for in full out of pocket.
You have the right to request that we communicate with you about medical matters in a specific way or at a specific location. For example, you may ask us to contact you only at home rather than at work. We will accommodate reasonable requests.
You have the right to a paper copy of this Notice at any time, even if you have agreed to receive it electronically. To request a paper copy, please contact our Privacy Officer.
You have the right to be notified if a breach occurs that may have compromised the privacy or security of your PHI.
If you have given us written authorization to use or disclose your PHI, you may revoke that authorization at any time in writing. The revocation will not affect any use or disclosure made before we received the revocation.
As a California medical practice, we are also subject to the California Confidentiality of Medical Information Act (CMIA), the Patient Access to Health Records Act, and other state laws that may provide you with additional protections beyond federal HIPAA standards. Where state law is more protective of your privacy than HIPAA, we will follow state law.
California law provides additional protections for mental health information, including psychotherapy notes. Mental health information from our Psychiatry practice will generally not be disclosed without your specific written authorization, except in limited circumstances required or permitted by law (such as a serious threat to safety).
California law also provides heightened protection for HIV test results and certain reproductive health information. These categories of information will generally require your specific written authorization before disclosure, except in limited circumstances allowed by law.
Under California’s Confidentiality of Medical Information Act, you may request that we communicate with you about sensitive services through a specific means or at a specific location. We will accommodate reasonable requests without requiring an explanation.
Essenza Wellness is required by law to:
We reserve the right to change the terms of this Notice and to make the revised Notice effective for all PHI we maintain. If we make a material change to this Notice, we will post the revised Notice in our office, on our website at essenzawellness.com/hipaa-notice, and make paper copies available upon request. You may request the most current version at any time.
If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer using the contact information below, or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against, penalized, or denied care for filing a complaint.
To file a complaint with the federal government:
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll-free: 1-877-696-6775
Online: hhs.gov/ocr/complaints
If you have questions about this Notice, would like additional information, or wish to exercise any of your rights, please contact our Privacy Officer: