HIPAA Policy

Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Introduction

Vita Pure IV, LLC is committed to safeguarding the privacy of your protected health information (“PHI”) and is required to do so by law. PHI includes any information that identifies you and relates to your physical or mental health, the provision of healthcare to you or the payment for that care. The law requires us to maintain the privacy of your PHI and to provide you with a notice of our legal duties and the privacy practices with respect to your PHI. This Notice of Privacy Practices (“Notice”) describes how we may collect, use and disclose your PHI and your rights concerning your PHI. This Notice also describes certain duties we have regarding your medical information and how we may use and disclose your medical information.

How We Obtain Use And Disclose PHI

We may use PHI for treatment purposes. We may also use and disclose your PHI for payment purposes such as paying physicians, hospitals and other entities that provide you with health care services. Payment purposes also include activities such as determining your eligibility, examining services for medical necessity, performing utilization reviews, obtaining premiums, coordinating benefits, subrogation and collection activities. We may use and disclose your PHI for healthcare operations. Healthcare operations include coordinating or managing care, assessing and improving the quality of healthcare services, reviewing the qualification and performance of providers, conducting medical reviews and resolving grievances. It also includes such activities as obtaining insurance coverage, determining coverage policies, and arranging for legal and auditing services.

We may use your PHI to contact you with information about health and wellness. Health and wellness information includes appointment reminders, treatment alternatives, or other healthcare related services and products that may interest you.

Along with treatment, payment, healthcare operations and health and wellness information, we may share your PHI with third parties, called business associates, who perform certain activities on our behalf. We will obtain assurances from our business associates that they will safeguard your information.

We may also disclose PHI for public health and safety activities such as responding to public health investigations, as required by law, or if we reasonably believe you are a victim of abuse, neglect or domestic violence. We will also discharge PHI when we believe in good faith that it is necessary to prevent or lessen a serious or eminent threat to your health and safety or others’ health or safety. We may also disclose your PHI in the course of legal proceedings in response to subpoenas, discovery requests, or other lawful processes.

We may disclose PHI to researchers and others such as medical examiners in connection with organ donation. If worker’s compensation laws require our disclosure of PHI then we will also disclose your PHI. We may disclose PHI to a family member, relative or friend or anyone else you identify when you agree to the disclosure. We may also disclose PHI when you are not present or are incapacitated and in the exercise of our professional judgment we determine that disclosure is in your best interests. If you are not present or you are incapacitated, we will disclose the PHI when it is directly relevant to your healthcare or payment related to your healthcare. We will also disclose PHI to your personal representative (such as a parent or guardian).

We will not make separate mailings for enrolled dependents at different addresses unless we are requested to do so and agree to the request. We may also use and disclose your PHI when we are required to do so by law. For example, we must disclose PHI to the Department of Health and Human Services upon request.

We will not use or disclose your PHI without your written permission (“Authorization”) if this Notice does not allow the disclosure. If you desire, you can later revoke an Authorization in writing.

Your Rights

You have the right to access your PHI by inspecting or getting a copy of any PHI we have about you. Under limited circumstances we may deny your request. If we deny your request, we will send you a written notice of denial describing the basis for our denial. We may charge a reasonable fee for the cost of producing and mailing the copies. Requests for access to your PHI must be made in writing and reasonably describe the information you would like to inspect or copy.

You also have the right to ask, in writing, that we restrict uses or disclosure of your PHI to carry out treatment, payment and healthcare operations and disclosures to family members or friends. We are not required to agree to the request and in certain cases Federal law does not permit a restriction. You also have the right to ask, in writing, us to send communications of PHI in a confidential manner to you at an address of your choice. For example, you may ask us to mail your information to an address other than the subscriber’s address. You also have the right to amend PHI we have about you. However, we may deny your request by sending you written notice of denial describing the reason for our denial and your right to submit a written statement disagreeing with the denial.

You have a right to request a written accounting of disclosures of PHI that we have made in the last six (6) years prior to the date you request accounting. However, except as otherwise provided by law, this right does not apply to disclosures we make for treatment, payment, healthcare operations, disclosures made to you or people you have designated, disclosures you or your personal representatives have authorized. If you request accounting more than once in a twelve-month period, we may charge you a reasonable fee.

Effective Date Of Notice

This notice will remain in effect until we change it. We may change the terms of this notice at any time in the future and make a new notice effective for all PHI that we maintain whether created or received before or after the effective date of the new notice. Whenever we make an important change, we will send subscribers an updated notice of privacy practices.

For More Information or to Report a Complaint

If you have questions or would like more information about our privacy practices, you may contact our Privacy Officer at (804) 636-3359 or by mail at the address noted below. If you believe your privacy rights have been violated, you may file a written complaint with our Privacy Officer or with U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint. To file a complaint with us, please direct your complaint to our Privacy Officer:

Privacy Officer, Vita Pure IV, 7110 Forest Avenue, Suite 100, Richmond, VA 23226.