Notice of Privacy Practices – Allostatix LLC

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.

In this notice we use the terms "we," "us," and "our" to describe Allostatix LLC and its business associates.

  1. WHAT IS "PROTECTED HEALTH INFORMATION?"
    Your protected health information (PHI) is health information that contains identifiers, such as your name, birth date, or other information that reveals who you are. For example, your medical record is PHI because it includes your name and other identifiers.

  2. ABOUT OUR RESPONSIBILITY TO PROTECT YOUR PHI

    In adherence to HIPAA guidelines, we must:

    • protect the privacy of your PHI,

    • tell you about your rights and our legal duties with respect to your PHI, and

    • tell you about our privacy practices and follow our notice currently in effect.

    3. We take these responsibilities seriously and we will continue to take appropriate steps to safeguard the privacy of your PHI.

    In the course of providing you with your Allostatix Load™ and health trajectory, we collect various types of PHI from you including contact and demographic information, blood biomarkers and biometric measurements. The medical information is used to calculate your Allostatix Load™ and provide you with actionable improvements steps to improve your Allostatix Load™.

  3. YOUR RIGHTS REGARDING YOUR PHI
    This section tells you about your rights regarding your PHI—for example, your medical records. It also describes how you can exercise these rights.

    Your right to see and receive copies of your PHI
    In general, you have a right to see and receive copies of your PHI in designated record sets such as your lab results and biometric measurements. If you would like to see or receive a copy of such a record, please write us at Allostatix LLC. 1776 Mentor Avenue Suite 361 Cincinnati, OH. 45212 or e-mail us at getanswers@allostatix.com. After we receive your written request, we will let you know when and how you can see or obtain a copy of your record. If you agree, we will give you a summary or explanation of your PHI instead of providing copies. We may charge you a fee for the copies, summary, or explanation. If we don't have the record you asked for but we know who does, we will tell you who to contact to request it.

    4. In limited situations, we may deny some or your entire request to see or receive copies of your records, but if we do, we will tell you why in writing and explain your right, if any, to have our denial reviewed.

    Your right to choose how we send PHI to you
    You may ask us to send your PHI to you at a different address (for example, your work address) or by different means (for example, fax instead of regular mail). When we can reasonably and lawfully agree to your request, we will. However, we are permitted to charge you for any additional cost of sending your PHI to different addresses or by different means.

    Your right to correct or update your PHI
    If you believe there is a mistake in your PHI or that important information is missing, you may request that we correct or add to the record. Please write us and tell us what you are asking for and why we should make the correction or addition. We will then send you a PHI Addendum Request Form to fill out and return to us. We will respond in writing after receiving your request. If we approve your request, we will make the correction or addition to your PHI. If we deny your request, we will tell you why and explain your right to file a written statement of disagreement. Details on where to send your disagreement are noted at the bottom of the PHI request form. Your statement must be limited to 250 words for each item in your record that you believe is incorrect or incomplete. You must clearly tell us in writing if you want us to include your statement in future disclosures we make of that part of your record. We may include a summary instead of your statement.

    Your right to an accounting of disclosures of PHI
    You may ask us for a list of our disclosures of your PHI. Please contact us at the address and e-mail above to request a disclosure list. The list we give you will include disclosures made in the last six years, unless you request a shorter time or if less than six years have passed since April 14, 2003. For example, if you requested a list of disclosures on April 14, 2005, the list would cover only two years.

    You are entitled to one disclosure accounting in any 12-month period at no charge. If you request any additional accountings less than 12 months later, we may charge a fee.

    An accounting does not include certain disclosures—for example, disclosures for which Allostatix LLC had a signed authorization; disclosures of your PHI to you; disclosures from an Allostatix LLC affiliate; or disclosures of persons acting on your behalf.

    Your right to receive a paper copy of this notice
    You also have a right to receive a paper copy of this notice upon request.

  4. HOW WE MAY USE AND DISCLOSE YOUR PHI
    Your confidentiality is important to us. Our science, medical staff and employees are required to maintain the confidentiality of the PHI of our participants. We have policies and procedures and other safeguards to help protect your PHI from improper use and disclosure. Sometimes we are allowed by law to use and disclose certain PHI without your written permission. We briefly describe these uses and disclosures below and give you some examples.

    5. How much PHI is used or disclosed without your written permission will vary depending, for example, on the intended purpose of the use or disclosure. Sometimes we may only need to use or disclose a limited amount of PHI, such as to send you an appointment reminder or to confirm that you are a health plan member. At other times, we may need to use or disclose more PHI such as when we are providing medical treatment.

    • Business associates: We may contract with business associates to perform certain functions or activities on our behalf, such as payment and health care operations. These business associates must agree to safeguard your PHI.

    • Research: Allostatix LLC engages in extensive and important research on allostasis and allostatic load. Some of our research may involve analysis of health data. Research of all kinds may involve the use or disclosure of your PHI. Your PHI can generally be used or disclosed for research without your permission if an Institutional Review Board (IRB) approves such use or disclosure. An IRB is a committee that is responsible, under federal law, for reviewing and approving human subjects’ research to protect the safety of the participants and the confidentiality of PHI.