Medical HIPAA Notice of Privacy Practices

This Notice describes how ELM Endocrinology & Lifestyle Medicine, PLLC may use and disclose your medical information and how you can get access to this information. Please review it carefully.

Our Legal Duty

We are required by law to:

• Maintain the privacy of your protected health information (PHI)

• Provide you with this Notice of our legal duties and privacy practices

• Follow the terms of the Notice currently in effect

Your Rights

You have the right to:

• Access your health records – You can request to view or receive a copy of your medical records in paper or electronic form.

• Request corrections – If you believe your records are incorrect or incomplete, you can request a correction.

• Request confidential communications – You can ask us to contact you in a specific way (e.g., via email or at a specific phone number).

• Limit what we use or share – You may request restrictions on how your PHI is used or disclosed.

• Get a list of disclosures – You can ask for a list of the times we've shared your PHI, for up to six years prior.

• Choose someone to act for you – If you have a legal guardian or medical power of attorney, that person can exercise your rights.

• File a complaint – You can file a complaint with us or with the U.S. Department of Health & Human Services if you believe your rights have been violated. We will not retaliate against you for filing a complaint.

Our Uses and Disclosures

We may use and share your health information to:

Treat You

We can use your PHI and share it with other professionals involved in your care.
Example: A PA discusses your treatment with a consulting cardiologist.

Run Our Organization

We use PHI to operate our practice and ensure quality care.
Example: We use PHI to manage scheduling, billing, and quality improvement.

Bill for Services

We can use and share your PHI to bill and receive payment from you, your insurance plan, or third-party payers.
Example: We submit information to your health insurer to receive payment.

Other Permitted or Required Disclosures

We may also share your information:

• With public health authorities for disease reporting

• For health oversight activities (e.g., audits, investigations)

• In response to court orders or legal processes

• To prevent or reduce a serious threat to your health or public safety

• With law enforcement when required by law

• To medical examiners for death investigations

• For workers’ compensation claims

• To business associates who help us deliver care, under a signed agreement to protect your PHI

We must obtain your written permission before:

• Using your PHI for marketing or promotional communications

• Selling your PHI

• Sharing psychotherapy notes (if applicable)

You may revoke your authorization at any time in writing.

Our Responsibilities

We:

• Are required by law to maintain the privacy and security of your PHI

• Will inform you promptly if a breach occurs that may compromise the privacy or security of your information

• Will not use or share your information except as described here unless you authorize it in writing

Telehealth and Electronic Communication

Because our services are delivered primarily through telehealth:

• We use HIPAA-compliant platforms for video visits and messaging.

• Electronic communication carries some risk (e.g., interception, misdelivery), but we take reasonable steps to protect your privacy.

• You agree to assume limited risk when opting in to electronic communication.

Changes to This Notice

We reserve the right to change this Notice and the revised Notice will apply to all PHI we maintain. The current version will be posted on our website and available upon request.

Contact Us or File a Complaint

If you have questions, concerns, or wish to exercise your privacy rights:

Privacy Officer
ELM Endocrinology & Lifestyle Medicine, PLLC
📧 myelmhealth@gmail.com
📞 602-556-3434

You may also file a complaint with the:
Office for Civil Rights (OCR)
U.S. Department of Health & Human Services
Website: https://www.hhs.gov/hipaa/filing-a-complaint/
Phone: 1-877-696-6775

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Download a copy of the ELM HIPAA Notice of Privacy Practices here: