Patient consent

Notice of Privacy Practices

This notice describes how your medical information may be used and disclosed and how you can access this information. Please review it carefully.

OUR COMMITMENT TO YOUR PRIVACY

At LAV Health, we are committed to protecting your medical information. This notice describes our privacy practices and how we handle your medical information in accordance with the Health Insurance Portability and Accountability Act (HIPAA).

HOW WE USE AND DISCLOSE YOUR MEDICAL INFORMATION

Your medical information may be used and disclosed in the following ways:

• Treatment: We will use your medical information to provide you with treatment and coordinate your care with other healthcare professionals.
• Payment: We will use your information to process payments and coordinate health insurance benefits.
• Healthcare Operations: We will use and disclose your information to conduct our healthcare operations and improve the quality of our services.

OTHER WAYS WE MAY USE AND DISCLOSE YOUR INFORMATION

We may disclose your medical information in the following situations:

• Emergencies: To provide you with emergency treatment.
• Law Compliance: In response to court orders, subpoenas, or other legal processes.
• Public Health: To report public health information required by law, such as communicable diseases.
• Health Oversight: For oversight activities authorized by law, such as audits and investigations.
• National Security: For authorized national security and intelligence activities.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION

You have the following rights regarding your medical information:

• Right to Inspect and Copy: You may request to review and obtain copies of your medical information.
• Right to Request Amendments: You may request corrections to your medical information if you believe it is incorrect or incomplete.
• Right to Request Restrictions: You may request limitations on the use and disclosure of your medical information.
• Right to Confidential Communications: You may request that we communicate with you in a specific manner or at a specific location.
• Right to a Paper Copy of This Notice: You may request a paper copy of this notice at any time.

CHANGES TO THIS NOTICE

We reserve the right to modify this notice at any time. Changes will be effective for all medical information we have about you and will be posted on our website.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with LAV Health or with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized for filing a complaint.

CONTACT

If you have any questions about this notice or need additional information, please contact: info@lavhealth.com 

Patient Consent

This notice of privacy practices has been provided to you in compliance with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).

Acknowledgment Statement

I, the undersigned, acknowledge that I have received a copy of the Notice of Privacy Practices of LAV Health.

Patient Name: __________________________________

Patient Signature: _______________________________

Date: _________________________________________