Notice of Privacy Practices (HIPAA)

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.

Our Pledge

We are required by law to maintain the privacy of your Protected Health Information ("PHI") and provide you this Notice.

Permitted Uses & Disclosures

• Treatment: Sharing with physicians, pharmacists, and labs involved in your care.
• Payment: Billing and collecting payment for services.
• Healthcare Operations: Quality assurance, training, accreditation.
• Legal Requirements: Public health reporting, court orders, law enforcement.

Your Rights

• Inspect and copy your records.
• Request amendments to your records.
• Receive an accounting of disclosures.
• Request restrictions on use or disclosure.
• Receive confidential communications.
• File a complaint without retaliation.

Complaints

File complaints with our Privacy Officer at info@mybodytonic.com or with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/hipaa/filing-a-complaint.

Privacy Officer

[PRIVACY OFFICER NAME]
Body Tonic, LLC
300 Beardsley Lane, D-102, Austin, TX 78746
info@mybodytonic.com · (512) 383-5204