EliteMD LLC Policy of Patients Rights

Last Updated: 1/1/2025

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

The Right to Access Your Own Health Information

With certain exceptions outlined by privacy regulations, you have the right to review and copy your health information and billing records.

To review or obtain a copy of your health information, you or your legal health care representative must submit a written request.

The request form is available at our office and on our website at EliteBodyandLaser.com.

Send your request form to:

Elite Body and Laser Center

60 Powell Road

Lewis Center, OH 43035

We have up to 30 days from the time of your written request to make your health information available to you. We may charge you a reasonable fee based on our costs to copy and mail your health information. You may ask for the cost in advance of the information being prepared.

In very limited circumstances, we may deny your request. If we deny your request, you will receive written notification of the denial.

You have the right to appeal the denial by submitting a written appeal request to:

Compliance Officer,

Elite Body and Laser Center

60 Powell Road

Lewis Center, OH 43035

Your appeal request will then be reviewed by a licensed health care professional not directly involved in your care or in the denial of your request for access to your health information. You will be notified in writing regarding the outcome of that appeal.

The Right to Amend Your Health Information

If you believe your health information is incorrect or incomplete, you have the right to request that we amend (change) the information as long as the information was created by us.

To request an amendment of your health information, you or your legal health care representative must submit a written amendment form stating the reason(s) for amending your health information.

The amendment request form is available at our office and on our website at elitebodyandlaser.com.

Send your amendment request form to:

Compliance Officer,

Elite Body and Laser Center
60 Powell Road

Lewis Center, OH 43035

We will respond within 60 days.

If your request is approved, we will place the amendment request form in your health record and correct your health information to reflect the approved amendment.

We may deny your request if the existing health information is correct and complete, was not created by us, or is not available for inspection. If your request is denied, we will notify you in writing and include the reason(s) for the denial. We will explain your right to file a written statement of disagreement with the denial.

The Right to an Electronic Copy of Electronic Medical Records

If your health information is maintained in an electronic record (known as an electronic medical record or electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your health information in the form or format you request.

We may charge you a reasonable fee based on our costs for the labor associated with preparing and transmitting the electronic health information.

The Right to an Accounting of Certain Disclosures of Your Health Information

You have the right to request a list of certain disclosures of your health information. The list will not include disclosures made:

1. for purposes of treatment, payment, or health care operations;
2. to you, your caregivers, or your legal health care representative;
3. for which you or your legal health care representative provided a written authorization;
4. for national security or intelligence purposes;
5. to correctional institutions or law enforcement officials;
6. for purposes of research or public health when direct patient identifiers are not used
7. as required by law;
8. to a health oversight agency in certain circumstances
9. before January 1, 2018.

By law, the maximum period the list must cover is 6 years immediately preceding the written request for an accounting of certain disclosures.

The first accounting of certain disclosures in a 12-month period will be provided at no charge. For any additional accounting of disclosures, you may be charged a reasonable fee based on our costs for the labor associated with preparing the accounting of disclosures.

To request an accounting of disclosures of your health information, you or your legal health care representative must submit a written request. The form to request for an accounting of disclosures is available at your physician’s office and on our website at elitebodyandlaser.com.

Send your account request form to:

Compliance Officer,
60 Powell Road

Lewis Center, OH 43035

The Right to Request Restrictions of Your Health Information

You have the right to request a restriction or limitation on how we use or disclose your health information. However, you may not restrict or limit the uses that are required by law.

You have the right to restrict disclosure of your health information to your health plan when you have paid out of pocket and in full for the health care item or service unless the disclosure is required by law.

To request a restriction of your health information, you or your legal health care representative must submit a written request.

The form to request a restriction of your health information is available at our office and on our website at elitebodyandlaser.com.

Send your restriction request form to:

Compliance Officer,
60 Powell Road

Lewis Center, OH 43035

The Right to Choose How We Share Your Health Information with You

You have the right to request, in writing, that we communicate your health information in a certain way or at a certain location.

For example, you may request that we only contact you by mail or at work.

We will accommodate reasonable and feasible requests.

The Right to a Paper Copy of this Notice

You have the right to a paper copy of this notice, and may request a paper copy of this notice at any time, even if you agreed to receive this notice electronically. You may obtain a copy of this notice from our office and on our website at www.elitebodyandlaser.com.

REVISIONS TO THIS NOTICE OF PRIVACY PRACTICES

We reserve the right to make revisions to the terms of this notice as required by law. Revised notices will be available at our and on our website at elitebodyandlaser.com

IF YOU HAVE A COMPLAINT ABOUT OUR PRIVACY PRACTICES

If you feel your privacy rights have been violated or you disagree with a decision we made about your health information rights, you may call the our office at at 614-334-4944, or send a written complaint to:

Compliance Officer,

Elite Body and Laser
60 Powell Road

Lewis Center, OH 43035

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. within 180 days of a violation of your rights. We will not retaliate against you for filing a complaint.  Complaints may be filed through the OCR Complaints portal at ocrportal.hhs.gov .

EFFECTIVE DATE

This Notice of Privacy Practices is effective January 1, 2025

ADDITIONAL INFORMATION

If you have any questions about this Notice, or need additional information related to this Notice, please contact our compliance Officer at: 614-334-4944