Privacy Practices | Bariatric Institute

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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE THOROUGHLY REVIEW THIS NOTICE OF PRIVACY PRACTICES CAREFULLY.

Bariatric Institute, APC, an California professional medical corporation (the “Clinic”), its affiliated clinics, and Bariatric Institute MSO, LLC, a Delaware limited liability company (the “Management Company”), its affiliated surgery centers (Clinic and Management Company will be referred to herein as “Bariatric Institute” and sometimes referred to herein as “we” or “us”), will follow and adhere to this HIPAA Notice of Privacy Practices (this “Notice”) at the service delivery locations listed at the end of this Notice. Bariatric Institute covered entities participate in an “organized health care arrangement.” These covered entities are considered part of an organized system of health care and are clinically-integrated organizations participating in the organized health care arrangement. Bariatric Institute organizations may share your health information, as necessary, for purposes including, but not limited to, treatment, payment or health care operations outlined in this Notice and related to the organized health care arrangement.

Bariatric Institute is committed to protecting the privacy of your protected health information. In conducting our business, we create, collect, and maintain identifiable information about you as well as the medical treatment and healthcare items/services we provide (collectively, your “Information”). The Medical Practices, Ambulatory Surgery Centers, and the Management Company are all subject to, and must comply with the requirements of, the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and other federal and state laws protecting the confidentiality, privacy, security, and availability of your Information. Bariatric Institute is required by HIPAA to provide you with this Notice describing Bariatric Institute’s legal duties and privacy practices. Bariatric Institute may make amendments to this Notice from time to time, with or without prior notice. By law, Bariatric Institute must follow the terms of the Notice in effect at the time.

This Notice explains how we may use and/or disclose your Information, which includes your medical history, symptoms, examination and test results, diagnoses and care plans, and other health-related information, for purposes such as treatment, payment, and health care operations and for other permissible purposes or as may be required of Bariatric Institute by law. This Notice also describes your rights to review and control the use and disclosure of your Information. We will report any breaches of your unsecured Information as required by applicable law.

The terms of this Notice apply to any and all records containing your Information that are created collected, and/or maintained by Bariatric Institute. Bariatric Institute reserves the exclusive right to revise or amend this Notice at any time, for any reason, or no reason at all. Any revision or amendment of this Notice will be effective for all of your records that the applicable Bariatric Institute entity created, collected, and/or maintained in the past and any of your records Bariatric Institute may create, collect, and/or maintain in the future. A copy of our current Notice is posted in applicable reception areas and on www.Bariatricinstitute.com. You may request a copy of this Notice at any time. Bariatric Institute will follow the terms of the Notice that is in effect at the time. The effective date of the Notice is (and will be) posted in the lower right-hand corner of the Notice.

Primary Use & Disclosure

Bariatric Institute may use and disclose your Information for purposes related to providing treatment, obtaining payment, and/or our health care operations, and there may be other incidental uses and/or disclosures of your Information. The following are examples of such uses and disclosures of your Information. Not every possible use and disclosure in a particular category is listed; however, all of the ways that Bariatric Institute is permitted to use and disclose your Information without your written authorization will fall within one of the categories.

Treatment. Bariatric Institute may use and/or disclose your Information to provide, coordinate, and manage your health care and related services. This includes the use/disclosure of your Information for treatment purposes by/to health care providers within and outside of Bariatric Institute, such as doctors, physicians, nurse practitioners, physician assistants, nurses, technicians, health care professionals, and/or other personnel involved in your care and treatment. For example, your Information may be provided to a doctor to whom you have been referred to ensure that the doctor has the information needed to diagnose and treat you. To the extent permitted by law, Bariatric Institute may also disclose your Information to other persons who are involved in your health care, such as family members and friends, unless and until you have specifically instructed us not to do so.
Payment. Bariatric Institute may use and disclose your Information so that the health care and related services that you receive from Bariatric Institute may be billed to, and payments may be collected from: you; an insurance company; another third-party payor; collection agency; or any other third-party. We may also tell your health plan about a treatment you are going to receive to obtain prior authorization and/or to determine whether your plan will cover the treatment. Bariatric Institute may also disclose your Information to other health care providers and health plans for payment activities of those providers and plans. For example, Bariatric Institute may provide your Information to a doctor who is not affiliated with Bariatric Institute so that the doctor may bill you, your insurer, and/or any other third-party for services you received from that doctor.
Health care Operations. Bariatric Institute may use and disclose your Information, as needed, for certain administrative and operational purposes in the course of running our business. These uses and disclosures are necessary for our operations and to ensure that all patients receive high-quality health care. For example, Bariatric Institute may use your Information to review our services and treatment and to evaluate our performance in caring for you. Bariatric Institute may combine the health information of some or all patients to decide what additional services Bariatric Institute should offer, what services may not be needed, and whether certain treatments are effective. Bariatric Institute may also disclose your Information to doctors, physicians, nurse practitioners, physician assistants, nurses, technicians, health care professionals, and our personnel for review and learning purposes. Bariatric Institute may also combine the information we have with information from other health care providers to compare how we are doing and see where we can make improvements in the care and services offered. Bariatric Institute may remove information that identifies you (e.g., name, date of birth, address, social security number) from this set of health information so that others may use it to study health care and health care delivery without learning your identity. Bariatric Institute may also disclose your Information to other individuals and organizations, including physicians, hospitals, healthcare clearinghouses, and/or health plans to assist with the health care operations activities of such individuals and organizations, as long as they have (or have had in the past) a treatment relationship with you. These are just some of the various uses and disclosures of your Information that we may engage in as part of its routine health care operations.
Incidental Uses/Disclosures. There may be incidental uses and disclosures of your Information that cannot reasonably be prevented. For example, when your name is called in our waiting room, we cannot prevent other people in the waiting room from overhearing your name.
Other Uses/Disclosures. Bariatric Institute may contact you by phone, SMS, text message, mail or secure mail (unless you request otherwise) to schedule, or remind you of, an appointment, including by leaving you voice messages on your cell phone or in a message left with the person answering the phone. Bariatric Institute may also use your Information to contact and tell you about health-related benefits, insurance updates, billing and payment information, treatment options or alternatives, and other services that may be of interest to you. You have the right to request no voicemail or specific communication methods.
- Messaging frequency may vary.
- Message and data rates may apply.
- You can opt out any time by texting STOP.
- For assistance, text HELP or visit our website at www.BariatricInstitute.com.
- Visit https://bariatricinstitute.com/privacy-policy for privacy policy and https://bariatricinstitute.com/privacy-policy for Terms of Service.

Other Uses & Disclosures Allowed or Required by Law

Bariatric Institute may disclose your Information in the following situations, as allowed or as required by law. These uses/disclosures of your Information generally do not require Bariatric Institute to obtain your written authorization.

Business Associates. Bariatric Institute may disclose your Information to various third-party entities that provide certain services for Bariatric Institute entities that involve access to your Information. Bariatric Institute has a written contract with each of these business associates that contains terms requiring them and their subcontractors to protect the privacy and security of your Information in accordance with HIPAA.
As Required By Law. Bariatric Institute will use/disclose your Information when Bariatric Institute is required to do so by federal, state or local law; however, Bariatric Institute will limit the use/disclosure to the minimum amount required for Bariatric Institute to comply with such legal requirement. When the law requires Bariatric Institute to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings or to law enforcement officials, Bariatric Institute will comply with any and all of the requirements set forth below concerning those activities.
Legal Proceeding. Bariatric Institute may disclose your Information in the course of judicial or administrative proceedings: (i) in response to an order of a court or administrative tribunal, to the extent such disclosure is authorized by such order; and (ii) in response to a subpoena, discovery request, or other lawful process that is not accompanied by an order of a court of administrative tribunal, but only if certain efforts have been made to inform you about the request or to obtain an order protecting the information being requested.
Compliance. By law, Bariatric Institute must make disclosures of your Information to the Secretary of the Department of Health and Human Services to enable the Secretary to evaluate Bariatric Institute’s compliance with HIPAA.

Law Enforcement. Bariatric Institute may disclose your Information if requested by federal, state or local law enforcement, for law enforcement purposes, such as:

in response to a court order, subpoena, summons, or warrant;

to identify or locate a suspect, fugitive, material witness, or missing person;

to assist with the identification of a victim of a crime;

in connection with death that may be the result of criminal conduct;

to report criminal conduct at our facility; and/or

in emergencies to report a crime, the location or victim(s) of the crime, or the description, identity or location of the perpetrator.

Proof of Immunization. Bariatric Institute may disclose proof of immunization to a school that is required to have it before admitting a student if you have agreed to the disclosure on behalf of yourself or your dependent.
Health Oversight. Bariatric Institute may disclose your Information to a state or federal health oversight agency for activities authorized by law, such as investigations, inspections, and audits; licensure and disciplinary actions; civil, administrative, and criminal actions; and activities necessary for the government to oversee the health care system, government benefit programs, and compliance with civil rights laws.
Public Health. We may disclose your Information for authorized state and federal public health activities, such as:

to report, prevent or control disease, injury or disability;
to report adverse reactions to medications;
to notify people of problems with, or recalls of, products;
to notify a person who may have been exposed to, or be at risk for contracting or spreading, a disease or condition.

Bariatric Institute will make these disclosures only if you agree unless and until we are required or otherwise authorized by law to do so. If directed by a public health authority, Bariatric Institute may disclose your Information to a foreign government agency collaborating with a public health authority.

Abuse/Neglect. Bariatric Institute may disclose your Information to a governmental entity/agency that is authorized by law to receive reports of child, elder, or dependent adult abuse or neglect or if Bariatric Institute believes that you have been a victim of abuse, neglect or domestic violence. In this case, the disclosure will be made consistent with the requirements of applicable laws and due regard for the safety of the individual.
Threats to Health or Safety. Bariatric Institute may use and disclose your Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any such disclosure, however, would only be to someone able to help prevent the threat and/or to identify victims of the threat.
FDA. When required by the U.S. Food and Drug Administration (“FDA”), Bariatric Institute may disclose your Information to a person or company for purposes relating to the quality, safety, or efficacy of FDA-regulated products or activities.
Coroners, Medical Examiners, Funeral Directors. Bariatric Institute may disclose your Information to a coroner or medical examiner for identification purposes, to determine a cause of death, or to perform other duties authorized by law. Bariatric Institute may disclose your Information to a funeral director as needed to carry out his/her duties.
Organ Donation. If you are an organ or tissue donor, Bariatric Institute may use and disclose your Information for permitted cadaveric organ, eye, or tissue donation and transplantation, including disclosures to organizations involved in procuring, banking or transplanting donor organs and tissues.
Facility Directories. Bariatric Institute will use and disclose in our facility directory your name, the location at which you are receiving care, your condition (in general terms), and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people who ask for you by name. If you do not want us to use or disclose such information or want some restrictions on what is placed in our facility directory or to who the information is disclosed, your request must be in writing, addressed to our Compliance Officer and state the specific restrictions requested. If you are not present or able to express your objection or request a restriction to such use or disclosure, then your physician may, using the physician’s professional judgment, determine whether the use or disclosure is in your best interest.
Research. Bariatric Institute may disclose your Information to researchers for research that has been approved by a privacy board or an institutional review board. Before Bariatric Institute discloses your Information, the project will be approved through a formal review and approval process; however, Bariatric Institute may disclose your Information to people preparing to conduct a research project (e.g., to help find participants), so long as the information that they review does not leave applicable premises. Bariatric Institute will usually ask for your specific permission if the researcher will have access to your name, address, or other information that reveals your identity.
Criminal Activity. Consistent with applicable federal and state laws, Bariatric Institute may use and/or disclose your protected health information if Bariatric Institute believes, in its sole and absolute discretion, the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Military and Veterans. If you are a member of the Armed Forces, Bariatric Institute may use and disclose your Information: (i) for activities deemed reasonably necessary by the military; (ii) for purposes of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (iii) to a foreign military authority if you are a member of that foreign military, in accordance with HIPAA.
National Security. Bariatric Institute may disclose your Information to federal officials for intelligence, counter-intelligence, and national security activities authorized by law, including to protect the President and other government officials or foreign heads of state.
Correctional Institutions. If you are an inmate or are under the custody of a law enforcement official, Bariatric Institute may disclose to the correctional institution or law enforcement official your Information as necessary: (i) for the correctional institution to provide health care services to you; (ii) to protect your health and safety or that of others; or (iii) for the safety and security of the institution or official.
Employers. Bariatric Institute may disclose to your employer the Information obtained in providing medical services to you specifically at the request of your employer for purposes of conducting an evaluation relating to medical surveillance of the workplace or determining whether you have a work-related illness or injury when such services are necessary by the employer to comply with certain legal requirements.
Workers’ Compensation. Bariatric Institute may disclose your Information to comply with workers’ compensation laws. For example, to the extent your care is covered by workers’ compensation, Bariatric Institute may make periodic reports to your employer about your condition. Bariatric Institute is required by law to report cases of occupational injury or occupational illness to the employer or workers’ compensation insurer.
Fundraising. Bariatric Institute may use or disclose your demographic information, the dates that you received treatment, the department of service, your treating physician, outcome information and health insurance status to contact you for our fundraising activities. If you do not want to receive these materials, please notify our Compliance Officer and Bariatric Institute will stop any further fundraising communications. Similarly, you should notify our Compliance Officer if you decide you want to start receiving these communications again.
Change of Ownership. If any Bariatric Institute entity is sold or merged with another organization, your Information will become the property of the new owner and be subject to the buyer’s HIPAA Notice of Privacy Practices. You will maintain the right to request that copies of your Information be transferred to another physician or medical group, and your rights with respect to your Information will remain the same.

Health Information Exchange

Bariatric Institute participates in one or more electronic health information exchanges which permits Bariatric Institute to electronically exchange medical information about you with other participating providers (for example, doctors, ambulatory surgery centers, health care providers) and health plans and their business associates. As permitted by law, a limited amount of your Information may be shared with the HIE in its capacity as a public health authority carrying out approved public health activities or as otherwise required by law, as discussed above.

Use and Disclosure of Health Information Requiring Written Authorization

Any use/disclosure of your Information for purposes other than as generally described in this Notice will be made only with your prior written authorization. Any authorization you provide to us regarding the use/disclosure of your Information may be revoked by you, at any time, for any reason, or no reason at all, by giving Bariatric Institute written notice of the revocation. Your revocation shall not apply to those uses and disclosures Bariatric Institute previously made on your behalf pursuant to your authorization prior to the time Bariatric Institute received your written revocation.

Marketing. Bariatric Institute may use/disclose your Information for marketing purposes only with your prior written consent and authorization unless the use is in the form of face-to-face communication made by us to you or involves a promotional gift of nominal value. The authorization will disclose whether Bariatric Institute receives any compensation for any marketing activity you authorize, and Bariatric Institute will stop any future marketing activity to the extent you revoke such authorization. Marketing uses/disclosures do not include activities such as us contacting you about health-related products or services offered by Bariatric Institute, and/or managing or coordinating your care, and/or encouraging you to maintain a healthy lifestyle and/or reminding you to refill prescriptions.
Sale of Your Information. Except in connection with the sale of an applicable Bariatric Institute entity or its merger with another organization (see above), Bariatric Institute may only sell your information to a third-party with your prior written authorization.

A valid authorization must contain a description of the information to be used, the name of the person(s) authorized to make the disclosure or use, the name of person(s) to whom Bariatric Institute may make the requested use or disclosure, description or purpose, expiration date or event, signature and date. You may revoke an authorization at any time provided that the revocation is in writing. Your revocation will not be effective for uses and disclosures made in reliance on your prior authorization.

Breaches

If your unsecured Information is accessed, acquired, used or disclosed in a manner not permitted by law and that compromises its security or privacy, Bariatric Institute will notify you within sixty (60) calendar days. Bariatric Institute will report any breaches of unsecured Information in accordance with applicable federal and state law. In certain circumstances, Bariatric Institute’s business associates may provide the notification to you.

Your Information Rights

Inspections and Copies. Subject to certain grounds for denial, you may ask to inspect and obtain copies of your Information that may be used to make decisions about your health care and treatment, including your medical records and billing records, but not including: (i) psychotherapy notes (if any); (ii) certain laboratory information restricted by federal law; and (iii) information compiled in reasonable anticipation of, or for use in, any civil, criminal, or administrative action or proceeding.

Any request for access to or copies of your Information must be submitted in writing to our Compliance Officer. Bariatric Institute will respond to your request within thirty (30) calendar days. Bariatric Institute may charge you a reasonable fee for the copying, mailing, labor and supplies associated with fulfilling your request. If Bariatric Institute maintains the requested Information electronically, Bariatric Institute will provide you with a copy in the electronic form and format that you request if Bariatric Institute can readily produce such format. If Bariatric Institute cannot readily produce the format you requested, Bariatric Institute will produce your electronic Information in another readable electronic format as reasonably agreed to between you and us. If your request directs us to transmit the copy of your Information directly to another person, Bariatric Institute will provide the copy to the person you designated; provided, your request is made in writing, signed by you, and identifies the designated person and where to send the copy of your Information.

Bariatric Institute may deny your request to inspect and/or copy your Information in certain circumstances. For example, Bariatric Institute may deny your request if it is determined that providing your Information could cause harm to you or another person. If your request is denied, you may, in some instances, have the right to have such denial reviewed. Bariatric Institute will provide you with a written statement of the reasons for denial and, if you are allowed to have such denial reviewed, Bariatric Institute will provide you with instructions for how to request a reconsideration.

Confidential Communication. You may request that Bariatric Institute send your Information to you by alternative means or at alternative locations. For example, you may request that Bariatric Institute contact you at your work or by U.S. Mail. Bariatric Institute will accommodate reasonable requests. You must submit your request in writing to our Compliance Officer. Your request must specify how and where you wish to be contacted. You must provide Bariatric Institute with a mailing address where you can receive mail from Bariatric Institute related to billing for Bariatric Institute services. Bariatric Institute reserves the right to contact you by any and all other means and at other locations if you fail to respond to any communication from us that requires a response.
Restrictions. You may ask us to restrict the use/disclosure of any part of your Information to carry out treatment, payment or healthcare operations. You may also request that any part of your Information not be disclosed to family, relatives or friends who may be involved in your care or not to notify them of your location, general condition or death. Your request must be submitted in writing to our Compliance Officer, and must specifically describe clearly and concisely: (1) what information you want limited; (2) whether you want to limit our use or disclosure or both; and (3) to whom you want the limits to apply. Bariatric Institute does not have the authority to bind anyone else to restrictions that you request and Bariatric Institute agrees. Bariatric Institute is not required or obligated to agree to your request unless the restriction involves the disclosure of your Information to a health plan for purposes of payment or health care operations and such Information pertains solely to a health care item or service for which you have paid for in full and out-of-pocket. If Bariatric Institute agrees to the restriction, Bariatric Institute will not use or disclose your Information in violation of that restriction, except in an emergency and as described herein. Bariatric Institute may terminate any restriction by giving you written notice; provided, Bariatric Institute’s termination shall only be effective with respect to information created or received after Bariatric Institute has given you such written notice. Bariatric Institute may not terminate a restriction that Bariatric Institute is required by law to agree to concerning disclosures to health plans, as described above.
Amendments. If you believe that the Information maintained by Bariatric Institute is incorrect or incomplete, you may request Bariatric Institute to amend such Information. Your request must be submitted in writing to Bariatric Institute’s Compliance Officer. Bariatric Institute may deny your request if it is not made in writing or does not include a valid reason to support your request. Bariatric Institute may deny your request to amend information that: (i) is accurate and complete; (ii) was not created or generated by Bariatric Institute, unless and until the person or entity that created such information is no longer available to make the amendment; (iii) is not part of the information kept by or for Bariatric Institute; or (iv) is not part of the information which you are permitted to inspect or copy. If we deny your request, you may file a statement of disagreement that will become part of your record. If you file a statement of disagreement, we reserve the right to respond to your statement. You will receive a copy of any response we make and such response will also become part of your record.

Accounting of Disclosures. You may request an accounting of certain disclosures of your Information that Bariatric Institute has made (if any) during the six (6) years prior to the date of your request, except for disclosures: (i) to carry out treatment, payment or healthcare operations; (ii) made directly to you; (iii) incident to a use or disclosure otherwise permitted or required by law; (iv) pursuant to a written authorization; (v) to persons involved in your care or for notification purposes; (vi) for national security purposes; (vii) to correctional institutions or law enforcement officials having custody over you; or (viii) as part of a limited data set. Your request must be submitted in writing to Bariatric Institute’s Compliance Officer. Your request must state a period that may not be longer than the six (6) years preceding the date of your request.

Your Right to a Copy of this Notice

You have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. To obtain a paper copy of this Notice, please contact Bariatric Institute’s Compliance Officer or ask for a copy during your next visit. You are also able to obtain a copy of this Notice by visiting www.BariatricInstitute.com.

Your Right to File a Complaint

If you believe that your privacy rights have been violated, you may file a complaint with our Compliance Officer and/or the Secretary of the U.S. Department of Health and Human Services (DHHS). Complaints must be submitted in writing. To submit a complaint to Bariatric Institute, send a letter describing your concerns to our Compliance Officer. DHHS provides information on its public website (www.hhs.gov) about how to file a complaint with the Secretary. We respect your privacy and we support efforts to protect the privacy and confidentiality of your Information. We will not retaliate against you for filing a complaint.

Compliance Officer Contact Information

If you have questions or concerns about this Notice and/or our privacy policies, contact our Compliance Officer by phone, facsimile, or regular mail address listed below. If you want to exercise any of your rights pursuant to this Notice, or if you wish to file a complaint, such request or complaint must be submitted in writing and delivered in person or faxed or mailed to our Compliance Officer at the contact information listed below.

Bariatric Institute

790 E. Willow Street, Suite 100

Long Beach, CA 90806

Service Delivery Sites

This Notice applies to the locations, facilities, and service delivery sites associated with the following:

Bariatric Institute MSO, LLC
Bariatric Institute owned, Affiliated and/or managed Ambulatory Surgery Center(s)
Bariatric Institute affiliated and/or managed Medical Practice(s)

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