Notice of Privacy Practices

Our Commitment to Your Privacy

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.

Restore Nutrition Therapy is committed to maintaining the privacy of your protected health information (PHI). We are required by law to maintain the privacy of PHI, provide you with notice of our legal duties and privacy practices, and notify you following a breach of unsecured PHI.

How We May Use and Disclose Your Information

Treatment

We may use your PHI to provide, coordinate, or manage your nutrition therapy and related services. We may share your information with other healthcare providers involved in your care, such as your physician, therapist, or treatment team.

Payment

We may use and disclose your PHI to bill and collect payment for services. This may include contacting your insurance company for prior authorization or submitting claims.

Healthcare Operations

We may use your PHI for our healthcare operations, including quality assessment, case management, and business planning.

As Required by Law

We may disclose your PHI when required by federal, state, or local law, including for public health activities, health oversight, judicial proceedings, or to avert a serious threat to health or safety.

Your Rights

• Access: You have the right to inspect and obtain a copy of your PHI.
• Amendment: You may request that we amend your PHI if you believe it is incorrect or incomplete.
• Accounting of Disclosures: You may request a list of certain disclosures we have made of your PHI.
• Restrictions: You may request restrictions on how we use or disclose your PHI.
• Confidential Communications: You may request that we communicate with you in a certain way or at a certain location.
• Breach Notification: You have the right to be notified if there is a breach of your unsecured PHI.

Authorization

Other uses and disclosures of your PHI not covered by this notice will be made only with your written authorization. You may revoke any authorization in writing at any time.

Questions or Complaints

If you have questions about this notice or wish to file a complaint about our privacy practices, please contact:

Shannon Houchin, RDN, CEDS
shannon@restorenutritiontherapy.com
(908) 403-0254

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.