Notice of Privacy Practices

Purifi Clinics, LLC - Purifi IV
1500 Peachtree Industrial Boulevard, Suite 125
Suwanee, Georgia 30024
Phone: 213-515-6396
Email: info@purifiiv.com
Effective Date: August 10, 2022

Your Rights and Our Responsibilities

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.

Purifi Clinics, LLC d/b/a Purifi IV (“Purifi IV,” “we,” “us,” or “our”) is required by law to maintain the privacy and security of your protected health information (“PHI”), provide you with this Notice of our legal duties and privacy practices, notify you following a breach of unsecured PHI when required by law, and follow the terms of the Notice currently in effect.

How We May Use and Disclose Your Health Information

We may use or disclose your PHI for the following purposes without a separate written authorization when permitted or required by law:

Treatment

We may use and disclose PHI to provide, coordinate, or manage your care. For example, we may share relevant information with healthcare professionals, pharmacies, laboratories, or other providers involved in your care.

Payment

Purifi IV is a self-pay practice and does not submit claims to health insurers. We may use or disclose PHI as needed to obtain payment for services, respond to a request from you for an itemized receipt, process a payment, or address a payment-related matter.

Health Care Operations

We may use and disclose PHI to operate and improve our practice. Examples include quality assessment, staff training, licensing and credentialing, compliance activities, audits, and managing our business.

Appointment Reminders and Service Communications

We may contact you by phone, text message, email, mail, or another reasonable method to remind you about appointments; provide treatment, follow-up, or lab-related communications; or share service-related information.

People Involved in Your Care or Payment

We may share relevant PHI with a family member, friend, or other person you identify as involved in your care or payment for care when you agree, do not object after being given an opportunity to do so, or when we reasonably determine it is in your best interest and you are unable to state your preference.

Public Health, Safety, and Legal Requirements

We may disclose PHI as permitted or required by law for public-health activities; reporting adverse events, product defects, or recalls; preventing or controlling disease, injury, or disability; health-oversight activities; workers’ compensation; judicial or administrative proceedings; law-enforcement purposes; organ and tissue donation; coroner, medical-examiner, or funeral-director duties; and to avert a serious threat to health or safety.

Research

We may use or disclose PHI for research only when permitted by law, such as with your written authorization or when a privacy board, institutional review board, or other legal process permits the use or disclosure.

Uses and Disclosures Requiring Your Written Authorization

Except as described in this Notice or otherwise permitted or required by law, we will obtain your written authorization before using or disclosing your PHI. We will obtain authorization when required for marketing or for the sale of PHI. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

Purifi IV may offer information about its own health-related services, service updates, office-hour changes, and promotions as permitted by law. Separate marketing consent and opt-out choices may apply to promotional email and text messages. You are not required to agree to receive promotional messages in order to receive care.

Your Rights Regarding Your Health Information

Right to Inspect and Receive a Copy

You have the right to inspect and obtain a copy of PHI in a designated record set that we use to make decisions about your care. You may request an electronic copy when the information is maintained electronically. We will act on your request within 30 days, subject to a permitted written extension of up to 30 additional days when necessary. We may charge a reasonable, cost-based fee as permitted by law.

Right to Request an Amendment

If you believe PHI we maintain about you is incorrect or incomplete, you may request that we amend it. Your request must be in writing and should explain why you believe an amendment is needed. We may deny certain requests as permitted by law, but we will provide a written response.

Right to an Accounting of Disclosures

You may request a list of certain disclosures of your PHI made during the six years before your request. This right does not include disclosures for treatment, payment, health care operations, disclosures made with your authorization, or certain other disclosures excluded by law.

Right to Request Restrictions

You may request restrictions on how we use or disclose PHI for treatment, payment, or health care operations. We are not required to agree to every requested restriction. However, if you pay for a service or item in full out of pocket and ask us not to disclose related PHI to a health plan for payment or health care operations, we will honor that request unless disclosure is otherwise required by law.

Right to Request Confidential Communications

You may ask us to contact you in a particular way or at a particular location. For example, you may ask us to contact you only by phone, email, or mail. We will accommodate reasonable requests.

Right to a Paper or Electronic Copy of This Notice

You may request a paper or electronic copy of this Notice at any time, even if you agreed to receive it electronically.

Right to Be Notified of a Breach

You have the right to be notified following a breach of unsecured PHI when notification is required by law.

Our Responsibilities

We will maintain the privacy and security of your PHI; provide this Notice; comply with the Notice currently in effect; and make reasonable efforts to use, disclose, and request only the minimum necessary PHI when that standard applies.

We may change the terms of this Notice. Any revised Notice will apply to all PHI we maintain. The current Notice will be available at our location, on our website, and upon request.

Questions, Requests, or Complaints

For questions about this Notice, to exercise your privacy rights, or to submit a complaint to Purifi IV, contact:

Privacy Contact
Purifi Clinics, LLC d/b/a Purifi IV
1500 Peachtree Industrial Boulevard, Suite 125
Suwanee, Georgia 30024
Phone: 213-515-6396
Email: info@purifiiv.com