Notice of Privacy Practices
Lifekind Health (a dba of Tobias Moeller-Bertram MD Corporation)
Effective June 17, 2025
THIS NOTICE DESCRIBES HOW MEDICALINFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TOTHIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this Notice, please contact:
Lifekind Health Compliance
10105E. Via Linda, Ste. 103 PMB 1253, Scottsdale, AZ 85258, United States
(949)732-1540
Compliance@lifekindhealth.com
The privacy practices described in this Notice of Privacy Practices (“Notice”) apply to Lifekind Health (hereinafter referred to as “Lifekind”). Lifekind is required by regulations issued under the federal law known as the Health Insurance Portability and Accountability Act (HIPAA Privacy Rule) to take reasonable steps to ensure the privacy of your personally identifiable health information (Protected Health Information) and to inform you about:
· Lifekind’s uses and disclosures of your Protected Health Information;
· Your privacy rights with respect to your Protected Health Information;
· Your right to file a complaint with Lifekind and to the Secretary of the U.S. Department of Health and Human Services; and
· The person or office to contact for further information about Lifekind’s privacy practices.
HOW WE MAY USE ORDISCLOSE HEALTH INFORMATION ABOUT YOU
Lifekind may use and disclose your health information for the following purposes without your express consent or authorization.
· Treatment includes, but is not limited to, the provision, coordination or management of health care and related services. For example, a Business Associate of Lifekind may disclose to a treating orthodontist the name of your treating dentist so that the orthodontist may ask for your dental X-rays from the treating dentist.
· Payment includes, but is not limited to, actions taken to make coverage determinations and payment (including billing, claims management, subrogation, plan reimbursement, reviews for medical necessity and appropriateness of care and utilization review and pre-authorizations). For example, a Business Associate of Lifekind may tell a doctor whether you are eligible for coverage or what percentage of the bill will be paid by Lifekind.
· Health Care Operations include, but are not limited to, quality assessment and improvement activities, evaluating the qualifications and performance of healthcare providers, underwriting, premium rating, and other activities related to the creation or renewal of insurance coverage. Lifekind may also use your Protected Health Information to support care coordination, inform you about programs or services we offer that may benefit your health, refer you to disease or case management programs, project future benefit costs, or audit and improve the accuracy of our claims and administrative processes.
· For purposes of this Notice, health care and related services include wellness initiatives, chronic condition management, lifestyle coaching, and information about services offered by Lifekind aimed at improving your health.
· When required by law.
· When required by the U.S. Department of Health and Human Services (HHS) to investigate or determine our compliance with HIPAA.
· When permitted for purposes of public health activities, including exposure to a communicable disease or risk of spreading a disease or condition, if authorized by law.
· When authorized by law to report information about certain abuse, neglect or domestic violence to public authorities.
· For public health oversight activities authorized by law, including audits; civil, administrative or criminal investigations; or licensure.
· For certain judicial or administrative proceedings, such as responding to a court order or a discovery request.
· For certain law enforcement purposes such as responding to a law enforcement request for the purpose of identifying a fugitive or material witness.
· To a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or other duties as authorized by law; and to funeral directors, consistent with applicable law.
· When permitted to carry out research, subject to certain conditions.
· For facilitating cadaveric organ, eye or tissue donations or transplants.
· When consistent with applicable law to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
· When permitted for certain specialized government functions, such as functions involving programs providing public benefits, certain situations at correctional institutions, national security, intelligence activities or the protection of the President of the United States.
· As authorized by and to the extent necessary to comply with workers’ compensation laws or similar legally established programs that provide benefits for work-related injuries or illness.
· We may provide you with promotional materials about our services or programs during your in-person visits, without requiring separate authorization.
· We may use or disclose a Limited Data Set (with certain identifiers removed) for research, public health, or health care operations, but only after entering into a required Data Use Agreement.
· We may create “de-identified” health information by removing all 18 identifiers specified under HIPAA.
OTHER USES ANDDISCLOSURES
We will obtain your express written authorization before using or disclosing your information for other purposes not described in this Notice. For example, authorizations are required for use and disclosure of psychotherapy notes, certain types of marketing arrangements, and certain instances involving the sale of your information. You may revoke such authorization in writing at any time, except to the extent that Lifekind has already relied on it.
YOUR RIGHTS REGARDINGYOUR HEALTH INFORMATION
In the event any of the rights described below require you to submit a written request to exercise such right, you must submit such request to the contact listed on the first page.
Right to Inspect and Copy
· You have the right to inspect and copy your health information maintained by Lifekind.
· To inspect and copy your health information, you must complete a specific form providing information we need to process your request. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies and services associated with your request. We may require that you pay such fee prior to receiving the requested copies. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you will be provided with a written denial setting forth the basis for the denial, a description of how you may request a review of the access denial and a description of how you may complain to the Secretary of the U.S. Department of Health and Human Services.
Right to Request an Amendment
· If you believe that health information we have about you is inaccurate or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Lifekind. To request an amendment, you must complete a specific form providing information we need to process your request, including the reason that supports your request. We may deny your request for an amendment if you fail to complete the required form in its entirety. In addition, we may deny your request if you ask us to amend information that:
o was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
o is not part of the health information kept by or for Lifekind;
o is not part of the information which you would be permitted to inspect and copy; or
o is accurate and complete.
· If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your health records.
Right to an Accounting of Disclosures
· You have the right to request a list of disclosures of your health information we have made, with certain exceptions defined by law.
· To request this list or accounting of disclosures, you must complete a specific form providing information we need to process your request.
· The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions
· You have the right to request a restriction on our uses and disclosures of your health information for treatment, payment, or health care operations.
· To request restrictions, you must complete a specific form providing information we need to process your request.
· Lifekind is not required to honor your request for restrictions, except if (a) the disclosure is for purposes of carrying out payment or health care operations and is not otherwise required by law, and (b) the protected health information pertains solely to a health care item or services for which you or any person (other than a health plan on your behalf) has paid Lifekind in full.
Right to Request Alternative Methods of Communications
· You have the right to request that we communicate with you in a certain way or at a certain location.
· To request alternative methods of communication, you must complete a specific form providing information we need to process your request.
· We will not ask you the reason for your request, and we will accommodate all reasonable requests.
Right to a Paper Copy of This Notice
· You have the right to a paper copy of this Notice. To obtain a paper copy of this Notice, contact the person identified on the first page of this Notice.
· You may obtain a copy of this Notice at our website: https://lifekindhealth.com/
Personal Representatives
· You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of his/her authority to act on your behalf before that person will be given access to your Protected Health Information or allowed to take any action for you.
· Lifekind retains discretion to deny access to your Protected Health Information to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may be subject to abuse or neglect.
CHANGES TO THIS NOTICE
Lifekind reserves the right to change the terms of this Notice and to make the revised Notice effective with respect to all protected health information regardless of when the information was created. The Notice will contain the effective date on the first page.
ADDITIONAL INFORMATION
The HIPAA Privacy Rule is set out at 45 Code of Federal Regulations Parts 160 and 164, subparts A and E. These regulations and additional information about the HIPAA Privacy Rule are available at www.hhs.gov/ocr/hipaa/.
QUESTIONS OR COMPLIANTS?
If you have questions or concerns, or if you wish to file a complaint because you believe that your privacy rights are being denied or your health information isn’t being protected, please contact Lifekind at:
· Lifekind Health Compliance
· 10105E. Via Linda, Ste. 103 PMB 1253, Scottsdale, AZ 85258, United States
· (949)732-1540
· Compliance@lifekindhealth.com
You may also file a privacy complaint with the U.S. government at:
· Office for Civil Rights
· U.S.DHHS 90 7th Street, Suite 4-100, San Francisco, CA 94103
· Phone:(415) 437-8310 Fax: (415) 437-8329 TDD: (415) 437-8329
· Website: www.hhs.gov/ocr (How to File a Complaint)
You may file a privacy complaint without fear of threat, coercion, discrimination or other retaliatory action from Lifekind.