NOTICE OF PRIVACY PRACTICES
New Genesis Vitality (NewGenesisVitality.com)
Effective Date: February 4, 2026
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.
OUR PLEDGE REGARDING MEDICAL INFORMATION
New Genesis Vitality (“we,” “us,” or “our”) is committed to protecting the privacy of your medical information. We create a record of the care and services you receive to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by New Genesis Vitality.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding the medical information we maintain about you:
1. Right to Inspect and Copy (Access)
You have the right to inspect and receive a copy of your medical and billing records. To do so, you must submit your request in writing to our Privacy Officer. We may charge a reasonable, cost-based fee for copies. We may deny your request in certain limited circumstances; if denied, you may request a review of the denial.
2. Right to Amend
If you feel that the medical information we have about you is incorrect 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 New Genesis Vitality. To request an amendment, your request must be made in writing and submitted to the Privacy Officer, including a reason that supports your request. We may deny your request if the information was not created by us, is not part of the information you are permitted to inspect, or if the information is accurate and complete.
3. Right to an Accounting of Disclosures (Disclosure Log)
You have the right to request an “accounting of disclosures.” This is a list of certain disclosures we made of your medical information for purposes other than treatment, payment, and healthcare operations, or for which you provided written authorization. To request this list, you must submit your request in writing to the Privacy Officer. 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.
4. Right to Request Restrictions
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request, except for requests to restrict disclosures to a health plan for services for which you have paid out-of-pocket in full.
5. Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location (for example, only at work or by mail). We will accommodate all reasonable requests.
6. Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
7. Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with New Genesis Vitality or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer. You will not be penalized for filing a complaint.
OUR RESPONSIBILITIES (COVERED ENTITY RESPONSIBILITIES)
• We are required by law to maintain the privacy and security of your protected health information (PHI).• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.• We must follow the duties and privacy practices described in this notice and give you a copy of it.• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
PERMITTED USES AND DISCLOSURES
We may use and disclose your medical information for the following purposes:
1. For Treatment
We can use your health information and share it with other professionals who are treating you.Example: A doctor treating you for an injury asks another doctor about your overall health condition.
2. For Payment
We can use and share your health information to bill and get payment from health plans or other entities.Example: We give information about you to your health insurance plan so it will pay for your services.
3. For Healthcare Operations
We can use and share your health information to run our practice, improve your care, and contact you when necessary.Example: We use health information about you to manage your treatment and services.
4. Other Permitted Uses and Disclosures
We are allowed or required to share your information in other ways—usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
• Public Health and Safety issues• Research• To Comply with the Law• Respond to Organ and Tissue Donation Requests• Work with a Medical Examiner or Funeral Director• Address Workers’ Compensation, Law Enforcement, and other Government Requests• Respond to Lawsuits and Legal Actions
CONTACT INFORMATION
If you have questions about this notice or wish to exercise any of your rights, please contact our Privacy Officer:
Privacy Officer: Keith KirbowEmail: newgenesisvitality@gmail.comMailing Address:New Genesis VitalityAttn: Privacy Officer
Changes to the Terms of This NoticeWe can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.