Notice of Privacy Practices & Acknowledgment of Receipt

Below is a summary of our Notice of Privacy Practices. It describes how your medical information may be used and disclosed and how you can get access to your information. Read it carefully.

How Vitality Health May Use and Disclose Your Protected Health Information (PHI)

• ActiveRx Inc. dba Vitality SarcoHealth (“Vitality SarcoHealth”) is required by law to keep your health information confidential and to inform you of how your information may be used or disclosed.
• Vitality SarcoHealth may use and disclose your protected health information (PHI) to carry out treatment (e.g., coordination of care with your physician), payment (e.g., submitting your PHI to your health benefits plan for reimbursement purposes), and other healthcare operations (e.g., to evaluate staff and quality of care) and is permitted to do so without obtaining your authorization.
• Vitality SarcoHealth may also use or disclosure your PHI as required for public health activities, to report child abuse or neglect, for investigations or oversight activities, in certain judicial proceedings (e.g., a court order), for law enforcement purposes, to coroners and examiners to identify a deceased person or cause of death, and other purposes delineated by applicable law additional examples are included in the Notice of Privacy Practices (NPP)).
• Most other uses and disclosures require your authorization.
• When you provide Vitality SarcoHealth with an authorization to disclose your PHI, you can revoke the authorization at any time.

Please see Vitality SarcoHealth’s NPP for a more complete description.

Summary of Your Rights

• You have the right to access and receive a copy of your treatment record and to receive a timely response to your request.
• You have the right to request that Vitality SarcoHealth restrict how it uses and discloses your PHI though Vitality SarcoHealth is not required to agree with the requested restriction.
• You have the right to receive confidential communications.
• You have a right to request an amendment to your PHI.
• You have the right to be notified if there is a breach involving your PHI.
• You have the right to receive an accounting of how your PHI has been used and disclosed.

Please see Vitality SarcoHealth’s NPP for a complete description of your rights.

Should you have any concerns about the use or disclosure of your PHI or you have a compliant regarding any violation of your privacy rights you may contact the Vitality SarcoHealth Privacy Officer as detailed in the NPP. You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights. Vitality Health will not retaliate against you for filing a complaint.

A copy of Vitality Health’s Notice of Privacy Practices was made available to me. I also understand that I may obtain the Notice of Privacy Practices at any time by visiting choosehowyouage.com/privacy or requesting a copy at any of the Vitality SarcoHealth facilities.