PRIVACY POLICY

OUR LEGAL RESPONSIBILITIES
We are required by law to give you this notice. It provides you on how we may use and disclose 
protected health information about you and describes your rights and our obligations regarding the 
use and disclosure of that information. We shall maintain the privacy of protected health 
information and provide you with notice of our legal duties and privacy practices with respect to 
your protected health information.

We have the right to change these policies at any time. If we change our privacy policies, we will 
notify you of these changes immediately. This current policy is in effect unless stated otherwise. 
If the policy is changed, it will apply to all your current and past health information.

You may request a copy of our notice any time. You may contact (Completely Centered Health, LLC at 
(1116 Mandarin Drive Upper Marlboro MD  20774. PH: (202) 578-9001) at any time to request a copy of 
this privacy policy.

HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION

The following examples describe ways that we may use your protected health information for your 
treatment, payments, healthcare operations etc. but please be advised that not every use or 
disclosure in a particular category will be listed.

Treatment: We may use and disclose your protected health information to provide you treatment. This 
includes disclosing your protected health information to other medical providers, trainees, 
therapists, medical staff, and office staff that are involved in your health care.

For example, your medical provider might need to consult with another provider to coordinate your 
care. Also, the office staff may need to use and disclose your protected health information to 
other individuals outside of our office such as the pharmacy when a prescription is called in.

Payment: Your protected health information may also be used to obtain payment from an insurance 
company or another third part. This may include providing an insurance company your protected 
health information for a pre-authorization for a medication we prescribed.

Health Care Operations: We may use or disclose your protected health information in order to 
operate this medical practice. These activities include training students, reviewing cases with 
employees, utilizing your information to improve the quality of care, and contacting you be 
telephone, email, or text to remind you of your appointments.

If we have to share your protected health information to third party “business associates” such as 
a billing service, if so, we will have a written contract that contains terms that will protect the
privacy of your protected health information.


We may also use and disclose your protected health information for marketing activities. For 
example, we might send you a thank you card in the mail with a coupon for specialized services or 
products. We may also send you information about products or services that might be of interest to 
you. You can contact us at any point to stop receiving this information.

We will not use or disclose your protected health information for any purpose other than those 
identified in this policy without your specific, written Authorization. You may give us written 
authorization to use your protected health information or to disclose it to anyone for any purpose. 
You can revoke this authorization at any time but will not affect the protected health information 
that was shared while the authorization was in effect.

Appointment reminders: We may contact you as a reminder that you have an appointment for your 
initial visit, follow up visit, or lab work via text, phone or email.

Others Involved in Your Health Care: We may disclose protected health information about you to your 
family members or friends if we obtain your verbal agreement to do so, or if we give you an 
opportunity to object to such a disclosure and you do not raise an objection. For example, we may 
assume that if your spouse or friend is present during your evaluation, that we can disclose 
protected professional information to this person. If you are unable to agree or object to such a 
disclosure, we may disclose such information as necessary if we determine that it is in your best 
interest based on our professional judgment if there is an urgent or emergent need.

Research; We will not use or disclose your health information for research purposes unless you give 
us authorization to do so.

Organ Donation: If you are an organ donor, we may release protected health information to 
organizations that handle organ procurement or organ, eye or tissue transplantation if it is 
necessary to facilitate this process.

Public Health Risks: We may disclose your protected health information, if necessary, in order to 
prevent or control disease, report adverse events from medications or products, prevent injury, 
disability or death. This information may be disclosed to healthcare systems, government agencies, 
or public health authorities. We may have to disclose your protected health information to the Food 
and Drug Administration to report adverse events, defects, problems, enable recalls etc. if 
required by FDA regulation.

Health Oversight Activities: We may disclose protected health information to health oversight 
agencies for audits, investigations, inspections or licensing purposes. These disclosures might be 
necessary for state and federal agencies to monitor healthcare systems and compliance with civil 
law.

Required by Law: We will disclose protected health information about you when required to do so by 
federal, state and/or local law.


Workman’s compensation: We may disclose your protected health information to workman’s comp or 
similar programs.

Lawsuits: We may disclose your protected health information in response to a court action, 
administrative action or a subpoena.

Law Enforcement: We may release protected health information to a law enforcement official in 
response to a court order, subpoena, warrant, subject to all applicable legal requirements.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

Access to medical records: You have the right to access and receive copies of your protected health 
information that we use to make decisions about your care. You must submit a written request to 
obtain your protected health information to the individual listed at the end of this privacy 
policy. We reserve the right to charge you a fee for the time it takes to obtain and copy the 
protected health information and provide it to you.

Amendment: If you believe the protected health information, we have about you is incorrect or 
incomplete, you may ask us to amend the information You will need to submit a written request on 
why you feel the health information should be amended. We may deny your request to amend if you did 
not send a written request or give a reason on why it should be amended. If we deny your request, 
we will provide you a written explanation. We may deny your request if we believe the protected 
health information is accurate and complete.

Accounting of Disclosures: You have the right to receive a list of instances in which we disclosed 
your personal health information unless the disclosure was used for treatment, payment, healthcare 
operations, was pursuant to a valid authorization and as otherwise provided in applicable federal 
and state laws and regulations. You must submit a written request to obtain this “accounting of 
disclosures” to the individual listed at the bottom of this policy. After your request has been 
approved, we will provide you the dates of the disclosure, the name of the individual or entity we 
disclosed the information to, a description of the information that was disclosed, the reason why 
it was disclosed, and any additional pertinent information. This information may not be longer than 
(STATUTE OF LIMITATIONS) years ago prior to the date the accounting is requested. We reserve the 
right to charge a reasonable fee for this process.

Restriction Requests: You have the right to request a restriction or limitation on the protected 
health information we use or disclose about you for treatment, payment, or healthcare operations. 
We shall accommodate your request except where the disclosure is required by law. We require this 
be a written request submitted to the individual at the end of this policy.

Confidential Communication: You have the right to request that we communicate with you about 
healthcare matters in a certain way and at a certain location.  We must accommodate your request if 
it is reasonable and allows us to continue to collect payments and bill you.
Paper copy of this notice: You may request a hard copy of this practice policy if you reviewed and 
signed it via electronic means. To obtain this copy, contact the individual at the end of this 
privacy policy.

Complaints: If you believe your privacy rights have been violated, you may file a complaint with 
our office. You also file a complaint with the U.S. Department of Health and Human Services. We 
will provide you with the address to file your complaint with the U.S. Department
of Health and Human Services upon request.