Notice of Privacy Practices (HIPAA)

I. Who we are

This Notice describes the privacy practices of Elevation Medical Weight Loss. This policy was updated on 5/11/2020.

While treating you, our employees and the health care professionals affiliated with Elevation Medical Weight Loss operate in accordance with the policies outlined in this Notice. Additionally, any  persons, entities, sites, and/or locations  involved in your care may share collected medical information about you with each other on behalf of Elevation Medical Weight Loss exclusively for the purposes of providing treatment, receiving payment, or other health care operations as described in this notice.

We are required by law to maintain the privacy of your health information as well as to provide you with this Notice of Privacy Practices.

II. Our duties to safeguard your protected health information

Protected health information (“PHI”) is any information related to your health care that is shared or maintained in any manner, whether physical or electronic. This also includes any insurance information provided. This Notice applies to all PHI generated by  Elevation Medical Weight Loss or any of its entities.  

This Notice is intended to inform on how may handle, use and/or disclose your PHI. As well as to describe your rights and our certain obligations regarding the use, storage and disclosure of your PHI.

We are required by law to:

  • Make sure that your PHI is kept private
  • Give you this Notice of our legal duties and privacy practices related to your PHI
  • Follow the terms of the Notice that is currently in effect

III. How Elevation Medical Weight Loss may use and disclose medical information about you – treatment, payment, and health care operations.

Except in an emergency or other special situation, we will ask you to sign a general consent, as required by Pennsylvania law, so that we may use and disclose your PHI for the following purposes:

Treatment. We may use and disclose PHI among the above stated entities in connection with your treatment, for example and diagnosis given would be noted and shared with necessary staff. In addition, we may contact you to remind you about appointments, give you instructions prior to tests or surgery, or inform you about treatment alternatives or other health-related benefits or services. If necessary, we may also disclose your PHI to other providers, doctors, nurses, technicians, medical students, hospital personnel, or other health care facilities involved in your treatment. We may need to communicate this PHI to other health care providers using phone, fax, or electronic transfer.

Payment. We may use and disclose your PHI to obtain payment for services we provide to you. For example, we may contact your insurance company to pay for the services you receive, to verify that your insurer will pay for the services, to coordinate benefits, or to collect any outstanding accounts.

Health care operations. We may use and disclose your PHI for health care operations which include: activities related to evaluating treatment effectiveness, teaching and learning purposes, evaluating the quality of our services, investigating complaints related to service, fundraising activities, and marketing activities.

Other health care providers. We may also disclose your PHI to other health care providers when such PHI is required for them to treat you, receive payment for services you receive, or conduct certain health care operations. For example, we will share your PHI with an ambulance company so the ambulance company can be reimbursed for transporting you to the hospital.

IV. Other uses and disclosures of your PHI for which authorization is not required

Disclosure to relatives and close friends. We may disclose your PHI to a family member, other relatives, a close personal friend or any other person if we: 1) obtain your agreement; 2) provide you with the opportunity to object to the disclosure; or, 3) we can reasonably infer that you do not object to the disclosure.

Incapacity or emergency circumstances. If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of your incapacity or an emergency circumstance, we may exercise our professional judgment to determine whether a disclosure to relatives and/or close friends is in your best interest. If we disclose information to a family member, other relatives, or a close personal friend, we would disclose only information that is directly relevant to the person’s involvement with your health care.

Public health activities. We may disclose your PHI for public health activities including the following:

  • Reporting births or deaths
  • To prevent or control disease, injury or disability
  • To report child abuse or neglect
  • To report reactions to medications or problems with products
  • To notify individuals who may have been exposed to a disease or may be at risk for contracting a disease or condition
  • Reporting PHI to your employer as required by laws addressing work-related illnesses and injuries or workplace medical surveillance

Victims of abuse, neglect, or domestic violence. If we reasonably believe you are a victim of abuse, neglect or domestic violence, in accordance with current Pennsylvania law, we may disclose your PHI to a governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence.

Health oversight activities. We may disclose your PHI to a health oversight agency that is responsible to ensure compliance with rules of government health programs such as Medicare and Medicaid. These oversight activities include, for example, audits, investigations, inspections, and licensure.

Legal proceedings and law enforcement. We may disclose your PHI in response to a court order, subpoena, or other lawful processes.

Public Safety. We may use or disclose your PHI to prevent or lessen a serious or imminent threat to the safety of a person or the public.

Disaster relief efforts. We may disclose your PHI to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

Military, national defense, and security. We may release your PHI if required for military, national defense and security and other special government functions.

Workers’ compensation. We may release your PHI for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

Communications from us. We may use or disclose your PHI to identify health-related services and products that may be beneficial to your health, such as notification of a new physician and/or additional products and services, and then contact you about those products and services. If you do not wish to receive information of this type, please contact us at or at

As Required by law. We may use and disclose your PHI when required to do so by any other laws not already referenced above.

V. Uses and disclosures requiring your specific authorization

Highly confidential information. Federal and State laws require special privacy protections for certain highly confidential information about you. This includes PHI that is: 1) maintained in psychotherapy notes; 2) documentation related to mental health or developmental disabilities services; 3) drug and alcohol abuse, prevention, treatment, and referral information; and, 4) information related to HIV status, testing, and treatment as well as any information related to the treatment or diagnosis of sexually transmitted diseases. Generally, we must obtain your authorization to release this type of PHI. However, there are limited circumstances under the law when this type of PHI may be released without your consent. For example, certain sexually transmitted diseases must be reported to the Department of Health.

Other uses or disclosures not described in this Notice. Other uses and disclosures of PHI not covered by this Notice or permitted under the laws that apply to us will be made only with your written permission. Except as permitted under this Notice or as permitted by law, we will seek your written permission prior to using or sharing your information for marketing purposes or selling your information. If you provide us permission to use or disclose your PHI, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose your PHI for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain a record of the care that we provided to you.

VI. Your rights regarding medical information about you

You have the following rights regarding PHI we maintain about you:

Right to inspect and copy. You have the right to inspect and copy PHI that may be used to make decisions about your care excluding psychotherapy notes.

You may request an electronic copy of your PHI if we maintain the PHI in an electronic format.

You must submit your request in writing to the appropriate  Elevation Medical Weight Loss office or department. You may be charged a fee for the costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. You may request that the denial be reviewed. Another licensed health care professional will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to amend. You have the right to request that we amend the PHI we keep about you in your medical and billing records. Your request to amend your medical or billing records must be made in writing and submitted to the appropriate  Elevation Medical Weight Loss office or department. We may deny your request if we believe the information you wish to amend is accurate, current, and complete, if the PHI was not created by  Elevation Medical Weight Loss or if other special circumstances apply.

We will ask your attending physician to review any amendments to the medical record.

Right to an accounting of disclosures. You have the right to request a record of all disclosures of your PHI. We are not required to give you an accounting of information we have used or disclosed for treatment, payment, or health care operations or information you authorized us to disclose.

To request this list or accounting of disclosures, you must submit your request in writing to the appropriate  Elevation Medical Weight Loss office or department. Your request may cover any disclosures made in the six years prior to the date of your request.

The right to request restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or health care operations. We are not required to agree to your request with one exception. We will honor your request to not share your PHI with your medical insurer or other third-party payers, provided you pay in full for the health care item or service. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing. In your request, you must tell us: 1) what information you want to limit; 2) whether you want to limit our use, disclosure or both; and, 3) to whom you want the limits to apply, for example, disclosures to your spouse.

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.

To request confidential communications, you must make your request in writing to the appropriate  Elevation Medical Weight Loss office. We will accommodate reasonable requests. Your request must specify how or where you wish to be contacted.

The right to revoke your authorization. You may revoke your authorization for us to use and disclose your PHI at any time by submitting a request in writing to the appropriate office or department.

VII. Changes to this Notice

We reserve the right to change this Notice. Revised Notices will be posted in appropriate locations and online at We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. A copy of the current Notice is available upon request.