Notice of Privacy Practices Policy

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The HIPAA Privacy Rule requires healthcare providers to notify patients of their rights with respect to their personal health information and the healthcare provider’s privacy practices. This policy provides guidance to team members and business associates as to their responsibility to inform patients of Conviva’s privacy practices and to obtain from patients, acknowledgement of these privacy practices.  



Elite Health has developed and maintains a Notice of Privacy Practices that provides patients with adequate notice of the uses and disclosures of protected health information that may be made by Elite Health, and of a patient’s rights with respect to this information as stated within the Notice of Privacy Practices. Uses and disclosures of PHI in a manner inconsistent with the Notice of Privacy Practices is strictly prohibited. Notice of Privacy Practices is displayed in each medical center lobby and supplied to each patientA Notice of Privacy Practices Acknowledgement must be reviewed and signed by the patient.  



This policy provides guidelines which should be followed by all Elite Health operating entities, subsidiaries, affiliates, business groups, markets and/or departments. It applies to all Elite Health team members, and all temporarily assigned individuals, all contrac­tors, vendors or others who are provided with authorized access to Elite Health’s Infor­mation Technology Systems or the information derived from those systems (“User”). This policy  applies to oral, written and electronic individually identifiable health infor­mation and non-public personal information in all Elite Health facilities and operational areas. The information protected applies to individual, patient, agent, broker, employer group, provider, ven­dors and third parties including person(s) who are deceased.



COMPLAINT — Any concern or expression of dissatisfaction regarding privacy issues of protected information that cannot be resolved promptly to the satisfaction of the patient or complainant.

MEDICAL CENTER — A health care center that provides routine preventative medical care by a primary care provider and/or specialist including ancillary services.


(1) A health plan. 

(2) A health care clearinghouse. 

(3) A health care provider who transmits any health information in electronic form in connection with a transaction covered HIPAA.

DISCLOSURE — The act of releasing, transferring, divulging, or providing access to protected information to an entity or individual outside of Conviva.

INDIVIDUAL PRIVACY RIGHTS – According to HIPAA Title II- Administrative simplification regulations, individuals are entitled to the following individual privacy rights:  


    •  Right to Notice of Privacy Practices 
    •  Right to Restrictions on Use and Disclosure of PHI
    • Right to Alternate Communications (i.e., communicate in different means or locations)
    •  Right of Access to PHI
    • Right to Amend PHI
    • Right to file a Complaint
    • Right to an Accounting of Disclosures of PHI


PROTECTED HEALTH INFORMATON (PHI) —All individually identifiable health information held or transmitted by Elite Health or its business associate. PHI includes information in any form or media: electronic, paper or oral.  PHI specifically includes demographic information related to past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present or future payment for the provision of health care to an individual; and identifies the individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual.


PROTECTED INFORMATION (PI) —information that contains data elements or a combination of data elements that could identify a person or provides a reasonable basis to believe someone could be identified, such as social security number, name, bank account information, address, date of birth, sex.

USE — sharing, applying, examining, or analyzing protected information within Convivia or its affiliates and subsidiaries.



1.    Upon a patient’s initial first-time appointment as a new patient, annually and upon request, a Notice of Privacy Practices must be reviewed and provided.


2.    Additionally, if a significant change is made to the Notice of Privacy Practices a copy must be reviewed and provided to patient at their first appointment following the change


3.    This Notice must include an Acknowledgement Statement that should be completed in its entirety and signed by the patient.


4.    The Notice of Privacy Practices Acknowledgement must be stored in the patient’s medical record.


5.    If the patient refuses to sign the employee must document the reason, they were unable to obtain the patient’s signature. 






Right to Notice

An individual has a right to adequate notice of the uses and disclosures of protected health information that may be made by Elite Health, of the individual’s rights and of Elite Health’s legal duties with respect to the use and disclosure of protected health information.


Content of Notice 

Elite Health will provide a notice that is written in plain language and contains the following required elements:




The description of uses and disclosures that are permitted to carry out treatment, payment and health care operations.  

·      A description of each of the purposes for which Elite Health is permitted or required to use or disclose protected health information without the patient’s written authorization.

·      A statement that other uses and disclosures must be made only with the patient’s written authorization and that the patient may revoke his or her authorization as provided by the Privacy Rule.  


If a use or disclosure for any purpose is prohibited or materially limited by other applicable law, the description of such use or disclosure must reflect the more stringent law.


For each purpose described, the description must include sufficient detail to place the individual on notice of the uses and disclosures that are permitted or required under HIPAA and other applicable law.


The notice contains a statement of the following patient’s rights and how the patient may exercise these rights: 

·      The right to request restrictions on certain uses and disclosures of protected health information.  

·      The right to receive confidential communications of protected health information.  

·      The right to inspect and copy protected health information.  

·      The right to amend protected health information

·      The right to receive accounting of disclosures of protected health information.   


The notice must contain the following regarding Elite Health’s duties:

·      A statement that  Elite Health reserves the right to change the terms of its notice and to make the new notice provisions effective for all protected health information that it maintains, including protected health information that it created or received prior to issuing a revised notice.

·      A statement that patients may place a complaint with the medical center administrator, privacy officer or Secretary of the Department of Health and Human Services if they believe their privacy rights have been violated.  

·      A statement that Elite Health is required by law to maintain the privacy of protected health information, to provide individuals with notice of its legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information;

·       A statement that Elite Health is required to abide by the terms of the notice currently in effect.



Elite Health will retain copies of the Privacy Notice in accordance with the Retention Policy.



Attachment A – HIPAA Notice of Privacy Practices.



HIPAA Privacy Rule and Administrative Simplifications.



Elite Health follows all federal and state laws and regulations. Where more than one state is impacted by a particular issue, to allow for consistency, Elite Health will follow the most stringent requirement. 


This document is intended as a guideline. Situations may arise in which professional judgment may necessitate actions that differ from the guideline. Circumstances that justify the variation from the guideline should be noted and submitted to the appropriate business area for review and documentation. This policy/standard is subject to change or termination by Elite Health any time. Elite Health has full and final discretionary authority for its interpretation and application. This policy/standard supersedes all other policies, standards, guidelines, procedures or information conflicting with it. 



Failure to comply with any part of Elite Health’s policies, standards, guidelines, and procedures may result in disciplinary actions up to and including termination of employment, services or relationship with Elite Health. In addition, state and/or federal agencies may take action in accordance with applicable laws, rules and regulations.


Any unlawful act involving Elite Health systems or information may result in Elite Health turning over any and all evidence of unlawful activity to appropriate authorities. 


Attachment A



Your Information. Your Rights. Our Responsibilities.

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. 


Your Rights

You have the right to: 

·       Get a copy of your paper or electronic medical record

·       Correct your paper or electronic medical record

·       Request confidential communication

·       Ask us to limit the information we share

·       Get a list of those with whom we’ve shared your information

·       Get a copy of this privacy notice

·       Choose someone to act for you

·       File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we: 

·       Tell family and friends about your condition

·       Provide disaster relief

·       Include you in a hospital directory

·       Provide mental health care

·       Market our services and sell your information

·       Raise funds

Our Uses and Disclosures

We may use and share your information as we: 

·       Treat you

·       Run our organization

·       Bill for your services

·       Help with public health and safety issues

·       Do research

·       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


Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record 

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. 

Ask us to correct your medical record 

You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. 

We may say “no” to your request, but we’ll tell you why in writing within 60 days.


Request confidential communications 

You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. 

We will say “yes” to all reasonable requests. 

Ask us to limit what we use or share 

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. 

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information. 

Get a list of those with whom we’ve shared information 

You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. 

We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. 

Get a copy of this privacy notice 

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. 

Choose someone to act for you 

If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. 

We will make sure the person has this authority and can act for you before we take any action. 

File a complaint if you feel your rights are violated 

You can complain if you feel we have violated your rights by contacting us using the information on page 1. 

You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting

We will not retaliate against you for filing a complaint. 


Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. 

In these cases, you have both the right and choice to tell us to: 

·       Share information with your family, close friends, or others involved in your care 

·       Share information in a disaster relief situation 

·       Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission: 

·       Marketing purposes 

·       Sale of your information 

·       Most sharing of psychotherapy notes 

In the case of fundraising: 

We may contact you for fundraising efforts, but you can tell us not to contact you again. 


Our Uses and Disclosures

How do we typically use or share your health information? 

We typically use or share your health information in the following ways. 

Treat you

We can use your health information and share it with other professionals who are treating you. We may also share your health information with other third parties, such as hospitals, pharmacies and other health care facilities and agencies to provide health care services, medications, equipment and supplies you may need. 

Example: A doctor treating you for an injury asks another doctor about your overall health condition. 

Run our organization 

We can use and share your health information to run our practice, improve your care, and contact you when necessary. We may also use summary or de-identified data to learn how we may improve our services or create additional service offerings. 

Example: We use health information about you to manage your treatment and services. 

Bill for your services

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. 

How else can we use or share your health information? 

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 must meet many conditions in the law before we can share your information for these purposes. For more information see:


Help with public health and safety issues 

We can share health information about you for certain situations such as: 

·       Preventing disease 

·       Helping with product recalls 

·       Reporting adverse reactions to medications 

·       Reporting suspected abuse, neglect, or domestic violence 

·       Preventing or reducing a serious threat to anyone’s health or safety 

Do research 

We can use or share your information for health research. 

Comply with the law 

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law. 

Respond to organ and tissue donation requests 

We can share health information about you with organ procurement organizations. 

Work with a medical examiner or funeral director 

We can share health information with a coroner, medical examiner, or funeral director when an individual dies. 

Address workers’ compensation, law enforcement, and other government requests 

We can use or share health information about you: 

·       For workers’ compensation claims 

·       For law enforcement purposes or with a law enforcement official

·       With health oversight agencies for activities authorized by law 

·       For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions 

We can share health information about you in response to a court or administrative order, or in response to a subpoena.



Appointment reminders 

Your health information will be used by our staff to send you appointment reminders or to contact you via the telephone number you provided 

Information about treatment 

Your health information may be used to send you information on the treatment and management of your medical condition that you may find of interest. We may also send you information describing other health-related goods and services that we believe may interest you. 

Business Associates 

Some of the services we provide are delegated to contractors known as Business Associates. We will provide your health information to those of our contractors who require the information to perform certain services on our behalf. For example, we may provide your health information to a claims submission service that ensures that our claims are submitted in the appropriate form to the appropriate payors. To protect you, we require the Business Associate and their contractors to appropriately safeguard your health information.

Participation in Health Information Exchanges (HIE) 

We can share information about you with one or more HIEs we may participate in. HIEs are secure electronic systems that allow health care providers to exchange patient information to better coordinate your care and to help us make more informed decisions regarding the best way to treat you. For example, if you were to visit anther provider or hospital that also participates in the same HIE, we would receive treatment information from that provider. If you do not wish to participate in the HIE, we will provide you a HIE Opt-Out Form to complete. You can receive services from us even if you decide to opt out of participation in the HIE.

Our Responsibilities 

We are required by law to maintain the privacy and security of your protected health information. 

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. 

For more information see:


Changes to the Terms of this Notice 

We 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 web site. 

This Notice of Privacy Practices applies to the following organizations 

This notice applies to the Elite Health. 


Please click HERE to contact our compliance department for further information concerning our privacy practices.


Effective Date: 11/16/2021