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“We,” “us,” and “our” refers to, and this Notice applies to, medical groups that provide healthcare services. These medical groups, including but not limited to Providence RX Health, LLC, may employ or contract with physicians who offer certain healthcare services.

Your Rights for Use and Disclosure of your PHI

You have the right to request a copy of your records. 

You have the right to request confidential communications. Ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

Restriction request. We reserve the right to decline such requests unless the requested restriction involves disclosure to a health plan and you have paid for the services out of pocket.

You have the right to request access for a trusted party. 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.

You have the right to request a list of those with whom we’ve shared information. Ask us 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. This request has to be presented in writing.

Access to Your PHI. You can access and inspect paper or electronic copies of certain PHI that we maintain about you. In line with set fees under federal and state law, we may charge you for a copy of your medical records.

Amendments to Your PHI. You can request amendments, or changes, to certain PHI that we maintain about you that you think may be incorrect or incomplete. All requests for changes must be in writing, signed by you or your representative, and state the reasons for the request. If we decide to make an amendment, we may also notify others who have copies of the information about the change. Note that even if we accept your request, we may not delete any information already documented in your medical record.  You can make such requests by contacting or directly inside your Providence RX Customer Portal under the “Customer Portal” section of our website.

Accounting for Disclosures of Your PHI. In accordance with applicable law, you can ask for an accounting of certain disclosures made by us of your PHI. This request must be in writing and signed by you or your representative. This does not include disclosures made for purposes of treatment, payment, or health care operations or for certain other limited exceptions. 

Restrictions on Use and Disclosure of Your PHI. You can request restrictions on certain of our uses and disclosures of your PHI for treatment, payment, or health care operations.

Restrictions on Disclosures to Health Plans. You can request a restriction on certain disclosures of your PHI to your health plan. We are only required to honor such requests when services subject to the request are paid in full. Such requests must be made in writing and identify the services to which the restriction will apply.


Confidential Communications. You can request that we communicate with you through alternative means or at alternative locations, and we will accommodate reasonable requests. You must request such confidential communication in writing to each department you would like to accommodate the request.


Breach Notification. We are required to notify you in writing of any breach of your unsecured PHI without unreasonable delay and no later than 60 days after we discover the breach.

Uses and Disclosures.

The Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH) set the standard for sensitive patient data protection. We typically use or share your health information in the following ways:

  1. Help manage the health care treatment you receive.

  2. We can use your health information and share it with medical professionals who are treating you.


The information we collect, why we need it, and how we use it.

  1. Help manage the health care treatment you receive.

  2. We can use your health information and share it with medical professionals who are treating you.


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

Our Responsibilities:

We are required by law to maintain the privacy and security of your protected health 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 at if you change your mind.


Our Qualified Team is Always Ready to Help You!


Our team of medical providers are here to help whenever you need us most! We strive on creating a patient first experience that allows you to receive the best care, all while helping you reach your weight loss goals.

Your Success is Our Success!



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