This notice describes how Levity Ventures LLC ('Levity,' 'we,' 'us') may use and disclose your medical information and how you may access this information. Please review the information carefully. 

Summary
Here we include a summary of the ways in which Levity may use or disclose your information and your rights regarding your personal and medical information. Detailed information can be found later on the page. 

Levity may use and share your information to support: 
•    Your treatment
•    Clinic management
•    Contractor Delivery
•    Services billing and payment
•    Public health and safety 
•    Research
•    Legal compliance
•    Organ and tissue donation requests 
•    Medical Examiner or Funeral Director Cooperation
•    Response to lawsuits or legal actions
•    Patient communication
•    Health oversight
•    Marketing health-related services

Other uses of your information generally require your written consent. 

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You have the right to: 

•    Request an electronic or paper copy of your medical record
•    Request corrections to your health record
•    Request confidential communication
•    Requests to limit use or disclosure
•    Request a list of those with whom we have shared your information 
•    Receive a copy of this privacy notice
•    Appoint someone to act on your behalf
•    File complaints in the case of rights violations 
•    Share medical information with others
 

Levity is legally obliged to protect client’s health information and to provide clients with an overview of these legal duties and the company’s corresponding privacy practices to comply with the duty of protecting clients’ health information. Select states have enacted their own privacy laws and/or other laws regarding medical information confidentiality; see more details below.   

The privacy practices in this notice are effective while the notice is active and applies to all stakeholders. 

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I.   Use and Disclosure

Levity may use and share your information to support: 

a)    Your treatment
Levity may use and/or disclose your health information to other healthcare professionals for the purpose of evaluating your health, diagnosing medical conditions and/or providing treatment. For example, results of intake evaluations and treatment protocol will be available in your medical record to all health professionals who may provide treatment or who may be consulted by workforce members. For those receiving prescriptions from prescribing partners, their health information will be shared with relevant medical professionals at these institutions. 

b)    Clinic management
In order to effectively run the practice, Levity may utilize client health information. The ways in which we could do so include, for example, general practice management, client communications or care improvement. This implies that client health information may be shared with the Levity management team. This is especially important to support practitioner quality assessments, training programs, accreditation, certification, licensing, credentialing activities, budgeting and financial reporting, and other activities to evaluate and promote quality.

c)    Contractor delivery
Some Levity services are provided via service contracts. In this case, clients’ health information may be disclosed to individuals immediately involved in delivering services through these contracts. In this case, individuals to whom patient information may be disclosed are required to sign agreements to comply with Levity’s privacy practices. These individuals may include business analysts, program coordinators, therapists, practitioners or other medical professionals. 

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d)    Services billing and payment
Client health information may be used to seek or obtain payment from health plans or other forms insurance coverage (e.g., benefits insurer). Levity may also share needed information with credit card companies or other credit providers used by clients to pay for services or to collect client payments more generally. This information may include, but is not limited to, conditions treated, services provisioned and service provision dates. Please note Levity will also use or share clients’ health information to support workers’ compensation claims as requested.

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e)    Public health and safety 
Levity may disclose client medical information to support public health activities. These activities generally include the following:

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 of product recalls they may be using and to provide your social security number and/or other required information to medical device companies and similar organizations regulated by the U.S. Food and Drug Administration (for example, biologic supply companies and donor banks) so that such organizations may locate individuals should there be a need to do so;

To notify people who may have been exposed to a disease, or who may be a risk for contracting or spreading a disease or condition; and

To notify the appropriate government or law enforcement authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. Levity will only make this disclosure if the client agrees or when required or authorized by law.

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Levity may use or disclose client medical information when necessary to prevent a serious threat to their health and safety or the health and safety of the public or another person. In this case, disclosure of information would only be permitted to someone able to prevent the threat. 

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f)    Research
Levity can use client health information for health research. In some jurisdictions, regulatory approval is required for such use. Generally, absent your consent, any such research will be anonymized. 

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g)    Legal Compliance
Should local, state, or federal laws require, Levity will share client health information with authorities. Client health information may be disclosed to law enforcement agencies in various scenarios. This includes government audit and inspection support, law-enforcement investigation facilitation and compliance with government mandated reporting.  For example, if requested to do so by a law enforcement official, Levity may release client medical information in the following scenarios: 

In response to a court order, subpoena, warrant, summons, or similar process;

To identify or locate a suspect, fugitive, material witness, or missing person;

About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;

About a death we believe may be the result of criminal conduct;

About criminal conduct at the facility; and

In emergency circumstances to report a crime, or the location of the crime.
 

Should military command authorities require, Levity will share client health information for those clients who are members of the armed forces, active or reserve. This includes the release of medical information about foreign military personnel to the appropriate foreign military authority.

h)    Organ and Tissue Donation Requests
For those clients who are organ donors, Levity may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

i)    Medical Examiner or Funeral Director Cooperation
Levity may release medical information to a coroner or medical examiner in order to, for example, identify a deceased person or determine the cause of death. Levity may also release medical information about clients as required by funeral facilities to carry out their duties.

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j)    Response to lawsuits and legal action
Levity will share client health information in response to a court order or administrative order. Levity may also disclose client medical information in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute. Sharing information in these scenarios is only permitted if Levity has made effort to communicate the request to the client in question or to obtain an order protecting the requested information.

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k)    Patient Communication
Unless otherwise directed, Levity may use or disclose client health information to provide clients with appointment reminders (such as voice mail messages, text messages, emails, postcards, or letters).

l)    Health Oversight
We may release client health information to health oversight agencies for legally authorized health oversight activities.

m)    Marketing Health-Related Services
We may use and disclose medical information to tell clients about health-related benefits or services that may be of interest to them.
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Other Uses and Disclosures Require Your Prior Written Authorization
Client health information disclosures, or use for any purposes, other than those listed above requires, in most cases, clients’ specific written authorization. If clients should decide they wish to revoke their authorization of a use or disclosure of their information, they can do so in writing.

Should the client revoke authorization, Levity will no longer use or disclose their medical information for reasons covered by the written notification. However, the client decision to revoke authorization will not affect or undo any personal or health information occurring before Levity receives the client notification indicating the decision to revoke the relevant authorization(s). The client understands Levity is unable to revoke any disclosures made with client authorization and that Levity is required by state law to retain records of the care we provide. 

Without client authorization, Levity is expressly prohibited to use or disclose clients’ protected health information for marketing purposes other than face-to-face communication or provision of promotional gifts of nominal value. Levity may not disclose personal health information when financial remuneration is in question nor sell clients’ protected health information without their authorization. The majority of clients’ psychotherapy notes are not permissible to share without client authorization. Levity will not use or disclose any protected health information that contains genetic information used for underwriting purposes.

 

 

II.   Client Rights

You have the right to: 

a)    Request an electronic or paper copy of your medical record
Clients can request a copy of their medical records and their other health information held by medical providers, in this case Levity, with limited exceptions. All such requests must be in writing; clients may request a form to obtain access to their relevant medical records (paper or electronic copy) and health information by using the general information listed in this notice. 

The personal and health information covered by this provision usually includes medical and billing records but excludes some information such as psychotherapy notes. 
Clients requesting medical records copies in order to support a claim or appeal under any provision of the Social Security Act or any federal or state financial needs-based benefit program, copies will be provided to the client or their representative free of charge. 

Clients requesting medical records for any other purposes, including personal use or delivery to primary care physicians or other medical practitioners or therapists, Levity reserves the right to impose reasonable, cost-based fees, which include only processing (including supplies and labor) and postage (in the event the client requests mailed documents). 

Should a client request a summary or explanation of their protected health information, Levity may also charge a cost-based fee for the preparation of the relevant information. However, the fee will not include costs associated with searching for and retrieving requested information. 

b)    Request corrections to your health record
Clients can request that Levity correct health information which they understand to be incorrect or incomplete. The said request must be submitted in writing, explaining which information should be amended and how. Under some circumstances, Levity may deny the client request. In this case, Levity will provide a written explanation within 60 days of your request. 

c)    Request confidential communication
Clients can request that we contact them in a specific way or send communications to a specific request. Levity will honor all reasonable requests in this regard.

d)    Requests to limit use or disclosure
Clients can request that we do not share certain health information for treatment, payment or health care operations. If the request could harm client care, Levity reserves the right to no process the request. 

Client’s paying for Levity services ‘out of pocket’ can Levity does not share that information for the purpose of payment with your health insurer. Levity will honor such requests unless otherwise required by law.

e)    Request a list of those with whom we have shared your information 
Clients can request a list (accounting) of the occasions Levity has shared their health information during a period of six years prior to the date requested. This accounting should include with whom the information was shared and for what purpose. Levity will also include all disclosures outside those regarding treatment, payment and health care operations and certain other disclosures (such as any requested by the client).

To request this list, clients must submit the request in writing to the address provided in this notice. The request should include a time period for which the information is requested which may be no longer than six (6) years and may not include dates before the opening of the client’s patient file. 

The first such ‘accounting’ requested within a12-month period will be free of charge. For additional ‘accountings,’ Levity may charge the costs of preparing and providing the list, in which case Levity will notify the requesting client of the costs involved. Upon receiving the notification of costs and before costs are incurred, the requesting client may choose to withdraw or modify the request.

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f)    Receive a copy of this privacy notice
Clients can request a physical copy of this notice at any time. Levity will comply with any such request promptly. 

g)    Appoint someone to act on your behalf
Clients with a medical power of attorney or legal guardian may have these legally appointed individuals act on their behalf to exercise their rights or make choices regarding their health care. Levity will verify this authority before taking any action in accordance with these individuals’ desires or requests.

h)    File complaints in the case of rights violations 
Clients can file official complaints should they feel Levity has violated their rights by contacting us as indicated in the general contact information provided in this notice. Clients can also file complaints 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 or calling 1-877-696-6755. Levity will not retaliate against clients for filing a complaint.

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i)    Share medical information with others
Levity is responsible for disclosing health information to client’s as described in this notice. If clients agree, Levity may also disclose client health information to a family member, friend or other individual to the extent necessary to assist with healthcare needs or payment for Levity services. Clients can inform Levity of the desire to share their health information with specific individuals by filling out the necessary form which is available upon request. 
 

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III.   Legal Obligation Details ​

a)    State law
Patient’s federal privacy standards are outlined by the Health Insurance Portability and Accountability Act of 1996. Select states have enacted their own privacy laws and/or other laws regarding medical information confidentiality. Such state laws result in requirements different from, and in some cases, more stringent than, those described in this notice. To the extent that an applicable state privacy law imposes requirements more restrictive than federal privacy law, state law will pre-empt the federal law.

Below is a summary of circumstances where your health information may be shared under state laws: 

• To other health care professionals in certain instances;

• To protect against imminent injury to clients or others;

• In the case of a medical emergency, if we are unable to contain the client’s consent or, in the case of Massachusetts, clients refuse to accept further treatment voluntarily;

• In certain legal proceedings and/or pursuant to a court order or subpoena; 

• Pursuant to requests from certain government agencies and programs, such as healthcare or benefits, or for audits, program evaluations, licensure and accreditation activities; 

• Other than in Massachusetts, for public health purposes;

• To law enforcement in certain instances; and 

• As otherwise permitted or required by relevant State laws. 

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Client information may be disclosed orally, in paper form or electronically. These exceptions are in addition to the uses and disclosures to which the client is consenting under this Privacy Practices Notice and the attached Consent to Treatment and its Schedules. 

b)    Notice for Residents of Washington State

We keep a record of the health care services we provide clients; they may request to see and copy that record. They may also ask we correct that record. We will not disclose client record to others unless clients direct us to do so or unless the law authorizes or compels us to do so. Clients may see their records or get more information about them under the heading ‘Complaints’ below. 

c)    Notice of Privacy Practices 

Levity is required to follow the privacy practices articulated in this notice while it is active. This notice takes effect July 1, 2022 and will remain in effect until we replace it. We reserve our legal right to amend or modify our privacy policies and practices. Changes in our policies and practices may even be required by changes in federal and state laws and regulations. Any changes to our privacy practices will apply to all personal information and personal health information we hold on all clients. In the case of a privacy and security breach, Levity will promptly inform all affected clients. 

Should clients wish to submit a comment or compliant about Levity privacy practices or request further information regarding these practices, they can do so by sending a letter to the general information outlined below. If clients believe their privacy rights have been violated, they should contact us immediately. Clients will not be penalized or otherwise retaliated against for filing a complaint.

IV.  Levity Contact Information
Email: info@levity.one
Phone: +1 (415) 638-9508
Mailing address: 530-B Harkle Road STE 100, Santa Fe, New Mexico, 87505