HIPAA NOTICE OF PRIVACY PRACTICES
Last Updated: March 4, 2025
THIS HIPAA NOTICE OF PRIVACY PRACTICES (“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.
Introduction
When this Notice refers to “we” or “us,” it is referring to WellCentra LLC, its affiliates and contractors,
including its payment processor, certain affiliated professional entities and their physicians, health care
practitioners and other personnel, and the pharmacy from which your prescription may be filled and
distributed. We are required by law to maintain the privacy of your protected health information (“PHI”), to
follow the terms of this Notice that are currently in effect, to give you this Notice setting forth our legal
duties and privacy practices concerning your PHI and to notify affected individuals following a breach of
unsecured PHI. This Notice describes how we may use and disclose your PHI. Additionally, this Notice
explains the rights you have with respect to your PHI, and certain obligations we must abide by in
accordance with the law. We reserve the right to amend this Notice. If we make any material revisions to
this Notice, we will post a copy of the revised Notice in the pharmacy, on our website and will offer you a
copy of the revised Notice.
Use and Disclosure of Your PHI
We will use and disclose your PHI for the purposes of delivering the requested treatment and prescription
services and processing payment for such services. We may also use your PHI for other purposes that
are permitted and/or required by law and pursuant to your written authorization. The following list includes
examples of how we may use and/or disclose your PHI. Any other uses not described in this Notice will
only be made with your explicit written authorization, which you may revoke at any time by providing us
with written notice of your revocation by emailing us at info@wellcentra.com.
● Treatment – We will use and disclose your PHI in order to provide you with the requested
telehealth services and any resulting prescription orders. We may disclose your PHI to other
pharmacists, pharmacy technicians and health care providers that are involved in your care. You
will receive an individual notice and have the opportunity to opt out of any treatment
communications.
● Billing Purposes – We will use and disclose your PHI in order to obtain payment for the health
care, treatment and prescription services we coordinate on your behalf.
● Health Care Operations – We will use and disclose your PHI in connection with the
management of our services and those of our telehealth and prescription service providers. For
example, this may include: answering questions, providing requested information, coordinating
treatment and consultation of health care providers, assessing and improving quality of treatment
and services, conducting internal compliance audits, and evaluating performance. Additionally,
we may use your PHI for our business management and general administrative activities.
● Prescription Refill Reminders, Treatment Alternatives or Health-Related Benefits – We may
use and disclose your PHI to contact you to remind you about prescription refills, to tell you about
treatment options or alternatives, or to inform you about health-related benefits or services that
may be of interest to you.
● Family Members, Caregivers or Close Friends – Unless you object to such disclosure, we may
disclose your PHI to your family members, relatives or close personal friends, or any other
persons identified by you as being involved in the treatment or payment for your medical care. If
you are not present to agree or object to our disclosure of your PHI to a family member, relative
or friend, we may exercise our professional judgment to determine whether the disclosure is in
your best interest. If we decide to disclose your PHI, we will only disclose the PHI that is relevant
to your treatment or billing.
● Other Permitted and Required Uses and Disclosures – We may use your PHI without
obtaining your authorization and without offering you the opportunity to agree or object as follows:
○ as required by law, provided however, that the use or disclosure will be made in
compliance with applicable law;
○ to a public health authority that is authorized by law to collect or receive such information,
or to a foreign government agency that is acting in collaboration with a public health
authority and these health activities generally include preventing or controlling disease,
reporting deaths, reporting adverse effects of prescription medications or problems with
other products, notification of communicable disease and reporting abuse or neglect
under certain circumstances;
○ to a health oversight agency for oversight activities authorized by law, including audits
and inspections, and civil, administrative or criminal investigations, proceedings or
actions;
○ to prevent or lessen a serious and imminent threat to a person’s or the public’s health or
safety;
○ to law enforcement to report certain injuries, comply with court orders or warrants or
similar process, to identify a suspect, fugitive, missing person or victim or to report a
crime;
○ 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;
○ to a coroner, medical examiner or funeral director as authorized by law;
○ to organ procurement organizations or similar entities for the purpose of facilitating organ,
eye or tissue donation and transplantation;
○ for research purposes provided that certain approvals take place and assurances are
given;
○ to units of the government with special functions, such as the U.S. military or the U.S.
Department of State under certain circumstances.
○ to the extent necessary to comply with laws relating to workers’ compensation and work-
related injuries; and
○ when required to do so by any other law not already referred to in the preceding
categories.
Your Rights as Our Patient
As our patient, you have a number of rights associated with your PHI. The following describes your
specific rights.
● You have the right to request restrictions or limitations on how we use and/or disclose your PHI.
Your written request must specify: (1) if you would like to restrict or limit our use and/or
disclosure; (2) what information you want restricted or limited; and (3) to whom the restriction or
limitation applies (e.g., spouse). If we agree to your request, it will not prevent us from disclosing
your PHI as follows: (1) to you if you request access or an accounting of disclosures; (2) for
purposes required or permitted by law; or (3) in case of an emergency. In addition, you recognize
that if you request to restrict or limit our use and/or disclosure of your PHI, it may prevent our
ability to provide and coordinate services on your behalf.
● You have the right to receive confidential communications concerning your PHI by alternative
means or via alternative locations. For example, you may want to receive communications related
to your prescriptions at a different address other than your home address. If you wish to receive
confidential communications via alternative means or locations, please submit your request in
writing to hello@wellcentra.com and set forth the alternative means by which you wish to receive
communications or the alternative location at which you wish to receive such communications.
We will accommodate all reasonable requests within a commercially reasonable timeframe from
acknowledgement of the request.
● You have the right to access, inspect and obtain a copy of your PHI, including any electronic PHI;
provided, however, you are not entitled to access certain PHI exempted under HIPAA. To the
extent we maintain electronic PHI, upon request we will provide you with a copy of your PHI in the
format requested. If we do not have your PHI in our possession, we will provide you with the
appropriate contact information when your request is received. If you request a copy of your PHI,
you will receive a response to your request in a timely fashion but may be charged a reasonable,
cost-based fee to cover copy costs and postage. In some limited circumstances, we may deny
your request for access to PHI in which case you may request for the denial to be reviewed. If
access is ultimately denied, you are entitled to a written explanation with the reason(s) for the
denial.
● You have the right to request in writing to receive an accounting of disclosures of your PHI made
by us, including disclosures to or by our business associate(s), for a period of six (6) years prior
to the date on which you request an accounting of disclosures, or such lesser period as you
indicate. You will receive one request annually free of charge and, thereafter, we may charge you
a reasonable, cost-based fee for each subsequent request for an accounting of disclosures within
the same twelve-month period. We will notify you of the cost for an accounting of disclosures and
you may choose to withdraw or modify your request before we charge you.
● If you believe we have PHI about you that is incorrect or incomplete, you may make a written
request to us stating the reasons to support any requested amendment. You have the right to
request an amendment to your PHI for so long as we maintain your PHI. If we do not have your
PHI in our possession, we will provide you with the appropriate contact information when we
receive your request. We will respond to your request for an amendment within a commercially
reasonable time after we receive your written request. However, we may deny your request for
amendment if, for example, we determine that the PHI you requested was not created by us or is
already accurate and complete. You may respond to our denial by filing a written statement of
disagreement, but we have the right to rebut your disagreement. If this occurs, you have the right
to request that your original request, our denial, your statement of disagreement and our rebuttal
be included in future disclosures of your PHI.
● You have the right at any time to obtain a paper copy of this Notice, even if you receive this
Notice electronically. If you have received an electronic copy of this Notice but wish to obtain a
paper copy of this Notice, please send your request in writing to the Privacy Officer at the email
address listed below.
● You have the right to opt-out of fundraising and your PHI will not be used for fundraising purposes
or sold without your prior authorization.
Additional Information/Questions or Complaints
If you need any additional information about this Notice or wish to exercise any of your rights set forth in
this Notice, please contact us at the following address:
WellCentra LLC
info@wellcentra.com
If you believe your privacy rights have been violated, you may file a complaint without retaliation with us
or any relevant state or federal agency.