HIPAA Notice – Vita Nova Ketamine & Wellness Clinic

HIPAA Notice of Privacy Practices

Effective Date: January 1, 2026

NOTICE OF PRIVACY PRACTICES

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 Regarding Your Health Information

This notice describes how medical information about you may be used and disclosed and how you can get access to this information at Vita Nova Ketamine & Wellness Clinic. Please review it carefully.

Treatment: Sharing your health information with our providers, nurses, or referral specialists to coordinate care like ketamine or IV vitamin therapy.
Payment: Submitting your information to insurance companies to process claims.
Healthcare Operations: Using data to improve our services, conduct staff training, or comply with audits.

Some disclosures—such as for marketing purposes or sharing psychotherapy notes—require your written authorization, which you may revoke at any time.

Other Disclosures Permitted by Law

We may also use or disclose your information without your consent in the following situations:

We only do so when required or allowed by federal/state law.

Your Rights as a Patient

You have the right to:

Request limits on how we use/disclose your information
Receive confidential communications (e.g., by phone, email, or mail)
Access your medical records
Request corrections to your records
Receive a list of disclosures
Choose someone to act for you
Opt out of certain communication or fundraising messages

Our Duties

As your care provider, we are legally required to:

Breach Notification

If there is ever a breach of unsecured PHI, we are required by law to notify you within 60 days of discovering the breach.

Our Legal Duty

We are required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to your health information. We are required to abide by the terms of this Notice of Privacy Practices.

How We May Use and Disclose Your Health Information

Treatment

We may use your health information to provide you with medical treatment or services. We may disclose your health information to doctors, nurses, technicians, or other personnel who are involved in taking care of you at our clinic.

Payment

We may use and disclose your health information to obtain payment for the treatment and services you receive from us. This may include contacting your insurance company to verify coverage or to obtain prior authorization for treatment.

Healthcare Operations

We may use and disclose your health information for healthcare operations. These activities include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, and conducting training programs.

Your Individual Rights

Right to Request Restrictions

You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or healthcare operations. We are not required to agree to your request.

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. For example, you can ask that we only contact you at work or by mail.

Right to Inspect and Copy

You have the right to inspect and copy your health information. Usually, this includes medical and billing records, but does not include psychotherapy notes.

Right to Amendv

If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our clinic.

Right to an Accounting of Disclosures

You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you.

Filing a Complaint or Contacting Us

If you believe your privacy rights have been violated, you can:

We will never retaliate against you for filing a complaint.

Changes to This Notice

We reserve the right to change this notice. 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.

Contact Information

If you have any questions about this Notice of Privacy Practices, please contact us:

Vita Nova Ketamine & Wellness Clinic

Privacy Officer

513 Bayview Blvd, Baltimore, MD 21224

Phone: (443) 563-1059

Email: info@vitanovawellnessclinic.com

Important: You may also 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.

Effective Date: December 20, 2024