NOTICE OF PRIVACY PRACTICES
Kopec Wellness, LLC staff are committed to maintaining client confidentiality while complying with all
stated and federal regulations in regards to protected health information. This policy was put in place as
a result of the Health Insurance Portability and Accountability Act of 1996(HIPPA) federal laws that went
into effect April 2003. The new laws were designed to protect and enhance rights of consumers by
providing access to private health information and controlling the inappropriate use of that information.
STATEMENT OS USES AND DISCLOSURES
Protected Health Information (PHI) is covered by state and federal laws. Therefore, the release of this
information is carried out under strict guidelines. The disclosure of health information requires an
authorization signed by the individual or legal guardian. The authorization is revocable in writing 90 days
from the date signed. We may use or disclose identifiable health information without your authorization
for the following purposes: public health reporting, auditing purposes, research studies, workers’
compensation, and emergency care.
STATEMENT OF INDIVIDUAL RIGHTS
Under HIPPA regulations individuals and their dependents have virtually unlimited access to their own
health care information. Individuals’ rights include:
a. Consent to the use and disclosure of protected health information to carry out payment, or health
related services.
b. Receive notice of privacy practices as part of the required consent form or process.
c. Access protected health information.
d. Receive an accounting of how their protected health information has been disclosed outside normal
care channels.
e. Agree or object to certain disclosures.
f. Request amendment or correction to protected health information.
g. Request restrictions on use of protected health information for payment, or health related services.
We maintain the privacy of confidential information. We abide by this Notice. We reserve the right to
change the terms of this Notice and to provide our clients with the revised copy immediately.
