Effective Date: November 7, 2025

This notice explains how Body Alchemy La Verne may use and share your health information, and outlines your rights and our responsibilities in protecting it. Please read it carefully.

Your Health Information

When you receive services from Body Alchemy, we create records that contain your personal and health information. This information may include details about your treatments, medications, test results, or communications with our healthcare providers.

We are required by law to maintain the privacy and security of your Protected Health Information (PHI) and to follow the practices described in this notice.

Your Rights

You have several rights when it comes to your health information. These include:

• Get a Copy of Your Records: You can request an electronic or paper copy of your medical records and other health information. We’ll provide it within 30 days and may charge a reasonable fee.
• Request a Correction: You can ask us to amend information you believe is incorrect or incomplete.
• Request Confidential Communications: You can ask us to contact you in a specific way (for example, at a particular phone number or address).
• Limit What We Use or Share: You can ask us not to use or share certain information for treatment, payment, or operations. If you pay for a service entirely out-of-pocket, you can ask us not to share that information with your health insurer.
• Get a List of Disclosures: You can request a list of certain disclosures of your health information made in the past six years.
• Get a Copy of This Notice: You can request a paper or electronic copy of this privacy notice at any time.
• Choose Someone to Act for You: If you have granted someone medical power of attorney or have a legal guardian, that person can exercise your rights on your behalf.
• File a Complaint: If you believe your privacy rights have been violated, you can file a complaint with us or with the U.S. Department of Health and Human Services (HHS). We will never retaliate against you for filing a complaint.

Your Choices

In certain cases, you have choices about how we use and share your information. You can tell us whether or not to:

• Share information with family or friends involved in your care
• Share information in a disaster relief situation
• Include your information in directories

We will never share your information without written authorization for:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

We may contact you for fundraising efforts but you can ask not to be contacted again.

Our Typical Uses and Disclosures

We typically use or share your information in these ways:

• Treatment: To provide and coordinate your care.

Example: A provider sharing test results with another clinician.

• Payment: To bill and obtain payment from insurance or other payers.
• Operations: To manage our business, evaluate performance, and improve care quality.

Other Ways We May Use or Share Your Information

We may share your health information when permitted or required by law, including:

• Public Health and Safety: To prevent or control disease, report adverse reactions, or reduce serious threats to health or safety.
• Research: For approved medical research under HIPAA guidelines.
• Compliance with Law: When required by federal, state, or local law.
• Organ and Tissue Donation: To support donation and transplantation processes.
• Medical Examiner or Funeral Director: For identification or cause-of-death determination.
• Workers’ Compensation, Law Enforcement, and Government Requests: As necessary for claims, investigations, or authorized oversight activities.
• Legal Proceedings: In response to a court order, subpoena, or other lawful request.

Our Responsibilities

We are required by law to:

• Maintain the privacy and security of your PHI.
• Notify you promptly if a breach occurs that may compromise your information.
• Follow the practices outlined in this notice.
• Only use or disclose your PHI as described here or with your written permission.
• Allow you to revoke your authorization at any time, in writing.

Changes to This Policy

We may update this Privacy Policy periodically. Any changes will apply to all PHI we maintain and will be posted on our website with an updated effective date.

Questions or Complaints

If you have questions about this notice or believe your privacy rights have been violated, please contact:

Body Alchemy La Verne

1035 Bonita Ave, La Verne, CA 91750, United States

bodyalchemylaverne@gmail.com 626-771-7620

You may also contact the U.S. Department of Health and Human Services, Office for Civil Rights:

200 Independence Avenue, S.W. Washington, D.C. 20201

📞 1-877-696-6775

🌐 https://www.hhs.gov/ocr/privacy/hipaa/complaints/

LegitScript Compliance Confirmation

This Privacy Policy has been created in accordance with LegitScript Certification Standard #6 and the HIPAA Notice of Privacy Practices template provided by the U.S. Department of Health and Human Services (HHS). It includes:

• How Body Alchemy handles Protected Health Information (PHI)
• Patients’ rights regarding their PHI
• HIPAA-required details on uses, disclosures, responsibilities, complaint procedures, and updates