HIPAA Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.


The members of Common Table Nutrition (including Rochelle Adriano Nutrition, Geanna Revell Nutrition, Maria Taylor Nutrition, and Jamie Clayton Nutrition) are committed to protecting the privacy of your personal health information (PHI). We create a record of the care and services you receive, which is stored in an electronic health record (EHR). While this record is the property of the practice, the information contained within it belongs to you. We are required by law to maintain the privacy of your PHI, provide you with this notice of our legal duties and privacy practices, and notify you following a breach of unsecured PHI.


How We May Use and Disclose Your Health Information

The law permits us to use or disclose your PHI for the following purposes without your written authorization:

  • Treatment: We use your PHI to provide nutrition care and related services. We may disclose medical information to other healthcare providers involved in your care.

  • Payment: We use and disclose PHI to obtain payment for services provided, such as submitting information to your health insurance plan.

  • Health Care Operations: We may use PHI to operate this practice, including quality improvement, care coordination, legal services, and business management.

  • Business Associates: We share PHI with third-party "business associates" (e.g., billing services, EHR platforms) who are contractually obligated to safeguard your information.

  • Appointment Reminders: We may use PHI to contact you regarding appointments via your preferred communication methods (email, text, or portal).

  • Individuals Involved in Your Care: We may disclose relevant PHI to family members or others involved in your care or payment with your consent unless it is an emergency.

  • Public Health and Safety: As required by law, we may disclose PHI to public health authorities for disease prevention, reporting abuse/neglect, or averting serious threats to health or safety.

  • Legal Proceedings and Law Enforcement: We may disclose PHI in response to court orders, subpoenas, or as otherwise required by law for law enforcement purposes.

Uses and Disclosures Requiring Your Authorization

We will not use or disclose your PHI for marketing purposes, sell your information, or disclose substance use disorder records without your specific written authorization. You may revoke such authorization at any time in writing.


Your Rights Regarding Your Health Information

You have the following rights regarding the PHI we maintain:

  • Right to Inspect and Copy: You may request to inspect or obtain electronic or paper copies of your medical records.-

  • Right to Amend: If you believe your information is incorrect or incomplete, you may request a written amendment.-

  • Right to an Accounting of Disclosures: You may request a list of certain disclosures we have made of your PHI.-

  • Right to Request Restrictions: You may request limits on how we use or disclose your PHI, including restricting disclosures to health insurance for self-paid services.-

  • Right to Confidential Communications: You may request that we communicate with you in a specific manner.

  • Right to a Paper Copy: You may request a paper copy of this notice at any time.

Changes to This Notice

We reserve the right to change this notice. The revised notice will apply to all PHI we maintain. The current version will be available on our website.


Complaints

If you have any questions about your rights, please contact Common Table Nutrition at admin@commontablenutrition.com or 206-659-922. If you believe your privacy rights have been violated, you may file a complaint with this practice or the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint.


Effective Date: May 12, 2026