Consent
Houston Slim Club Consent
You have asked Houston Slim Club to arrange for a licensed physician (“Physician”) to review the health information you provided to Houston Slim Club through its online platform (the “Providers” or Platform) to determine what, if any, Houston Slim Club healthy lifestyle products are medically appropriate for you. The purpose of this consent form (“Consent”) is to provide you with information about telehealth and to obtain your informed consent for Houston Slim Club and its associated providers to provide you with care.
In this Consent, the words “you” and “yours” means the person using the Houston Slim Club website or the Providers, or in the case of a minor between the ages of 13 and 18 years-old (or a higher age of majority under applicable state law) means both the parent or guardian who provides consent to use the platform by minor and the minor for whom consent is being provided.
Please carefully read all of the information below. By clicking “I Agree” below, by carrying through with the Providers, or by signifying your acceptance of any other component of the form means you understand and agree to all of the following:
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Telehealth means the use of electronic communication systems and information technology to provide care when the patient and the health care provider are not in the same physical location. Telehealth may be used for diagnosis, treatment, prescribing, patient education, and follow-up care, and can be done through phone, electronic transmission of medical records and health information, or by electronic communication between the patient and the provider by audio, visual, audiovisual, or other data transmission, including messaging or email.
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The use of telehealth may have some or all of the following benefits for you: increase your access to care; increase the efficiency of medical care, allow you to access health care at times and places that are convenient for you.
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The use of telehealth may also present some or all of the following risks to you: the inability of your health care provider to perform an in-person exam may limit the quality, accuracy or effectiveness of the care you receive, and may limit or negatively impact your health care provider’s ability to diagnose your condition and provide you with the care that you need; you may be required to seek alternative sources of medical care; the technology used for telehealth, including the online visit or form, may have errors or bugs that negatively impact the quality and timeliness of care provided, the accurate or timely transmission of health care information, the accuracy or completeness of information used to provide health care, render the technology, including the care inoperable or unavailable, or cause the loss of health information and/or personal data.
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The use of telehealth also involves the risk of possible failures of technology, equipment, electronic systems or security systems and protocols that could result in a loss of your health information or a breach of privacy and unintended disclosure to unauthorized individuals or entities, which may also negatively impact the care you receive by telehealth.
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The health care you receive through use of the Platform will be provided to you using telehealth. By starting or continuing to use the Platform or by requesting or receiving a Physician Review, you consent to the use of telehealth to provide you with care.
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You understand that at any time a Physician using their independent medical judgement may determine that it is not medically appropriate to provide health care to you using telehealth or the Platform. You agree to discontinue using the Platform immediately if the Physician makes such a determination.
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You may withdraw your consent to use telehealth for the provision of health care at any time by providing Houston Slim Club with written notice. Your withdrawal of consent is immediately effective upon Houston Slim Club receipt of your written notice but will not impact health care provided using telehealth prior to Houston Slim Club receipt of your notice of withdrawal of consent. Your withdrawal of consent shall not impact any other terms of this Consent, and you must continue to follow the Consent. You understand that withdrawal of consent for telehealth means that Houston Slim Club and the Physicians will no longer be able to provide you with care using the Platform or otherwise, as neither the Physician nor Houston Slim Club provides in-person care.
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The Platform is not designed to provide you with emergency medical or mental health guidance.
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IF YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD DIAL 911.
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IF YOU ARE HAVING A MENTAL HEALTH EMERGENCY OR ARE THINKING ABOUT SUICIDE, YOU SHOULD DIAL THE SUICIDE AND CRISIS LIFELINE AT 988.
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Houston Slim Club and its Physicians use software and network security systems and protocols to safeguard the security and privacy of your health information. Houston Slim Club and its Physicians will not release your protected health information to third parties without your consent, except as permitted or required by law. You may receive phone, email, or other electronic communication from Houston Slim Club or a Physician that may contain your protected health information. You acknowledge that Houston Slim Club and the Physicians cannot and do not guarantee the security and privacy of the technology or Platform or equipment you use to receive such communications.
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Neither Houston Slim Club nor the Physician makes any guarantee that you will receive a prescription for a Houston Slim Club product as a result of using the Platform or receiving a Physician Review.
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Neither Houston Slim Club nor the Physician guarantees any specific result if you use the Platform or a Houston Slim Club product.
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You agree to provide accurate and complete information about yourself and your health when using the Platform or communicating with a Physician. There are risks to your health and well-being if you give incorrect or incomplete information. You certify that all of the information you provide to Houston Slim Club and the Physician is true, accurate, and complete.
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You understand that the information you provide to the Physician when using the Platform or communicating with the Physician might be the only information used by the Physician to provide you with health care. The Physician will not have access to your health information held by other medical professionals.
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The fees you have paid or will pay to Houston Slim Club cover the cost of using the Platform, receiving a Physician Review, and any Houston Slim Club products prescribed by the Physician. Houston Slim Club and the Physician will not bill your medical insurance company or any other third-party payor for your use of the Platform, the Physician Review, or the Houston Slim Club products.
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You are responsible for arranging and paying for any follow-up care you receive after the Physician Review or while or after using the Platform.
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If the Physician prescribes a product for you, the Physician will send the prescription to a Houston Slim Club affiliated pharmacies for dispensing. Houston Slim Club and the pharmacy will work together to deliver the prescribed products to you at the address you have provided to Houston Slim Club. Please be sure you have provided Houston Slim Club with an address where you may safely and securely receive delivery of the Houston Slim Club products. You have the right to choose the pharmacy of your choice but Houston Slim Club cannot guarantee if the product is available.
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By clicking “I Agree” or utilizing the platform, you are consenting to the Physician’s and Houston Slim Club sharing of your protected health information with certain third parties, including the pharmacy, as more fully described in Houston Slim Club Notice of Privacy Practices, available on the Houston Slim Club website.
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Copies of your medical record associated with your use of the Platform are available in accordance with applicable law by request to Houston Slim Club at info@houstonslimclub.com.
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If you have a concern or complaint about the Physician, please contact the medical licensing board in your state.
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If you have a concern or complaint about the pharmacy that fills your prescription for a Houston Slim Club product, please contact the pharmacy licensing board in your state
Refund Policy
All products we offer are non-refundable.
Our medications are ordered specifically per patient and therefore cannot be refunded. We have a ‘no refund policy’.
Once a prescription is started, you may use it until the expiration date specified in your chart AND on your vial.
Cancellations: Any orders not approved by the physician are instantly refunded.
Need help?
Contact us at info@houstonslimclub.com
Privacy Policy
What information do we collect?
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We collect information from you when you register on the site, place an order, enter a contest or sweepstakes, respond to a survey or communication such as e-mail, or participate in another site feature.
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When ordering or registering, we may ask you for your name, e-mail address, mailing address, phone number, credit card information or other information. You may, however, visit our site anonymously.
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We also collect information about gift recipients so that we can fulfill the gift purchase. The information we collect about gift recipients is not used for marketing purposes.
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Like many Web sites, we use cookies to enhance your experience and gather information about visitors and visits to our Web sites. Please refer to the “Do we use cookies?” section below for information about cookies and how we use them.
How do we use your information?
We may use the information we collect from you when you register, purchase products, enter a contest or promotion, respond to a survey or marketing communication, surf the Web site, or use certain other site features in the following ways:
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To personalize your site experience and to allow us to deliver the type of content and product offerings in which you are most interested.
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To allow us to better service you in responding to your customer service requests.
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To quickly process your transactions.
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To administer a contest, promotion, survey or other site feature.
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If you have opted-in to receive our e-newsletter, we may send you periodic e-mails. If you would no longer like to receive promotional e-mail from us, please refer to the “How can you opt-out, remove or modify information you have provided to us?” section below. If you have not opted-in to receive e-newsletters, you will not receive these e-mails. Visitors who register or participate in other site features such as marketing programs and ‘members-only’ content will be given a choice whether they would like to be on our e-mail list and receive e-mail communications from us.
How do we protect visitor information?
We implement a variety of security measures to maintain the safety of your personal information. Your personal information is contained behind secured networks and is only accessible by a limited number of persons who have special access rights to such systems, and are required to keep the information confidential. When you place orders or access your personal information, we offer the use of a secure server. All sensitive/credit information you supply is transmitted via Secure Socket Layer (SSL) technology and then encrypted into our databases to be only accessed as stated above. For Protected Health Information (PHI), we use a certified Electronic Health Record (EHR) technology. This information is stored in our certified EHR for the time period required by law for the storage of medical records.
HIPAA, Protected Health Information (PHI) and Medical Records
Our Medical Providers privacy practices are available here. Medical Provider Privacy Practices
Patients can request medical records by emailing info@houstonslimclub.com.
Complaints?
If you believe that your privacy rights as described in this notice have been violated, you may file a complaint at info@houstonslimclub.com
Do we use cookies?
Yes. Cookies are small files that a site or its service provider transfers to your computer’s hard drive through your Web browser (if you allow) that enables the site’s or service provider’s systems to recognize your browser and capture and remember certain information. For instance, we use cookies to help us remember and process the items in your shopping cart. They are also used to help us understand your preferences based on previous or current site activity, which enables us to provide you with improved services. We also use cookies to help us compile aggregate data about site traffic and site interaction so that we can offer better site experiences and tools in the future. We may contract with third-party service providers to assist us in better understanding our site visitors. These service providers are not permitted to use the information collected on our behalf except to help us conduct and improve our business. You can choose to have your computer warn you each time a cookie is being sent, or you can choose to turn off all cookies. You do this through your browser (like Netscape Navigator or Internet Explorer) settings. Each browser is a little different, so look at your browser Help menu to learn the correct way to modify your cookies. If you turn cookies off, you won’t have access to many features that make your site experience more efficient and some of our services will not function properly. However, you can still place orders over the telephone by contacting customer service.
Do we disclose the information we collect to outside parties?
We do not sell, trade, or otherwise transfer to outside parties your personally identifiable information unless we provide you with advance notice, except as described below. The term “outside parties” does not include Houston Slim Club or any parent, sibling or subsidiary entities. It also does not include Web site hosting partners and other parties who assist us in operating our Web site, conducting our business, or servicing you, so long as those parties agree to keep this information confidential. We may also release your information when we believe release is appropriate to comply with the law, enforce our site policies, or protect ours or others’ rights, property, or safety. However, non-personally identifiable visitor information may be provided to other parties for marketing, advertising, or other uses.
Changes to our policy
If we decide to change our privacy policy, we will post those changes on this page. Policy changes will apply only to information collected after the date of the change.
Questions and feedback
We welcome your questions, comments, and concerns about privacy. Please send us any and all feedback pertaining to privacy, or any other issue.
Online Policy Only
This online privacy policy applies only to information collected through our Web site and not to information collected offline.
Your consent
By using our site, you consent to our privacy policy.
Shipping and Delivery
Our Compound Pharmacy has up to 5 business days processing time.
Consultations: If any additional clarification is needed, the physician might reach out to gather more information. If the physician cannot reach you at the number provided, this may take longer. If physician has no questions, there is no need for a call and medication gets shipped out.
Packaging: All orders are packaged and shipped within 48 hours of an approved physician order.
Shipping: Shipping times are chosen at checkout by the patient, orders are given the shipping option chosen at checkout. Shipping times start once the order is approved by the physician and packaged.
Cancellations: Any orders not approved by the physician are instantly refunded
Terms and Conditions
PLEASE READ THE FOLLOWING TERMS AND CONDITIONS OF USE CAREFULLY BEFORE USING THIS WEB SITE. All users of this site agree that access to and use of this site are subject to the following terms and conditions and other applicable law. If you do not agree to these terms and conditions, please do not use this site.
Copyright
The entire content included in this site, including but not limited to text, graphics or code is copyrighted as a collective work under the United States and other copyright laws, and is the property of Houston Slim Club®. The collective work includes works that are licensed to Houston Slim Club®. Copyright 2024, Houston Slim Club® ALL RIGHTS RESERVED. Permission is granted to electronically copy and print hard copy portions of this site for the sole purpose of placing an order with Houston Slim Club® or purchasing Houston Slim Club® products. You may display and, subject to any expressly stated restrictions or limitations relating to specific material, download or print portions of the material from the different areas of the site solely for your own non-commercial use, or to place an order with Houston Slim Club® or to purchase Houston Slim Club® products. Any other use, including but not limited to the reproduction, distribution, display or transmission of the content of this site is strictly prohibited, unless authorized by Houston Slim Club®. You further agree not to change or delete any proprietary notices from materials downloaded from the site.
Trademarks
All trademarks, service marks and trade names of Houston Slim Club® used in the site are trademarks or registered trademarks of Houston Slim Club®.
Warranty Disclaimer
This site and the materials and products on this site are provided “as is” and without warranties of any kind, whether express or implied. To the fullest extent permissible pursuant to applicable law, Houston Slim Club® disclaims all warranties, express or implied, including, but not limited to, implied warranties of merchantability and fitness for a particular purpose and non-infringement. Houston Slim Club® does not represent or warrant that the functions contained in the site will be uninterrupted or error-free, that the defects will be corrected, or that this site or the server that makes the site available are free of viruses or other harmful components. Houston Slim Club® does not make any warranties or representations regarding the use of the materials in this site in terms of their correctness, accuracy, adequacy, usefulness, timeliness, reliability or otherwise. Some states do not permit limitations or exclusions on warranties, so the above limitations may not apply to you.
Limitation of Liability
Houston Slim Club® shall not be liable for any special or consequential damages that result from the use of, or the inability to use, the materials on this site, even if Houston Slim Club® has been advised of the possibility of such damages. Applicable law may not allow the limitation of exclusion of liability or incidental or consequential damages, so the above limitation or exclusion may not apply to you.
Typographical Errors
In the event that a Houston Slim Club® product is mistakenly listed at an incorrect price, Houston Slim Club® reserves the right to refuse or cancel any orders placed for product listed at the incorrect price. Houston Slim Club® reserves the right to refuse or cancel any such orders whether or not the order has been confirmed and your credit card charged. If your credit card has already been charged for the purchase and your order is cancelled, Houston Slim Club® shall issue a credit to your credit card account in the amount of the incorrect price.
Term; Termination
These terms and conditions are applicable to you upon your accessing the site and/or completing the registration or shopping process. These terms and conditions, or any part of them, may be terminated by Houston Slim Club® without notice at any time, for any reason. The provisions relating to Copyrights, Trademark, Disclaimer, Limitation of Liability, Indemnification and Miscellaneous, shall survive any termination.
Notice
Houston Slim Club® may deliver notice to you by means of e-mail, a general notice on the site, or by other reliable method to the address you have provided to Houston Slim Club®.
Miscellaneous
Your use of this site shall be governed in all respects by the laws of the state of Michigan, U.S.A., without regard to choice of law provisions. You agree that jurisdiction over and venue in any legal proceeding directly or indirectly arising out of or relating to this site (including but not limited to the purchase of Houston Slim Club® products) shall be in the state or federal courts located in Livonia, Michigan. Any cause of action or claim you may have with respect to the site (including but not limited to the purchase of Houston Slim Club® products) must be commenced within one (1) year after the claim or cause of action arises. Houston Slim Club®’s failure to insist upon or enforce strict performance of any provision of these terms and conditions shall not be construed as a waiver of any provision or right. Neither the course of conduct between the parties nor trade practice shall act to modify any of these terms and conditions. Houston Slim Club® may assign its rights and duties under this Agreement to any party at any time without notice to you.
Use of Site
Harassment in any manner or form on the site, including via e-mail, chat, or by use of obscene or abusive language, is strictly forbidden. Impersonation of others, including a Houston Slim Club® or other licensed employee, host, or representative, as well as other members or visitors on the site is prohibited. You may not upload to, distribute, or otherwise publish through the site any content which is libelous, defamatory, obscene, threatening, invasive of privacy or publicity rights, abusive, illegal, or otherwise objectionable which may constitute or encourage a criminal offense, violate the rights of any party or which may otherwise give rise to liability or violate any law. You may not upload commercial content on the site or use the site to solicit others to join or become members of any other commercial online service or other organization.
Participation Disclaimer
Houston Slim Club® does not and cannot review all communications and materials posted to or created by users accessing the site, and is not in any manner responsible for the content of these communications and materials. You acknowledge that by providing you with the ability to view and distribute user-generated content on the site, Houston Slim Club® is merely acting as a passive conduit for such distribution and is not undertaking any obligation or liability relating to any contents or activities on the site. However, Houston Slim Club® reserves the right to block or remove communications or materials that it determines to be (a) abusive, defamatory, or obscene, (b) fraudulent, deceptive, or misleading, (c) in violation of a copyright, trademark or; other intellectual property right of another or (d) offensive or otherwise unacceptable to Houston Slim Club® in its sole discretion.
Indemnification
You agree to indemnify, defend, and hold harmless Houston Slim Club®, its officers, directors, employees, agents, licensors and suppliers (collectively the “Service Providers”) from and against all losses, expenses, damages and costs, including reasonable attorneys’ fees, resulting from any violation of these terms and conditions or any activity related to your account (including negligent or wrongful conduct) by you or any other person accessing the site using your Internet account.
Third-Party Links
In an attempt to provide increased value to our visitors, Houston Slim Club® may link to sites operated by third parties. However, even if the third party is affiliated with Houston Slim Club®, Houston Slim Club® has no control over these linked sites, all of which have separate privacy and data collection practices, independent of Houston Slim Club®. These linked sites are only for your convenience and therefore you access them at your own risk. Nonetheless, Houston Slim Club® seeks to protect the integrity of its Web site and the links placed upon it and therefore requests any feedback on not only its own site, but for sites it links to as well (including if a specific link does not work).
Medical Provider 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 carefully.
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OUR OBLIGATIONS
We maintain the privacy of your medical information and notify affected individuals following a breach of unsecured medical information, in each case to the extent required by state and federal law. We provide you this Notice explaining our legal duties and privacy practices with respect to medical information about you.
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HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe the different ways that we typically use and disclose medical information, the purposes for such uses and disclosures, and the reasons for such uses and disclosures. As noted below, we may contact you via different methods that you may approve, such as via text message, email, thru secure video or phone call. In most instances, your initial communication with the applicable medical provider will be through video or phone call.
Specifically speaking, the applicable medical provider may communicate with you in the following specific ways and for the following specific purposes:
Type & Purpose
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Video or Phone communications: To obtain information from you necessary to provide services to you, communicate with you about your diagnosis and treatment.
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Email communications: To obtain information from you necessary to provide services to you, communicate with you about your diagnosis and treatment and provide you with information on special offers and deals
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Texts: To obtain information from you necessary to provide services to you and communicate with you about your diagnosis and treatment
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Customer Service Emails, texts, or app notifications; To provide you with updates on problems with orders, late shipments, and other questions applicable to your provider visit(s)
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Tracking emails; To notify you when prescriptions have been shipped, will arrive, and other confirmations
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Order information; To provide information on content of orders (additional products or samples)
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Referral programs: To provide you with information on benefits you may receive if you refer another patient.
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For Treatment. We may use and disclose medical information about you to provide you with health care treatment and related services, including coordinating and managing your health care. We may disclose medical information about you to physicians, nurses, other health care providers and personnel who are providing or involved in providing health care to you (both within and outside of the applicable medical provider(s)). For example, should your care require referral to a pharmacy for the provision of prescription drugs, we may provide that pharmacy with your medical information in order to aid the pharmacist in his or her treatment of you.
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For Payment. We may use and disclose medical information about you so that we or may bill and collect from you, an insurance company, or a third party for the health care services we provide. This may also include the disclosure of medical information to obtain prior authorization for treatment and procedures from your insurance plan. For example, we may send a claim for payment to your insurance company, and that claim may have a code on it that describes the services that have been rendered to you. If, however, you pay for an item or service in full, out of pocket and request that we not disclose to your health plan the medical information solely relating to that item or service, as described more fully in Section IV of this Notice, we will follow that restriction on disclosure unless otherwise required by law.
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For Health Care Operations. We may use and disclose medical information about you for our health care operations. These uses and disclosures are necessary to operate and manage our practice and to promote quality care. For example, we may need to use or disclose your medical information in order to assess the quality of care you receive or to conduct certain cost management, business management, administrative, or quality improvement activities or to provide information to our insurance carriers.
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Quality Assurance and Utilization Review. We may need to use or disclose your medical information for our internal processes to assess and facilitate the provision of quality care to our patients. We may need to use or disclose your medical information to perform a review of the services we provide in order to evaluate whether that the appropriate level of services is received, depending on condition and diagnosis.
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Credentialing and Peer Review. We may need to use or disclose your medical information in order for us to review the credentials, qualifications and actions of our health care providers.
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Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that we believe may be of interest to you.
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Appointment Reminders and Information about Health Related Benefits and Services. We may use and disclose medical information, in order to contact you (including, for example, contacting you by phone and leaving a message on an answering machine) to provide appointment reminders and other information. We may use and disclose medical information to tell you about health-related benefits or services that we believe may be of interest to you. See also the specific types of communications noted above.
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Vendors. There are some services (such as billing or legal services) that may be provided to or on behalf of the medical providers.
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Individuals Involved in Your Care or Payment for Your Care. We may disclose medical information about you to a friend or family member who is involved in your health care, as well as to someone who helps pay for your care, but we will do so only as allowed by state or federal law (with an opportunity for you to agree or object when required under the law), or in accordance with your prior authorization.
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As Required by Law. We will disclose medical information about you when required to do so by federal, state, or local law or regulations.
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Other. Subject to applicable legal requirements, and where appropriate for your medical care or required by law, we may also use your medical information (i) to avert an imminent threat of injury to health or safety, (ii) for organ donation purposes, for research, (iii) to appropriate military authorities if you are in the armed forces, (iv) for workers’ compensation programs, (v) for public health activities, (vi) for health oversight activities, (vii) for other legal matters, (viii) for law enforcement purposes, (ix) to coroners and medical examiners, or (x) for marketing or fundraising purposes
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Electronic Disclosures of Medical Information. Under the law of certain states, we are required to provide notice to you if your medical information is subject to electronic disclosure. This Notice serves as general notice that we may disclose your medical information electronically for treatment, payment, or health care operations or as otherwise authorized or required by state or federal law.
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OTHER USES OF MEDICAL INFORMATION
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Authorizations. There are times we may need or want to use or disclose your medical information for reasons other than those listed above, but to do so we will need your prior authorization. Other than expressly provided herein, any other uses or disclosures of your medical information will require your specific written authorization.
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Psychotherapy Notes, Marketing and Sale of Medical Information. Most uses and disclosures of “psychotherapy notes,” uses and disclosures of medical information for marketing purposes, and disclosures that constitute a “sale of medical information” under applicable state and federal law require your authorization. The Medical providers do not anticipate that they will or sell medical information or use or disclose any psychotherapy notes created by a Provider while providing you mental health therapy except by your Provider to provide you with ongoing mental health care.
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Right to Revoke Authorization. If you provide us with written authorization to use or disclose your medical information for such other purposes, you may revoke that authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your medical information for the reasons covered by your written authorization. You understand that we are unable to take back any uses or disclosures we have already made in reliance upon your authorization, and that we are required to retain our records of the care that we provided to you.
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YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
Certain laws and regulations provide you with certain rights regarding the medical information we have about you. The following is a summary of those rights.
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Right to Inspect and Copy. Under most circumstances, you have the right to inspect and/or copy your medical information that we maintain in our possession in a designated record set, which generally includes your medical and billing records. To inspect or copy your medical information, you must submit your request to do so in writing to the applicable medical provider at info@houstonslimclub.com. If you request a copy of your information, we may charge a fee for the costs of copying, mailing, or certain supplies associated with your request. The fee we may charge will be the amount allowed by state law. If your requested medical information is maintained in an electronic format (e.g., as part of an electronic medical record, electronic billing record, or other group of records maintained by the applicable medical provider that is used to make decisions about you) and you request an electronic copy of this information, then we will provide you with the requested medical information in the electronic form and format requested, if it is readily producible in that form and format. If it is not readily producible in the requested electronic form and format, we will provide access in a readable electronic form and format as agreed to by the applicable medical provider and you. In certain very limited circumstances allowed by law, we may deny your request to review or copy your medical information. We will give you any such denial in writing. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by our medical director will review your request and the denial. The person conducting the review will not be the person who denied your request. We will abide by the outcome of the review.
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Right to Amend. If you feel the medical 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 the applicable medical provider. To request an amendment, your request must be in writing and submitted to info@houstonslimclub.com. In your request, you must provide a reason as to why you want this amendment. If we accept your request, we will notify you of that in writing. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that (i) was not created by us (unless you provide a reasonable basis for asserting that the person or organization that created the information is no longer available to act on the requested amendment), (ii) is not part of the information kept by the applicable Medical provider, (iii) is not part of the information which you would be permitted to inspect and copy, or (iv) is accurate and complete. If we deny your request, we will notify you of that denial in writing.
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Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures” of your medical information. This is a list of the disclosures we have made for up to six years prior to the date of your request of your medical information, but may not include disclosures for Treatment, Payment, or Health Care Operations (as described in this Notice) or disclosures made pursuant to your specific authorization (as described in this Notice), or certain other disclosures. To request a list of accounting, you must submit your request in writing to info@houstonslimclub.com. Your request must state a time period, which may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a twelve-month period will be free. For additional lists, we may charge you a reasonable fee for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
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Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for Treatment, Payment, or Health Care Operations. You also have the right to request a restriction or limitation on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. Except as specifically described below in this Notice, we are not required to agree to your request for a restriction or limitation. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment. In addition, there are certain situations where we won’t be able to agree to your request, such as when we are required by law to use or disclose your medical information. To request restrictions, you must make your request in writing to info@houstonslimclub.com. In your request, you must specifically tell us what information you want to limit, whether you want us to limit our use, disclosure, or both, and to whom you want the limits to apply. As stated above, in most instances we do not have to agree to your request for restrictions on disclosures that are otherwise allowed. However, if you pay or another person (other than a health plan) pays on your behalf for an item or service in full, out of pocket, and you request that we not disclose the medical information relating solely to that item or service to a health plan for the purposes of payment or health care operations, then we will be obligated to abide by that request for restriction unless the disclosure is otherwise required by law. You should be aware that such restrictions may have unintended consequences, particularly if other providers need to know that information (such as a pharmacy filling a prescription). It will be your obligation to notify any such other providers of this restriction. Additionally, such a restriction may impact whether an insurance company will pay for related care that you may not want to pay for out of pocket (and which would not be subject to the restriction).
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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 through a personal email address and not at work or, conversely, only at work and not a personal email address. To request such confidential communications, you must make your request in writing to info@houstonslimclub.com. We will not ask the reason for your request, and we will use our best efforts to accommodate all reasonable requests, but there are some requests with which we will not be able comply. Your request must specify how and where you wish to be contacted.
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Right to an Email or Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. To obtain a copy of this Notice, you must make your request in writing to info@houstonslimclub.com.
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Right to Breach Notification. In certain instances, we may be obligated to notify you (and potentially other parties) if we become aware that your medical information has been improperly disclosed or otherwise subject to a “breach” as defined in and/or required by applicable law.
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CHANGES TO THIS NOTICE
We reserve the right to change this Notice at any time, along with our privacy policies and practices. 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. We will post a copy of the current notice, along with an announcement that changes have been made, as applicable, on our website and in any physical office in which the medical providers practice medicine. When changes have been made to the Notice, you may obtain a revised copy by writing to info@houstonslimclub.com.
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COMPLAINTS
If you believe that your privacy rights as described in this Notice have been violated, you may file a complaint with the applicable medical provider at info@houstonslimclub.com
