Your health information privacy rights.

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.

Who this notice covers

This notice applies to Holistic Wellness Maryland, operated by Clarksburg Healthcare (“we,” “us,” or “our practice”), and to Christopher Touzeau, M.S., FNP-C, as your treating provider. We are required by law to maintain the privacy of your protected health information (“PHI”), provide you with this notice describing our legal duties and privacy practices, and follow the terms currently in effect.

How we may use and disclose your health information

We may use and disclose your PHI for the following purposes:

• Treatment. To provide, coordinate, or manage your care, including your medical cannabis evaluation and medication-safety review, and to communicate with other healthcare providers involved in your care, with your authorization where required.
• Payment. To bill you directly for services, since our practice does not bill health insurance.
• Healthcare operations. For internal purposes such as quality assessment, staff training, and practice management.
• As required by law. Including reporting to the Maryland Cannabis Administration as necessary to issue or maintain your written certification.
• Public health and safety. When required to prevent a serious threat to health or safety, or as otherwise required by public health authorities.
• Other uses require your written authorization. Any use or disclosure not described in this notice will only be made with your written authorization, which you may revoke at any time.

Your rights regarding your health information

• Right to inspect and copy. You may request access to your medical record. We will respond within the timeframes required by law.
• Right to request amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete.
• 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 ask us to limit how we use or disclose your PHI; we are not required to agree to every request.
• Right to request confidential communications. You may ask that we contact you in a specific way or at a specific location.
• Right to a paper copy. You may request a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Right to file a complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the U.S. Department of Health and Human Services, Office for Civil Rights. You will not be retaliated against for filing a complaint.

Our duties

We are required by law to maintain the privacy of your PHI, provide you with this notice, and abide by the terms currently in effect. We reserve the right to change the terms of this notice and to make the revised notice effective for all PHI we maintain. Any revised notice will be made available on this website.

Contact us

If you have questions about this notice or want to exercise any of the rights described above, contact us at info@holisticwellnessmaryland.com or 410.321.0642.