Effective April 14, 2003

SUMMARY

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.

We have a responsibility to protect your health information. You Have Certain Rights. You May:

  • Receive and view a copy of your records.
  • Ask for a change to your records.
  • Ask for a list of certain disclosures of your health information.
  • Ask us to communicate with you by another means.
  • Request limited use of your health information.
  • Ask us not to share information with your family members.
  • Make complaints related to the privacy of your health information.
  • Receive a paper copy of this Notice.

We May Use and Share Your Health Information in compliance with certain rules:

  • To perform health related services, obtain payment, or conduct our operations.
  • To participate in research projects approved by an Institutional Review Board, a legally authorized committee that protects research participants’ rights and oversees research projects.
  • As otherwise required or allowed by law, or with your written authorization.

Any time you wish to contact Alere Wellbeing regarding your privacy rights, please refer to the back page of this Notice.

Federal regulations require that we ask you to acknowledge receipt of this Notice. After you have read the information, please sign and return the enclosed acknowledgement.

Alere Wellbeing's Responsibilities:

Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), because our services are related to your health we must take steps to protect the privacy of the information you provide to us or that we create on your behalf. This information may include both health information and personal information such as your name, social security number, address, and phone number.

Although our services are related to your health, Alere Wellbeing, Inc. is not a medical treatment provider and our staff cannot provide medical treatment, diagnosis, or monitoring. Alere Wellbeing, Inc. programs should not be relied upon as a substitute for professional medical advice. Alere Wellbeing, Inc. programs are intended to assist you with personal health improvement efforts through coaching, education, and instruction. Alere Wellbeing, Inc. recommends that you seek the advice of your doctor with any questions you may have regarding your medical conditions.

Under Federal Law, We are Required to:

  • Maintain the privacy of your health information.
  • Provide you with this Notice of Privacy Practices explaining our duties and practices regarding your health information and to follow the practices and procedures set forth in this Notice.
  • Notify you following a breach of your health information if it is unsecured.

Uses and Disclosures that DO NOT Require Your Authorization:

Federal law permits Alere Wellbeing, Inc. to use and share health information for certain limited purposes. Some examples of how Alere Wellbeing, Inc. may use or share your health information without your authorization are listed below.

Health related services
Alere Wellbeing, Inc. may share health information with employees, other members of our workforce and, other health care providers in the course of providing you with treatment and / or other health related services.

Payment purposes
Alere Wellbeing, Inc., when applicable, may share your information with organizations responsible for payment or administration of your health benefits, including managing incentives.

Health care related operations
Alere Wellbeing, Inc. may share your health information with organizations that assist with the administration and support of our business activities, provided that such organizations agree to protect the privacy of your information.

Research
Alere Wellbeing, Inc. may use and share your health information for research projects that have been approved by an Institutional Review Board (IRB), a legally authorized committee that protects participants’ rights and oversees research. For example:

  • When an IRB determines that the need to use your health information without your authorization is justified and steps are taken to ensure only limited use of such information, we may use and share it for a research project without your authorization.
  • When an IRB approves the use and sharing of information or you authorize the use and sharing of information for a research project, your information may be shared with other institutions connected with the research project.
  • In all other cases, we must obtain your authorization to use your information for a research project.

Contacting You:
Alere Wellbeing, Inc. may use your health information to contact you or send you reminders by phone, mail, e-mail, mobile application, or text message.

Other Uses and Disclosures:
We may use or share your health information, if necessary to protect the public health or safety, or when otherwise allowed by law. For example, we may provide information to:

  • Public health authorities for health surveillance, to investigate or track problems with prescription drugs and medical devices (U.S. Food and Drug Administration).
  • Government entities authorized to receive reports regarding suspected abuse, neglect, or domestic violence.
  • Health care oversight agencies for the purpose of enforcement, audits, examinations, investigations, inspections, and licensures.
  • Courts and law enforcement agencies when required or allowed by law
  • Coroners, medical examiners, and funeral directors.
  • Correctional facilities, if we are providing health related services to you while you are incarcerated.
  • Government officials as required for specifically identified government functions.

Uses and Disclosures That You Have the Right to Object:
Unless you object, Alere Wellbeing, Inc. will use its professional judgment to provide relevant health information to a family member, friend, or other person you indicate has an active interest in your care.

Uses and Disclosures That Require Your Authorization:

  • Except in the situations listed in the sections above, we will use and share your health information only with your written authorization, including that we must obtain your written authorization:
  • To use or disclose your health information for marketing purposes.
  • For disclosures that constitute the sale of your health information.
  • To use or disclose your psychotherapy notes created by a mental health professional, except as allowed by law.
  • You may revoke such authorization at any time by written notice to the Alere Wellbeing, Inc. Privacy Officer. Such revocation shall be effective upon Alere Wellbeing, Inc.’s receipt of your written notice. If you revoke your authorization, Alere Wellbeing, Inc. will no longer use or disclose your information for the purposes covered by your authorization.

In some situations, federal and state laws provide special protections for specific kinds of health information and require authorization from you before we can share such information. In these situations, we will contact you for the necessary authorization. In cases where state privacy laws differ from federal law, we will comply with the most stringent law.

To exercise your privacy rights or to make a complaint, you may contact:
Alere Wellbeing, Inc.
Attn: Privacy Officer
999 3rd Avenue, Suite 2000
Seattle, Washington 98104
Quit for Life® Program: 1-866-QUIT-4-LIFE (1-866-784-8454)
Weight Talk® Program: 1- 855-WGT-TALK (855-948-8255)
Accomplish® Program:  1-888-874-7783
TTY: 1-877-777-6534

If you have a complaint you may also contact:
Office for Civil Rights, Region X
U.S. Department of Health and Human Services
2201 6th Avenue, Mailstop RX-11
Seattle, Washington 98121-1831
206-615-2290

Participant Forms
The following Alere participant forms are available as downloadable pdf's for your convenience:

Request for Health Information
This form is used when a participant wants to request a copy of his/her own health record.

Authorization for Disclosure of Protected Health Information

This form is used when a participant wants to share his/her own health record with someone.

Participant Complaint Form

This form is used when a participant wants to make a complaint.

Request for Amendment of Health Information

This form is used when a participant wants to make changes to the information in his/her own health record.

Request for an Accounting of Disclosures
This form is used when a participant wants an accounting of disclosure for his/her own records.

Request for Restriction and/or Confidential Communications

This form is used when a participant wants to add special restrictions on his/her health information or communicate via an alternative means of communication.

Changes to privacy practices: Alere Wellbeing, Inc . may change the terms of this Notice at any time. Any revised Notice will apply to all health information that we maintain. We post our current Notice on our web site (www.alerewellbeing.com) and at our facilities. If you have any questions about this Notice or would like an additional copy, please contact our Privacy Officer at the numbers listed above.