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Notice of Privacy Practices

 

Potens Wellness Clinic
Effective Date: 03/15/2026

This Notice describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully.

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Our Commitment to Your Privacy

 

Potens Wellness Clinic is committed to protecting the privacy of your health information. We are required by law to maintain the confidentiality of your protected health information (“PHI”), provide you with this Notice of our legal duties and privacy practices, and follow the terms currently in effect.

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How We May Use and Disclose Your Information

We may use and share your health information in the following ways:​

1. Treatment

We may use your information to provide, coordinate, or manage your healthcare. This includes sharing information with:

  • Other healthcare providers

  • Diagnostic imaging centers

  • Laboratories

  • Specialists involved in your care

2. Payment

We may use and disclose your information to bill and receive payment for services. This may include:

  • Insurance companies (such as BCBS, Aetna, Cigna, Medicare)

  • Billing services or clearinghouses

  • Collection processes when necessary

3. Healthcare Operations

We may use your information to operate and improve our practice. Examples include:

  • Quality assessment and staff training

  • Business management and administrative activities

  • Compliance and auditing functions

4. Other Permitted and Required Uses

We may also use or disclose your information without your written authorization in certain situations, including:

  • Legal requirements: When required by federal, state, or local law

  • Public health and safety: To prevent or control disease, injury, or disability

  • Health oversight activities: Audits, inspections, or investigations

  • Legal proceedings: In response to a court order, subpoena, or lawful request, including communication with attorneys involved in your care

  • Law enforcement purposes: As permitted or required by law

  • Serious threats: To prevent a serious threat to your health or safety or that of others

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Uses Requiring Your Authorization

We will obtain your written permission before:

  • Using or sharing your information for marketing purposes (beyond general communications)

  • Sharing psychotherapy notes (if applicable)

  • Using identifiable information for testimonials, reviews, or photos

You may revoke your authorization at any time in writing.

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Patient Testimonials and Photos

We may wish to use patient testimonials, reviews, or photos. We will only do so with your explicit written authorization. Your decision will not affect your care in any way.

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Your Rights Regarding Your Information

You have the following rights:

1. Right to Access

You may request copies of your health records.

2. Right to Amend

You may request corrections to your records if you believe information is inaccurate or incomplete.

3. Right to an Accounting of Disclosures

You may request a list of certain disclosures we have made of your information.

4. Right to Request Restrictions

You may request limits on how we use or share your information. While we are not always required to agree, we will consider all requests.

5. Right to Request Confidential Communications

You may request that we contact you in a specific way (e.g., only by phone or only at a certain address).

6. Right to a Copy of This Notice

You may request a paper or electronic copy of this Notice at any time.

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Our Responsibilities

We are required to:

  • Maintain the privacy and security of your health information

  • Notify you if a breach occurs that may compromise your information

  • Follow the duties and privacy practices described in this Notice

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Changes to This Notice

We reserve the right to update this Notice at any time. Any changes will apply to all information we maintain and will be posted on our website with an updated effective date.

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Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

To file a complaint with us, contact:

Potens Wellness Clinic
2800 NE Kendallwood Pkwy, Ste 3, Gladstone, MO 66219

(816) 396-7397
info@potenswellnessclinic.com

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

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Acknowledgment of Receipt

We will ask you to sign an acknowledgment that you have received this Notice. This acknowledgment will be kept in your records.

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