NOTICE OF PRIVACY PRACTICES
Your Information. Your Rights. Our Responsibilities.
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.
Effective date: 10/26/2026
This notice applies to Life Without Limits / Brian Gluck, DO, PC and its workforce in connection with services provided by our practice. It explains how we protect and use your protected health information (PHI), your privacy rights, and how to contact us.
1 Your Rights
You have the right to exercise the following rights regarding your health information:
· Review or obtain records. Request an electronic or paper copy of your medical record and other PHI we maintain about you. We generally provide access within 30 days, subject to permitted extensions and reasonable cost-based fees.
· Request corrections. Ask us to amend information you believe is incorrect or incomplete. We may deny a request as allowed by law, and we will explain a denial in writing, generally within 60 days.
· Request confidential communications. Ask that we contact you by a particular method or at a different address. We will accommodate reasonable requests.
· Request restrictions. Ask us to limit some uses or disclosures for treatment, payment, or health care operations. We are not always required to agree. When you pay in full out of pocket for a specific service or item, you may request that we not disclose related information to your health plan for payment or health care operations; we must honor that request unless disclosure is required by law.
· Request an accounting. Ask for a list of certain disclosures of your PHI during the preceding six years. Some disclosures are excluded by law. One accounting in a 12-month period is free; additional accountings may involve a reasonable cost-based fee.
· Receive this notice. Request a paper copy at any time, including if you previously agreed to receive it electronically.
· Authorize a representative. A legally authorized personal representative may exercise your rights when permitted by law. We may verify that person’s authority.
· File a complaint. Complain to the practice or to the U.S. Department of Health and Human Services Office for Civil Rights (OCR). We will not retaliate against you.
2 Your Choices and Authorizations
You may tell us your preferences regarding information shared with family members, friends, or others involved in your care or payment for your care, and in disaster-relief situations. If you cannot communicate a preference, we may use professional judgment and applicable law to act in your best interest. Our separate “Permission to Discuss My Care” form helps document your choices.
We generally need your written authorization for uses and disclosures for marketing as defined by HIPAA, the sale of PHI, and most uses and disclosures of psychotherapy notes. Other uses and disclosures not described in this notice also require authorization unless permitted or required by law. You may revoke an authorization in writing, except to the extent we have already acted in reliance on it.
If we conduct fundraising communications using information permitted by law, you may opt out of further fundraising communications. Special rules apply if such communications would use records protected by 42 CFR Part 2
3 How We Use and Disclose Your Information
We may use and disclose PHI without a separate written authorization when permitted or required by law, including:
· Treatment: Providing and coordinating bariatric, general surgical, medical weight-management, dietitian and related care; communicating with hospitals, laboratories, pharmacies, referring clinicians and other treating professionals.
· Payment: Submitting claims, checking benefits, processing payments, sending billing statements, seeking payment for balances, and working with permitted billing and collection service providers.
· Health care operations: Quality improvement, credentialing, staff training, auditing, business administration, patient service, compliance activities and practice management.
· Business associates: Using appropriately contracted service providers, such as EHR, portal, communication, payment, billing, IT, and document vendors, that help us perform permitted functions and must safeguard information as required.
· Other permitted or required uses: Public health reporting, health oversight, reporting abuse or neglect, certain research activities, responding to serious threats, organ donation, coroners and funeral directors, workers’ compensation, legally authorized government or law-enforcement requests, and judicial or administrative proceedings, subject to legal requirements.
4 Specially Protected Information
Certain information may receive additional protections under applicable federal or Michigan law, including some behavioral health, HIV-related, genetic, or substance use disorder information. We will follow stricter requirements where they apply.
If we receive or maintain records subject to the federal confidentiality rules for substance use disorder treatment programs (42 CFR Part 2), additional restrictions apply. Such records, and testimony describing them, generally may not be used or disclosed in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a qualifying court order accompanied by a subpoena or similar legal mandate. Other Part 2 consent and redisclosure rules may also apply. If our practice creates or maintains Part 2 records, any additional required disclosures and patient choices will be handled in accordance with those rules.
5 Portal, Email, Texting and Electronic Payments
We offer a secure patient portal for nonurgent clinical messages, medication questions and other patient communications. We may also communicate about appointments, office operations and care using telephone, email, or text through our communications platform, Weave, consistent with your documented preferences, law and reasonable safeguards.
Ordinary SMS messages and email may present privacy risks; notifications can appear on shared devices or accounts. We encourage use of our portal for sensitive nonurgent medical matters. Our separate Electronic Communication & Patient Preferences Agreement explains optional medical text messaging and patient choices. You may request reasonable alternative confidential communication arrangements.
Our routine patient billing statements are delivered by email, not by text. If you separately consent, we may send a Weave Text-to-Pay message stating an amount due and linking to a secure payment process. That message is a payment request, not an itemized billing statement. Contact our billing department if you need copies, assistance or a reasonable alternative method.
Life Without Limits uses Freed AI-assisted transcription and documentation technology, with patient consent, during in-person and telehealth appointments. The software temporarily records and processes appointment audio and protected health information (PHI) to assist healthcare providers in preparing clinical documentation.
Audio is retained temporarily in accordance with the software provider's data-retention practices. Providers remain responsible for reviewing and approving clinical documentation. Patients may decline AI-assisted recording and request that their visit be documented using another method.
Do not use email, text messages or the patient portal for emergencies. Call 911 for emergencies; for urgent concerns, contact the office or answering service.
6 Our Legal Responsibilities
· We are required by law to maintain the privacy and security of PHI and to follow the terms of the notice currently in effect.
· We will notify affected individuals of breaches of unsecured PHI when required by law.
· We will not use or disclose PHI for purposes outside those described here unless authorized in writing or otherwise permitted or required by law.
· We may update this notice and apply the revised terms to PHI we already maintain. The current notice will be available in the office, on our website, and upon request.
7 Questions, Requests and Complaints
Life Without Limits / Brian Gluck, DO, PC
Privacy Contact: Wanda Johnson 231-246-1114
Office mailing address: 1325 E. Sherman Blvd. Norton Shores, MI 49444
Telephone: 231-246-1114 Email: wanda@drbriangluck.com
Website: https://www.drbriangluck.com
You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201; telephone 1-877-696-6775; or https://www.hhs.gov/hipaa/filing-a-complaint/index.html. We will not retaliate against you for filing a complaint.
8 Availability of This Notice
You may obtain a copy of this notice at check-in, by contacting our office, or on our website. We will provide a paper copy upon request. We request a separate written acknowledgment of receipt as part of our new-patient paperwork; that acknowledgment is not permission for unrestricted release of your records.
Email: info@drbriangluck.com
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This Privacy Policy template is based on standard practices and should be reviewed by legal counsel to ensure compliance with all applicable laws and regulations specific to your practice.