HIPAA Notice of Privacy Practices

Last Updated: 18th Feb 20206

This Notice describes how your protected health information (“PHI”) may be used and disclosed by Vital Shape LLC and how you can access this information. Please review it carefully.

Vital Shape operates under the supervision of a licensed medical director and partners with third‑party medical providers for GLP‑1 weight‑loss services. As such, certain information you provide may be considered PHI under HIPAA.

1. Our Responsibilities

Vital Shape is required to:

• Maintain the privacy of your PHI
• Provide this Notice of our legal duties
• Notify you in the event of a breach of unsecured PHI
• Follow the terms of this Notice

2. How We May Use & Disclose Your PHI

For Treatment
To coordinate care, communicate with medical partners, or provide services.

For Payment
To process payments, verify benefits, or coordinate billing.

For Healthcare Operations
To improve services, conduct quality assessments, or train staff.

As Required by Law
We may disclose PHI when required by federal, state, or local laws.

3. Your Rights Regarding Your PHI

You have the right to:

• Access your health information
• Request corrections
• Request restrictions on certain uses
• Request confidential communications
• Receive an accounting of disclosures
• Obtain a paper copy of this Notice

Requests may be submitted in writing to Vital Shape.

4. Uses Requiring Authorization

We will obtain your written authorization before:

• Using PHI for marketing
• Sharing PHI with third parties for non‑treatment purposes
• Disclosing psychotherapy notes (if applicable)

You may revoke authorization at any time.

5. Contact Information

For questions about this Notice or your rights, contact:

Vital Shape LLC
PO Box 7352, Reno Nevada, United States 89510
Email: patminbros@gmail.com
Phone: (775) 722-9663