CONTACT US

Call Today to Schedule an Appointment.

Don’t hesitate to call us directly during office hours at 702-292-9729

Hours

Monday, Tuesday, Thursday, Friday:- 8:30AM – 4PM
Wednesday, Saturday, Sunday:- Closed

New Patient Form

Below are 2 options for completing the 6 page New Patient Form (both are in English). Select which one is most convenient for you. Complete all 6 pages and sign each page.

Please bring your completed form for your initial consultation.

The first one is for printing and then writing in your information. PRINT AND WRITE IN – New Patient information packet

The second one is for filling out online, typing in your information, then print it out, sign it. FILLABLE ONLINE – New Patient information packet

PRIVACY POLICY

Yu &I Wellness Center
NOTICE OF PRIVACY POLICY
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.

If you have any questions about this notice, please contact the designated privacy officer at
Yu &I Wellness Center
6268 S. Rainbow Blvd #100
Las Vegas, NV 89118

We take our responsibility to safeguard your protected
health information very seriously. We value your trust as an important part of our ability to provide you with the best
possible medical care. We are dedicated to defending your right to a confidential relationship with your physician.
This notice is intended to inform you of how we protect, use and disclose your information, as well as to explain your right to control these disclosures.
Your Health Information
We may use and disclose health information about you without your permission for the following purposes:
1.We may disclose your information for treatment purposes and to coordinate your medical care.
2.We may disclose your information to ensure that you receive
insurance benefits.
3.We may disclose your information internally to enhance the
operation of our practice. This includes our commitment to reviewing the quality of care we provide.
4.We may disclose your information to comply with a limited number of legal requirements, as outlined in this notice.
Additional information regarding each of these disclosures is
provided in this notice. In any case, we will only disclose the
minimum amount of information necessary for the purpose it was requested.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the
Department of Health and Human Services. To file a complaint with our office, contact:

Yu & I Wellness Center
6268 S. Rainbow Blvd. #I00 Las Vegas, NV 89118
Phone 702-292-9729
You will not be penalized for filing a complaint

Special Situations
We may use or disclose health information about you without your permission for the following purposcs,subject to all applicable legal requirements and limitations:
1. To Avert a Serious Threat to Health or Safety.We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
2. Required By Law.We will disclose health information about you when required to do so by federal,state or local law.
3.Research.We may use and disclose health information about you for research projects that are subject to a special approval
process.We will ask you for your permission if the researcher will have access to your name,address or other information that reveals who you are,or will be involved in your care at the
office.
4,Organ and Tissue Donation.If you are an organ donor,we may release health information to organizations that handle organ
procurement or organ,eye or tissue transplantation or to an organ donation bank,as necessary to facilitate such donation
and transplantation.
5.Military,Veterans,National Security and Intelligence.If you are or were a member of the armed forces,or part of the
national security or intelligence communities,we may be
required by military command or other government authorities to release health information about you.We may also release information about foreign military personnel to the appropriate foreign military authority.
6. Workers’Compensation .We may release health information about you for workers’compensation or similar programs.
These programs provide benefits for work-related injuries or illness.
7. Public Health Risks.We may disclose health information
about you for public health reason in order to prevent or control disease,injury or disability;or report births,deaths,suspected
abuse or neglect,non-accidental physical injuries,reactions to medications or problems with products.
8 . Health Oversight Activities.W e may disclose health
information to a health oversight agency for audits,
nvestigations,inspections,or licensing purposes.These
disclosures may be necessary for certain state and federal agencies to monitor the health care system,government programs,and compliance with civil rights laws.
9. Lawsuits and Disputes.If you are involved in a lawsuit or a dispute,we may disclose health information about you in
response to a court or administrative order.Subject to all applicable legal requirements,we may also disclose health information about you in response to a subpoena.
10.Law Enforcement.We may release health information if
asked to do so by a law enforcement official in response to a court order,subpoena,warrant,summons or similar process,
subject to all applicable legal requirements.
11. Coroners,Medical Examiners and Funeral Directors. We
may release health information to a coroner or medical
examiner.This may be necessary,for example,to identify a deceased person or to determine the cause of death.

12.Information Not Personally Identifiable.We may use or
disclose health information about you in a way that does not personally identify you or reveal who you are.
13.Family and Friends.We may disclose health information about you to your family members or ffiends if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection.We may
also disclose health information to your family or friends if we can infer from the circumstances,based on our professional
judgment,that you would not object.
14.Deceased Person’s PHI may be disclosed by our practice to family or others involved in the person’s care or payment for care,unless our practice knows the deceased preferred that
certain people not receive the PHI.Disclosures are limited to the PHI directly relevant to the person’s involvement.
or example,we may assume you agree to our disclosure of you personal health information to your spouse when you bring your spouse with you into the exam room during treatment or while treatment is discussed.
In situations where you are not capable of giving consent
(because you are not present or due to your incapacity or medical emergency),we may,using our professional judgment,determine that a disclosure to your family member or friend is in your best interest.In that situation,we will disclose only health information relevant to the person’s involvement in your care.
Other Uses and Disclosures of Health Information
We will not use or disclose your health information for any
purpose other than those identified in the previous sections without your specific,written Authorization.We must obtain your
Authorization separate from any Consent we may have obtained from you.
Ifyou give us Authorization to use or disclose health
information about you,you may revoke that Authorization,in writing,at any time.
If you revoke your Authorization,we will no longer use or
disclose information about you for the reasons covered by your
written Authorization.However,we cannot take back any uses or disclosures already made with your permission.

Contact us