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Dr. Swami's Wellness LLC

Phone: (803) 617-7553

Welcome

6326 Saint Andrews Road
Columbia, SC 29212

Dr. Swami's Wellness LLC

Notice of Privacy Practices of Healthcare Providers.

Your Rights

You have the right to:

Get a copy of your paper or digital medical records.

Correct your medical record.

Request confidential communication.

Ask us to limit the information we share.

Get a list of those with whom we've shared you information.

Choose someone to act for you.

Get a copy of this privacy notice.

File a complaint if your privacy rights have been violated.

You can file a complaint with U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Ave., S.W., Washington D.C. 20201 or call 1877-696-6775.


Our Uses and Disclosures

We may use and share your information as we:

Treat you

Run our organization

Bill for your services

Help with public health and safety issues

Do research

Comply with the law

Respond to organ and tissue donation requests

Work with a medical examiner or funeral director

Address workers’ compensation, law enforcement, and other government requests

Respond to lawsuits and legal actions

To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.

Travel Questionnaire

Gender
Male
Female
Date of Birth
Month
Day
Year
Multi-line address

Travel Details

Travel Date
Month
Day
Year

Start date of travel

Health Information

Have you received all your childhood vaccines?
No
Yes
Have you had any hypersensitivity or reaction to vaccine?
No
Yes
Have you received the TdaP vaccine in the last 10 years?
No
Yes
Have you received Polio vaccine as an adult?
No
Yes
Have you received Hepatitis A series?
No
Yes
Have you received the Typhoid vaccine?
No
Yes
Have you ever received the Yellow Fever vaccine?
No
Yes
Are you pregnant, plan to get pregnant or lactating?
No
Yes
Do you have any chronic medical conditions?
No
Yes
Are you currently taking any medications?
No
Yes
Do you have any known allergies?
No
Yes
Do you have any immunocompromising conditions or are you on immunosuppressive therapy?
No
Yes

Thank you for filling out the online form.

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