Righteous Livity Wellness Presents

National Diabetes Prevention Program

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NDPP Specific Disclosures

As a participant in the yearlong National Diabetes Prevention Program (DPP) Lifestyle Change Program (LCP), you are required to fulfill the following program requirements to track progress and ensure success:

1. Weekly Weight Reporting: Participants must report their weight weekly to monitor progress and make necessary adjustments.

2. Physical Activity Minutes: Participants are required to log and report the total number of physical activity minutes completed each week.

3. Diabetes Risk Survey: Periodic completion and submission of diabetes risk surveys are required to assess and track your progress throughout the program.

Additionally, Protected Health Information (PHI) and/or demographically identifiable information will be collected during your participation. PHI includes information such as your name, age, date of birth, phone number, address and similar information.

Data Privacy and Use:

• While PHI will be collected to track your progress, any information shared with the Centers for Disease Control and Prevention (CDC) will be de-identified, meaning it will not include any data that can directly link the information to you as an individual. For example, your reported weight and other progress metrics will not be associated with your name, contact information, or any other personal identifiers.

• The CDC uses this de-identified data to evaluate and determine program recognition status.

• At the discretion of the CDC’s Division of Diabetes Translation (DDT) or National DPP leadership, aggregated data at the organizational, state, regional, or national level may be shared on a limited basis with external partners. This sharing is solely for the purpose of preparing reports or providing targeted technical assistance aimed at improving program or organizational performance and quality.

• Data will not be shared with other stakeholders in any form.

Righteous Livity Works LLC (RLW) is fully compliant with all HIPAA laws and privacy protections as required by program regulations. Your data is handled securely and in accordance with all applicable privacy laws and program standards.

Acknowledgment of Participation and Liability Waiver:

• By enrolling in this program, you confirm that you have consulted with your Primary Care Provider (PCP) and have received clearance to participate in the program’s activities, including any dietary or physical activity recommendations.

• Participation in this program is entirely voluntary, and you acknowledge that you are freely choosing to take part in the program.

• You agree to hold harmless Righteous Livity Works LLC, its facilitators, and associated staff from any claims, liabilities, or damages that may arise as a result of your participation in the program.

If you have any questions or concerns about the program requirements, data collection, or reporting, please contact your program facilitator.

DISCLAIMER

By participating in the National Diabetes Prevention Program  you acknowledge and agree to the following:

1. Not Medical Advice: The Challenge, including all diet and exercise recommendations, is designed for general health and wellness purposes only. It is not intended to diagnose, treat, cure, or prevent any medical condition, illness, or injury. Always consult with a qualified healthcare provider before starting any new diet, exercise program, or wellness routine, particularly if you have any pre-existing medical conditions.

2. Individual Responsibility: You are responsible for your own health and safety. If you experience any pain, dizziness, discomfort, or any adverse reactions during the Challenge, stop immediately and seek medical advice. Righteous Livity Wellness and its representatives are not liable for any injuries or health issues that may arise from participation in the Challenge.

3. Results Not Guaranteed: While the Challenge is designed to help improve health and wellness, individual results may vary. No guarantees are made regarding weight loss, detoxification, or any other outcomes.

POLICY

1. Participation Requirements:

a. You must be 18 years or older to participate.

b. You agree to follow the dietary and exercise guidelines to the best of your ability but understand that modifications may be necessary based on your individual needs.

c. Participation is voluntary, and you may withdraw from the Challenge at any time.

2. Refund Policy:

a. Once you begin the Challenge, no refunds will be provided.

b. If you choose to withdraw before the Challenge begins, a partial refund may be issued based on the terms outlined in your registration agreement.

3. Code of Conduct:

a. Participants are expected to engage with the community in a respectful and supportive manner.

b. Discriminatory or inappropriate behavior will not be tolerated and may result in removal from the Challenge without a refund.

4. Confidentiality:

a. Any personal information shared during the Challenge will be kept confidential in accordance with our Privacy Policy.

b. Participants are encouraged to maintain the confidentiality of fellow participants and refrain from sharing any personal details of others without consent.

NDPP Specific Disclosures

As a participant in the yearlong National Diabetes Prevention Program (DPP) Lifestyle Change Program (LCP), you are required to fulfill the following program requirements to track progress and ensure success:

1. Weekly Weight Reporting: Participants must report their weight weekly to monitor progress and make necessary adjustments.

2. Physical Activity Minutes: Participants are required to log and report the total number of physical activity minutes completed each week.

3. Diabetes Risk Survey: Periodic completion and submission of diabetes risk surveys are required to assess and track your progress throughout the program.

Additionally, Protected Health Information (PHI) and/or demographically identifiable information will be collected during your participation. PHI includes information such as your name, age, date of birth, phone number, address and similar information.

Data Privacy and Use:

• While PHI will be collected to track your progress, any information shared with the Centers for Disease Control and Prevention (CDC) will be de-identified, meaning it will not include any data that can directly link the information to you as an individual. For example, your reported weight and other progress metrics will not be associated with your name, contact information, or any other personal identifiers.

• The CDC uses this de-identified data to evaluate and determine program recognition status.

• At the discretion of the CDC’s Division of Diabetes Translation (DDT) or National DPP leadership, aggregated data at the organizational, state, regional, or national level may be shared on a limited basis with external partners. This sharing is solely for the purpose of preparing reports or providing targeted technical assistance aimed at improving program or organizational performance and quality.

• Data will not be shared with other stakeholders in any form.

Righteous Livity Works LLC (RLW) is fully compliant with all HIPAA laws and privacy protections as required by program regulations. Your data is handled securely and in accordance with all applicable privacy laws and program standards.

Acknowledgment of Participation and Liability Waiver:

• By enrolling in this program, you confirm that you have consulted with your Primary Care Provider (PCP) and have received clearance to participate in the program’s activities, including any dietary or physical activity recommendations.

• Participation in this program is entirely voluntary, and you acknowledge that you are freely choosing to take part in the program.

• You agree to hold harmless Righteous Livity Works LLC, its facilitators, and associated staff from any claims, liabilities, or damages that may arise as a result of your participation in the program.

If you have any questions or concerns about the program requirements, data collection, or reporting, please contact your program facilitator.

 

Waiver of Liability:

I, the undersigned, hereby:

1. Release and discharge Righteous Livity Works LLC, its employees, agents, and affiliates from any and all claims, demands, and causes of action arising out of or related to my participation in the National Diabetes Prevention Program.

2. Agree to assume all risk associated with participating in this challenge, including but not limited to injury, illness, or any other adverse effects.

3. I Understand that Righteous Livity Wellness is not responsible for any medical or health conditions that may arise during or after the challenge.

CONSENT

By enrolling in the National Diabetes Prevention Program I hereby:

1. Acknowledge that I have read and fully understand the Disclaimer, waiver, and Policy outlined above.

2. Acknowledge that participation in the Challenge involves inherent risks, including but not limited to physical injury, and I voluntarily assume all such risks.

3. Release and hold harmless Righteous Livity Wellness, its owners, instructors, employees, and agents from any claims, liabilities, or damages that may arise from my participation in the Challenge.

4. Confirm that I have consulted with or will consult a healthcare provider before beginning this program, especially if I have any medical conditions.

5. Agree to abide by the Code of Conduct and understand that violations may result in removal from the Challenge without a refund.