Semper Wellness LLC

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.

This Notice of Privacy Practices (the “Notice”) describes how Semper Wellness LLC (“we” or “our”) may use and disclose your protected health information to carry out treatment, payment, or business operations and for other purposes that are permitted or required by law. Although we are not a “Covered Entity” as defined by the Health Insurance Portability and Accountability Act (“HIPAA”), we have elected to voluntarily comply with HIPAA standards. “Protected health information” or “PHI” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical health or condition, treatment, or payment for health care services. This Notice also describes your rights to access and control your protected health information.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:

Your protected health information may be used and disclosed by our healthcare practitioners, our staff, and others outside of our office who are involved in your care and treatment for the purpose of providing healthcare services to you, supporting our business operations, obtaining payment for your care, and for any other use authorized or required by law.

TREATMENT:

We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a healthcare provider to whom you have been referred to ensure the necessary information is accessible to diagnose or treat you.

PAYMENT:

Your protected health information may be used to bill or obtain payment for your healthcare services. This may include activities that your health insurance plan may undertake before it approves or pays for your services, such as determining eligibility or coverage for insurance benefits and reviewing services provided to you for medical necessity.

HEALTH CARE OPERATIONS:

We may use or disclose your protected health information, as needed, to support the business activities of our office. These activities include, but are not limited to, improving quality of care, providing information about treatment alternatives or other health-related benefits and services, maintaining and supporting computer systems, legal services, and conducting audits and compliance programs, including fraud, waste, and abuse investigations.

USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION:

We may use or disclose your protected health information in the following situations without your authorization: as required by law; for public health purposes; for healthcare oversight purposes; for abuse or neglect reporting; pursuant to Food and Drug Administration requirements; in connection with legal proceedings; for law enforcement purposes; to coroners, funeral directors, and organ donation agencies; for certain research purposes; for certain criminal activities; for certain military activity and national security purposes; for workers’ compensation reporting; relating to certain inmate reporting; and other required uses and disclosures. Under the law, we must make certain disclosures to you upon your request and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with HIPAA. State laws may further restrict these disclosures.

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION:

Other permitted and required uses and disclosures will be made only with your consent, authorization, or opportunity to object unless permitted or required by law. Without your authorization, we are expressly prohibited from using or disclosing your protected health information for marketing purposes. We may not sell your protected health information without your authorization. Your protected health information will not be used for fundraising. If you provide us with an authorization for certain uses and disclosures of your information, you may revoke such authorization in writing at any time, except to the extent that we have taken action in reliance on the use or disclosure indicated in the authorization.

YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION:

• Right to Inspect and Copy: You have the right to inspect and copy your protected health information.

• Right to Request Amendment: You may request access to or an amendment of your protected health information.

• Right to Request Restrictions: You have the right to request a restriction on the use or disclosure of your protected health information. Your request must be in writing and specify the restriction requested and to whom it applies. We are not required to agree to a restriction except for disclosures to a health plan for payment or healthcare operations related to services paid in full out-of-pocket.

• Right to Confidential Communications: You have the right to request to receive confidential communications from us by alternative means or at an alternate location. We will comply with reasonable requests submitted in writing specifying how or where you wish to receive these communications.

• Right to Request Amendment: You have the right to request an amendment of your protected health information. If we deny your request, you have the right to file a statement of disagreement, and we may prepare a rebuttal.

• Right to an Accounting of Disclosures: You have the right to receive an accounting of certain disclosures of your protected health information that we have made.

• Right to a Paper Copy: You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

REVISIONS TO THIS NOTICE:

We reserve the right to revise this Notice and to make the revised Notice effective for protected health information we already have about you as well as any information we receive in the future. You are entitled to a copy of the Notice currently in effect. Significant changes will be posted on our website. You have the right to object or withdraw as provided in this Notice.

BREACH OF HEALTH INFORMATION:

We will notify you if a reportable breach of your unsecured protected health information is discovered. Notification will be made no later than 60 days from the breach discovery and will include a description of the breach, the information involved, and contact information for questions.

COMPLAINTS:

Complaints about this Notice or our handling of your protected health information should be directed to our HIPAA Privacy Officer. If you are not satisfied with the manner in which a complaint is handled, you may submit a formal complaint to the Department of Health and Human Services, Office for Civil Rights, at 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

We must follow the duties and privacy practices described in this Notice. We will maintain the privacy of your protected health information and notify affected individuals following a breach of unsecured protected health information. If you have any questions about this Notice, please contact us at (240) 301-3349 and ask to speak with our HIPAA Privacy Officer.

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