HIPAA Omnibus Notice of Privacy Practices

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Effective Date: February 16, 2026

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Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

We are required by law to maintain the privacy of protected health information,
to provide individuals with notice of our legal duties and privacy practices with
respect to protected health information, and to notify affected individuals following
a breach of unsecured protected health information. We must follow the privacy practices
described in this Notice while it is in effect. This Notice takes effect February 16, 2026
and will remain in effect until replaced.

We reserve the right to change our privacy practices and the terms of this Notice at any time,
provided such changes are permitted by applicable law, and to make new Notice provisions
effective for all protected health information that we maintain. When we make a significant
change in our privacy practices, we will change this Notice and post the new Notice clearly
and prominently at our practice location and provide copies upon request.

You may request a copy of this Notice at any time. For more information about our privacy
practices, please contact us using the information listed at the end of this Notice.

How We May Use and Disclose Health Information About You

We may use and disclose your health information for treatment, payment, and healthcare
operations. Certain information (such as HIV-related information, genetic information,
substance use disorder treatment records, and mental health records) may receive special
confidentiality protections under applicable law.

Treatment

We may use and disclose your health information for your treatment. For example, we may
disclose your information to a specialist providing treatment to you.

Payment

We may use and disclose your health information to obtain reimbursement for services.
Payment activities include billing, collections, claims management, and eligibility
determinations. For example, we may send claims to your dental health plan.

Healthcare Operations

We may use and disclose your health information for healthcare operations such as
quality assessment, training programs, and licensing activities.

Individuals Involved in Your Care

We may disclose your health information to family members, friends, or others identified
by you who are involved in your care or payment for your care. If someone has legal
authority to make healthcare decisions for you, we will treat that person as we would treat you.

Disaster Relief

We may use or disclose your health information to assist in disaster relief efforts.

Required by Law

We may use or disclose your health information when required to do so by law.

Public Health Activities

• Prevent or control disease, injury, or disability
• Report child abuse or neglect
• Report reactions to medications or product problems
• Notify individuals of recalls
• Notify individuals of possible exposure to disease
• Report abuse, neglect, or domestic violence

National Security and Correctional Institutions

We may disclose health information to military authorities, authorized federal officials,
or correctional institutions as permitted by law.

Secretary of HHS

We will disclose your health information to the Secretary of the U.S. Department of
Health and Human Services when required for HIPAA compliance investigations.

Workers’ Compensation

We may disclose your PHI as authorized by laws relating to workers’ compensation programs.

Law Enforcement

We may disclose your PHI for law enforcement purposes as permitted by HIPAA or required by law.

Judicial and Administrative Proceedings

We may disclose your PHI in response to a court order, subpoena, or lawful process.

Research

We may disclose your PHI to approved researchers who follow strict privacy protocols.

Coroners, Medical Examiners, and Funeral Directors

We may release PHI to identify a deceased person, determine cause of death, or allow
funeral directors to carry out their duties.

Fundraising

We may contact you regarding fundraising activities. You may opt out of receiving
these communications.

Substance Use Disorder (SUD) Treatment Information

We will handle SUD treatment records in accordance with 42 CFR Part 2 and applicable law.
Such information will not be used in legal proceedings against you without proper authorization
or court order.

Other Uses and Disclosures of PHI

Your written authorization is required for disclosure of psychotherapy notes, marketing
uses, sale of PHI, and other uses not described in this Notice. You may revoke authorization
in writing at any time.

Your Health Information Rights

Access

You have the right to inspect or obtain copies of your health information, with limited
exceptions. Requests must be made in writing. Reasonable fees may apply.

Disclosure Accounting

You have the right to receive an accounting of certain disclosures of your health information.

Right to Request Restrictions

You may request restrictions on certain uses or disclosures of your PHI. We are not required
to agree except in limited circumstances.

Alternative Communication

You may request communication of your health information by alternative means or locations.

Amendment

You may request that we amend your health information. Requests must be in writing and
include a reason for the amendment.

Right to Notification of a Breach

You will receive notification of breaches of unsecured protected health information as required by law.

Electronic Notice

You may request a paper copy of this Notice even if you agreed to receive it electronically.

Questions and Complaints

If you have questions about this Notice or believe your privacy rights have been violated,
you may contact us using the information below. You may also file a complaint with the
U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

For Further Information

If you have questions or wish to submit a request under this Notice, please contact
[sc name="practice_name"] [/sc] Privacy Officer at
[sc name="phone"] [/sc] or at:

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