WELLNEXIO, LLC NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSEDAND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices describes how WELLNEXIO, LLC (“Company”) may use and disclose your protected health information (PHI) for purposes of treatment, payment and health care operations, and for other purposes that are permitted or required by law.

1. OUR RESPONSIBILITIES:
   We take the privacy of you / your dependent’s health information seriously. We are required by law to maintain the privacy of your health information and provide you with this Notice of Private Practices. We will abide by the terms of this Notice of Privacy Practices. We reserve the right to change this Notice of Privacy Practices and to make any new Notice of Privacy Practices effective for all protected health information that we maintain. Any new Notice of Privacy Practices adopted will be made available to you should you require Company’s services in the future.
2. WHAT IS PROTECTED HEALTH INFORMATION (PHI)?
   Protected Health information is demographic and individually identifiable health information that will or may identifythe patient and relates to the patient’s past, present or future physical or mental health or condition and related health care services.
3. USES AND DISCLOSURES OF INFORMATION
   
   Under federal law, we are permitted to use and disclose personal health information without authorization for: (i) treatment, (ii) payment, and (iii)health care operations.
4. WHAT DOES HEALTH CARE OPERATIONS INCLUDE?
   
   Health care operations include activities such as communications among health care providers, conducting quality assessment and improvement activities; evaluating the qualifications, competence, and performance of health care professionals; training future health care professionals; other related services that may be a benefit to you such as case management and care coordination; contracting with insurance companies; conducting medical review and auditing services; compiling and analyzing information in anticipation of or for use in legal proceedings; and general administrative and business functions.
5. HOW IS MEDICAL INFORMATION USED?
   We use medical records as a way of recording health information, planning care and treatment and as a tool for routine health care operations. If insurance companies are involved in reimbursing for payments for health care services, they may request information such as procedures and diagnostic information. Other health care providers or health plans reviewing your records must follow the same confidentiality laws and rules required of us. Patient records are also valuable tools used by researchers in finding the best possible treatment for diseases and medical conditions. All researchers must follow the same rules and laws that other health care providers are required to follow to ensure the privacy of patient information. Information that may identify patients will not be released for research purposes to anyone without written authorization from the patient or the patient’s parent or legal guardian.
6. HOW MEDICAL INFORMATION MAY BE USED FOR TREATMENT, PAYMENT OR HEALTHCARE OPERATIONS?Medical information may be used to justify needed patient care services, (i.e., lab tests, prescriptions, treatment protocols, research inclusion criteria). We will use medical information to establish a treatment plan. We may disclose protected health information to another provider for treatment (i.e., primary care physicians, specialist, physical therapist, hospitals, other providers, and etc.). If an insurance company is involved in reimbursement, we may provide information to your insurance company containing medical information and we may contact their utilization review department to receive pre- certification (prior approval for treatment) for non-urgent or emergency conditions. We will submit only the minimum amount of information necessary for this purpose. We may use the emergency contact information you provided to contact you if the address of record is no longer accurate. We may contact you to discuss treatment you received from Company.
   
   Minors: If you are an unemancipated minor, there may be circumstances in which we disclose health information about you to a parent or guardian in accordance with legal and ethical responsibilities.
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   Parents: If you are a parent of an unemancipated minor, and are acting as the minor’s personal representative, we may disclose health information about your child to you under certain circumstances. For example, if we are legally required to obtain you consent as your child’s personal representative in order for your child to receive care from us, we may disclose health information about your child to you. In some circumstances, we may not disclose health information about an unemancipated minor to you. For example, if your child is legally authorized to consent to treatment (without separate consent from you), consents to such treatment, and does not request that you be treated as his or her personal representative, we may not disclose health information about your child to you without your child’s authorization.
7. WHY DO I HAVE TO SIGN A CONSENT FORM?When you, as the patient or the parent or guardian of a patient, sign a consent form, you are giving us permission to use and disclose protected health information for the purposes of treatment, payment, and health care operations. If necessary, you will need to sign a separate authorization to have protected health information released for any reason other than treatment, payment or healthcare operations.
8. WHY DO I HAVE TO SIGN A SEPARATE AUTHORIZATION FORM?In order to release patient protected health information for any reason other than treatment, payment and health care operations, we must have an authorization signed by the patient or the parent or the guardian of the patient that clearly explains how they wish the information to be used and disclosed. The following are some examples of releases of information that require a separate authorization:
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   • Psychotherapy notes
   • Psychosocial information
   • Alcohol and drug abuse treatment information
   • Use of identifiable information in scientific and educational publications, presentations and materials.
9. CAN I CHANGE MY MIND AND REVOKE AN AUTHORIZATION?You may change your mind and revoke an authorization, except (1) to the extent that we have relied on the authorization up to that point, (2) information already provided is needed to maintain the integrity of a research study, or (3) if the authorization was obtained as a condition of obtaining insurance coverage. All requests to revoke an authorization should be in writing.
10. SHARING INFORMATION WITH BUSINESS ASSOCIATESThere are some services provided through contracts with business associates. Examples include billing services and transcription services but may include others. When these services are contracted, we may disclose your health information to the business associate so that they can perform the job we have contracted them to do. All business entities with whom we contract will comply with HIPAA regulations and be signatories to the acknowledgement of stated regulations.
11. WHEN IS MY AUTHORIZATION / CONSENT NOT REQUIRED?The law requires that some information may be disclosed without your authorization in the following circumstances:
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    • In case of an emergency;
    • When there are communication or language barriers;
    • When required by law;
    • When there are risks to public health (i.e., danger posed to self or others);
    • To conduct health oversight activities;
    • To report suspected child abuse or neglect;
    • To specified government regulatory agencies;
    • In connection with judicial or administrative proceedings under mandate of the court;
    • To coroners, funeral directors and for organ donation;
    • In the event of a serious threat to health or safety;
12. YOUR PRIVACY RIGHTSThe following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights:
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    You have the right to inspect and copy your health information. This means you may inspect and obtain a copy of your PHI that is contained in a “designated record set” for so long as we maintain the PHI. A designated record set contains medical and billing records and any other records that we use in making decisions about your healthcare. You may not however, inspect or copy the following records: psychotherapy and psychosocial notes; information compiled in a reasonable anticipation of, use in, a civil, criminal or administrative action or proceeding, and certain PHI that is subject to laws that prohibit access to that PHI. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have the right to have this decision reviewed.
    
    You have the right to request a restriction of your health information. This means you may ask us to restrict or limit the medical information we use or disclose for the purposes of treatment, payment or healthcare operations. We are not required to agree to a restriction that you may request. We will notify you if we deny your request. If we do agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment.
    
    You have the right to request to receive confidential communications by alternative means or at alternative locations. We will accommodate reasonable requests. We may also condition this accommodation by asking you for an alternative address or other method of contact. We will not request an explanation from you as the basis for the request.
    
    You have the right to request amendments to your health information. This means you may request an amendment of PHI about your designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request, you have the right to file a statement of disagreement and we may prepare a rebuttal to your statement and we will provide you with a copy of this rebuttal. Requests for amendment must be in writing.
    
    You have the right to receive an accounting of disclosures of your health information. You have the right to request an accounting of certain disclosures of your PHI. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this privacy Notice. We are also not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, to family or friends involved in your care, or certain other disclosures we are permitted to make without your authorization. The request should specify the time period sought for the accounting. We are not required to provide an accounting for disclosure that take place prior to April 14, 2003. Accounting requests may not be made for periods of time in excess of six years.
    
    You have the right to receive a paper copy of this Notice of Privacy Practices.
13. WHAT IF I HAVE A QUESTION / COMPLAINT?‍