Notice of Privacy Practices

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.

 

If you have any questions about this Notice, please contact the Clinic Privacy Office listed at the end of this Notice.

We, Horizen Medical (“Clinic”) are required by law to maintain the privacy of your health information and to give you our Notice of Privacy Practices (this "Notice") that describes our privacy practices, legal duties and your rights concerning your health information.

Our Pledge Regarding Medical Information: We understand that your medical information is personal. We are committed to protecting your medical information.

This Notice will tell about the ways in which the Clinic may use your medical information and disclose your medical information to others outside the Clinic. The law requires the Clinic to:

• Make sure that medical information that identifies you is kept private;

• Inform you of our legal duties and privacy practices with respect to your medical information;

• Follow the terms of the Notice that is currently in effect; and

• Notify you following a breach of your unsecure medical information.

Who Will Follow This Notice: The Clinic and all of its sites and locations will follow the terms of this Notice, including:

• All employees, contractors, volunteers, and other agents ("authorized personnel") of the Clinic.

• Health care professionals authorized to enter information into your medical records at the Clinic.

• Members of the Clinic's medical staff and their authorized personnel.

• Health care providers who share an electronic medical record with the Clinic may also use this Notice (although they may have their own, which they will follow).

How the Clinic May Use and Disclose Your Medical Information: We may use your medical information or share it with others for the following purposes:

• Treatment. Your medical information may be used to provide you with medical treatment or services. This medical information may be disclosed to doctors, interns, nurses, technicians, volunteers, students, and others involved in your care at the Clinic. We may also share your medical information with health care providers and their staff outside the Clinic. We may also use your medical information to contact you to provide appointment reminders or to give you information about treatment options or other health-related benefits and services that may interest you.
  
  For example: A doctor treating you for a weight loss may need to know if you have diabetes because diabetes may affect your weight loss process. The doctor may need to tell the dietitian about the diabetes so appropriate meals can be arranged. Different departments of the Clinic may also share medical information about you in order to coordinate your different needs, such as prescriptions, lab work and x-rays. The Clinic also may disclose medical information about you to people outside the Clinic who may be involved in your medical care after you leave the Clinic, such as family members, other health agencies, and others who provide services that are part of your care.

• Payment. Your medical information may be used and disclosed so that the treatment and services received at the Clinic may be billed and payment may be collected from you, your insurance company and/or a third party. Please note, we will comply with your request not to disclose your health information to your insurance company if the information relates solely to a healthcare item or service for which you have paid out of pocket and in full to us.
  
  For example: If insurance will be responsible for reimbursing the Clinic for your care, the health plan or insurance company may need information about a service you received at the Clinic so they can provide payment for that service. Information may also be given to someone who helps pay for your care. Your health plan or insurance company may also need information about a treatment you are going to receive to obtain prior approval or to determine whether they will cover the treatment.

• Health Care Operations. Your medical information may be used and disclosed for purposes of furthering day-to-day Clinic operations. These uses and disclosures are necessary to run the Clinic and to monitor the quality of care our patients receive. We may also share your medical information with outside companies that perform services for us such as accreditation, legal, computer or auditing services. These outside companies are called "Business Associates" and are required by HIPAA to keep your medical information confidential.
  
  For example: Your medical information may be:

  1. Reviewed to evaluate the treatment and services performed by our staff in caring for you.

  2. Combined with that of other Clinic patients to decide what additional services the Clinic should offer, what services are not needed, and whether certain new treatments are effective.

  3. Disclosed to doctors, nurses, technicians, and other agents of the Clinic for review and learning purposes.

  4. Disclosed to healthcare students, interns and residents for educational purposes.

  5. Combined with information from other facilities to compare how we are doing and see where we can improve the care and services offered. Information that identifies you in this set of medical information may be removed so others may use it to study health care and health care delivery without knowing who the specific patients are.

• Participation in a Shared Electronic Medical Record. The Clinic participates in a shared electronic medical record with other health care providers in the community. We do this so that it is easier for your health care providers to have access to your health information and it improves the quality of your care. If you would like a list of the health care providers that participate in the shared medical record, please contact the Clinic Privacy Office. (ARE WE DOING THIS?)

• Private Accreditation Organizations. Your medical information may be used to fulfill this Clinic's requirements to meet the guidelines of private Clinic accreditation organizations such as the Joint Commission, NCQA, etc.

• Participation in Health Information Networks and Exchanges. We may participate in health information networks and exchanges (HINs/HIEs) that securely share your electronic health information with others for treatment, payment, health care operations, public health, and other purposes allowed by law, such as giving you access to your own records. You may be asked to "opt in" or "opt out" of sharing your information through an HIN/HIE. If you choose to opt out, we may still use and share your information as required or permitted by law. If you ask to see your information through an HIN/HIE, please know that because of current technical and administrative limitations it is not feasible for us to provide you with all your information this way. You can exercise your right to access your medical information by sending a written request to the Clinic Compliance Office listed at the end of this Notice.

• Individuals Involved in Your Care. We may share your medical information with a family member, guardian or other individual involved in your care, or who helps pay for your care. If you have any objection to sharing your medical information in this way, please contact the Clinic Compliance Office listed at the end of this Notice.

• Research. Under certain circumstances, your medical information may be used and disclosed for research purposes. All research projects involving patients' medical information must be approved through a special review process to protect patient confidentiality. A researcher may have access to information that identifies you only through the special review process, or with your written permission. In addition, researchers may contact patients regarding their interest in participating in certain research studies. Researchers may only contact you if they have been given approval to do so by the special review process. You will only become a part of one of these research projects if you agree to do so and sign a consent form.

• Marketing or Sale of Health Information. Most uses and disclosures of your medical information for marketing purposes or any sale of your medical information will require your written permission. We may communicate with you about our own products or services.

• Artificial Intelligence (AI) Technologies. Your medical information may be used with AI technologies to support various functions, such as treatment, payment and health care operations. These AI tools may assist in analyzing health data, streamlining administrative workflows and supporting clinical decisions.
  
  For example: We may use AI solutions to assist with tasks such as medical transcription and summary services to improve the quality of care our patients receive or to provide your doctor with evidence-based insights to support treatment decisions.

• As Required by Law. Your medical information will be disclosed when we are required to do so by federal, state, or local authorities, laws, rules and/or regulations.

• Judicial or Administrative Proceeding. Your medical information may be disclosed in a judicial or administrative proceeding in response to (i) a court or administration order; or (ii) a subpoena, discovery request, or other lawful process if certain conditions are met.

• Law Enforcement. Your medical information may be released to law enforcement as authorized or required by law.
  
  For example, we may release your information:

  1. In response to a court order, subpoena, warrant, summons or similar process;

  2. To identify or locate a suspect, fugitive, material witness, or missing person;

  3. About the victim of a crime if, under certain limited circumstances, we are unable to obtain the victim's agreement;

  4. About a death we believe may be the result of criminal conduct;

• To Prevent a Serious Threat to Health or Safety. We may use or share your medical information when necessary to prevent a serious threat to your health and safety and that of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

• Health Oversight Activities. We may disclose your medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

• Military and Veterans. If you are a member of the armed forces, your medical information may be released as required by military command authorities. If you are a member of the foreign military personnel, your medical information may be released to the appropriate foreign military authority.

• National Security and Intelligence Activities. Your medical information will be released to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

• Protective Services for the President and Others. Your medical information may be disclosed to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

• Public Health Purposes. We may release your medical information for public health activities, such as activities:

  1. To prevent or control disease, injury or disability;

  2. To report reactions to medications or problems with products;

  3. To notify people of recalls of products they may be using;

  4. To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;

  5. To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

• Specially Protected Information

• Psychotherapy Notes: HIPAA provides additional protection for psychotherapy notes, which are the personal notes of a mental health professional about a private or group counseling session. Most uses or disclosures of psychotherapy notes require your written permission.

• Other Sensitive Information: Other types of information may have greater protection under state law, such as certain drug and alcohol information, HIV/AIDS and other communicable disease information, genetic information, mental health information, or information about developmental disabilities. For this type of information, we may be required to get your written permission before disclosing it to others. We may seek that permission in the Clinic's Condition of Admission form if permitted by law. If you have any questions about this, contact the Clinic Privacy Office at the end of this Notice.

• Other Uses and Disclosures: If the Clinic wants to use or disclose your medical information for a purpose that is not discussed in this Notice, the Clinic will ask for your written permission. If you give your permission to the Clinic, you may revoke (take back) that permission at any time, unless we have already relied on your permission to use or disclose the information. If you want to revoke your permission, please notify the Clinic Cpmpliance Office listed at the end of this Notice in writing.

Your Rights Regarding Your Medical Information: You have the following rights, subject to certain limitations, regarding your medical information: ** NOTE: All Requests Must Be Submitted in Writing to the Clinic Compliance Office listed at the end of this Notice **

• Right to Request Access to Your Medical Information. With certain exceptions, you have the right to see and get a copy of your medical information that may be used to make decisions about your care. If you request a paper copy of your information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request. There is no fee to see your medical information.

• Right to Request an Amendment of Your Medical Information. If you feel that the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. Please be specific about the information that you believe is incorrect or incomplete.

• Right to a List of Disclosures. You have the right to request a list of the disclosures we made of your medical information for purposes other than treatment, payment and health care operations. The first list you request will be free. For additional lists that you request within a 12-month period, we may charge you for the costs of providing the list. We will notify you of the cost in advance so that you can choose whether to get the list.

• Right to Request Restrictions on How Your Medical Information is Used or Disclosed. You have a right to request that we change the way we use or disclose your medical information for treatment, payment or health care operations. In your request, you must tell us:

  1. What information you want to limit;

  2. Whether you want to limit our use, disclosure or both;

  3. To whom you want the limits to apply, for example, disclosures to your spouse.
     
     We are not required to agree to your request, except that will not share your medical information with your health insurance company if you pay for the entire amount due for the services you receive (unless we are required by law to share the information with your health insurance company).

• Right to Request Confidential Communication. You have the right to request that we communicate with you in a certain way or at a certain location that you think will be more confidential. For example: You can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

• Right to Be Notified of Breach. You have the right to be notified if we discover a breach of your unsecured protected health information.

• Right to a Paper or Electronic Copy of This Notice. You have the right to a paper or electronic copy of this Notice. You may ask us to give you a copy at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.

ADDITIONAL INFORMATION CONCERNING THIS NOTICE:

• Notice of Redisclosure. Medical information that is disclosed pursuant to this Notice may be subject to redisclosure by the recipient and no longer protected by HIPAA. Federal or state law applicable to the recipient may limit their ability to use or disclose the medical information received, such as if they are another health care provider subject to HIPAA or a program or entity subject to Part 2.

• Changes To This Notice. We reserve the right to change this Notice and make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. The Clinic will post a current copy of the Notice with the effective date on its website and in the Clinic. In addition, each time you register at, or have an appointment at, the Clinic for treatment or health care services as an patient, we will offer you a copy of the current Notice in effect.

Complaints. You will not be retaliated against for filing a complaint. If you believe your privacy rights have been violated, you may file a complaint with the Clinic and/or with the Secretary of the U.S. Department of Health and Human Services. Some States may allow you to file a complaint with the State's Attorney General, Office of Consumer Affairs or another State agency as specified by applicable State law. To file a complaint with the Clinic, submit a written complaint to the Clinic Compliance Office:

Contact Information for the Clinic Compliance Office:
Phone Number: (513)-285-6973
Email Address: soraya@horizenmedical.com

EFFECTIVE DATE: 4/22/2026