Notice of Privacy Practices

Our Responsibilities

Solenne Health Services ("Solenne," "we") is required by law to:

• Maintain the privacy and security of your protected health information (PHI).
• Provide you with this Notice describing our legal duties and privacy practices.
• Follow the terms of the Notice that is currently in effect.
• Notify you if a breach occurs that may have compromised the privacy or security of your information, as required by law.

Your Rights

When it comes to your health information, you have certain rights, and we have responsibilities to help you with them.

Get an electronic or paper copy of your medical record

• You can ask to see or get a copy of your medical record and other health information we have about you.
• We will provide a copy or a summary, usually within 30 days of your request, and may charge a reasonable, cost-based fee as allowed by law.

Ask us to correct your medical record

• If you believe information is incorrect or incomplete, you can ask us to correct it.
• We may say "no," but we will tell you why in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, at a different mailing address, email, or phone number).
• We will accommodate reasonable requests.

Ask us to limit what we use or share

• You can ask us not to use or share certain information for treatment, payment, or health care operations; we are not required to agree, and we may say "no" if it would affect your care.
• If you pay for a service or item in full out-of-pocket, you can ask us not to share that information with your health plan for payment or health care operations, unless a law requires us to share it.

Get a list of those with whom we've shared information

• You can ask for an "accounting" of disclosures of your PHI for up to six years before the date of your request, excluding disclosures for treatment, payment, and health care operations, and certain other disclosures that the law does not require us to list.

Get a copy of this Notice

• You can ask for a paper copy of this Notice at any time, even if you agreed to receive it electronically.

Choose someone to act for you

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your information, as permitted by law.

File a complaint if you feel your rights are violated

• You can complain directly to us using the contact information at the end of this Notice.
• You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights; instructions are available at www.hhs.gov/ocr/privacy.
• We will not retaliate against you for filing a complaint.

Your Choices

In certain situations, you can tell us your preferences about what we share. If you have a clear preference, tell us what you want us to do, and we will follow your instructions when possible and as allowed by law.

You can tell us your choices about:

• Sharing information with your family, close friends, or others involved in your care or payment for your care.
• Sharing information in a disaster relief situation.
• Including your information in a facility directory (if applicable).

If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest, or when needed to lessen a serious and imminent threat to health or safety, as permitted by law.

We will never sell your PHI or share it for most marketing purposes without your written authorization, as required by law.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

Treat you

• We can use your health information and share it with other professionals who are treating you, including for coordination of care and consultation.

Run our organization

• We can use and share your health information to manage and improve our practice, perform quality assessment and improvement activities, train staff and students, and for other health care operations permitted by law.

Bill for your services

• We can use and share your health information to bill and receive payment from you, your health plan, or other payors.

We are allowed or required to share your information in other ways—usually in ways that contribute to the public good—such as public health and research, as long as we meet many conditions in the law. For example, we may share information:

• For public health and safety activities, such as reporting certain diseases, injuries, or adverse events, or preventing or reducing a serious threat to anyone's health or safety.
• With health oversight agencies for activities authorized by law, such as audits, investigations, inspections, and licensure.
• In response to a court or administrative order, subpoena, or other lawful process.
• With law enforcement officials in limited circumstances, such as to locate a missing person or report certain types of injuries or crimes, as allowed by law.
• With medical examiners or funeral directors, or for organ and tissue donation, as allowed by law.
• For workers' compensation or similar programs as authorized by law.
• For specialized government functions (such as military and veterans' activities, national security, and protective services), when applicable and permitted by law.

For uses and disclosures not described in this Notice or otherwise permitted or required by law, we will obtain your written authorization. If you give such an authorization, you may revoke it at any time in writing, except to the extent that we have already relied on it.

Our Duties and Changes to This Notice

• We are required by law to maintain the privacy and security of your PHI.
• We reserve the right to change our privacy practices and this Notice at any time, as permitted by law.
• When we make material changes, the new Notice will apply to all PHI we maintain, and we will post the revised Notice in our office(s), on our website (if applicable), and make it available upon request.

How We Provide This Notice

• You may receive this Notice in paper or electronic form.
• We will make this Notice available to anyone who asks for it, and we will post it prominently at our service location(s) and on any website we maintain that provides information about our services or benefits.

Contact Information

If you have questions about this Notice, want to exercise your rights, or wish to file a complaint, contact:

Privacy Officer: Sheree Young
Organization: Solenne Health Services
Address: 1660 Parcher Rd. Bucyrus, OH 44820
Phone: 614-389-9170
Email: privacy@solennehealthservices.com

You may also file a complaint with:

U.S. Department of Health and Human Services, Office for Civil Rights
Online: www.hhs.gov/ocr/privacy
Phone and mailing information are available on the OCR website.

You will not be penalized or retaliated against for filing a complaint.