Notice of Privacy Practices

Innate Wellness DFW 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.

Our Commitment

Innate Wellness DFW LLC (the "Practice") is required by law to maintain the privacy of your protected health information, to give you this Notice describing our legal duties and privacy practices, and to notify you if a breach of your unsecured health information occurs. We are required to follow the terms of the Notice currently in effect.

This Notice applies to all services provided by the Practice, including functional and integrative medicine, hormone and peptide therapy, medical weight management, longevity and performance testing, chiropractic services, and any other service line we operate. Tailored by Innate LLC is a separate legal entity affiliated with the Practice through common ownership. It maintains its own Notice of Privacy Practices, and services provided by that entity are not covered by this Notice.

How We May Use and Disclose Your Health Information

For treatment

We use your health information to provide, coordinate, and manage your care. This includes sharing information among our providers, and with providers outside the Practice to whom we refer you or from whom we obtain consultation. For example, our chiropractor may review notes from your medical provider where relevant to your care, and we may send an order and receive results from a laboratory or imaging provider involved in your care.

For payment

We use and disclose your health information to bill and collect payment for services. Because we are a direct-pay practice and do not bill insurance, Medicare, or Medicaid, these disclosures are limited and generally involve our payment processor and our own billing records. Where a laboratory or other provider bills your insurance directly under its own arrangement with your plan, that billing is between you and that provider.

For health care operations

We use your health information for activities necessary to operate the Practice, including quality assessment, provider review, training, business planning, and administrative services.

Appointment reminders and health-related communications

We may contact you to provide appointment reminders, scheduling updates, and care-related communications, and to tell you about treatment alternatives or other health-related benefits and services that may be of interest to you. You may ask us to stop these communications at any time by contacting our Privacy Officer using the details at the end of this Notice, and we will honor that request.

Fundraising

We do not use or disclose your health information for fundraising purposes.

Other Uses and Disclosures Permitted or Required by Law

We may use or disclose your health information without your authorization in the following circumstances:

• To persons involved in your care, where you agree or do not object, or where we reasonably infer from the circumstances that you do not object

• To notify a family member or personal representative of your location or general condition

• For public health activities, including disease reporting and adverse event reporting

• To report suspected abuse, neglect, or domestic violence as required by law

• For health oversight activities, including audits and investigations by licensing boards

• In response to a court order, subpoena, or other lawful process

• For law enforcement purposes as permitted by law

• To coroners, medical examiners, and funeral directors

• For organ and tissue donation purposes

• To avert a serious and imminent threat to health or safety

• For specialized government functions, including military and national security activities

• For workers’ compensation purposes as authorized by law

• Where otherwise required by federal, state, or local law

Business Associates

We may share your health information with business associates who perform functions on our behalf, such as our electronic records platform, our secure messaging platform, our scheduling system, and our billing and payment vendors. Each business associate is required by written agreement to safeguard your information consistent with HIPAA.

Providers who deliver care to you directly, including laboratories, imaging providers, pharmacies, and providers to whom we refer you, are not our business associates. They are independently responsible for your information under their own privacy obligations.

Uses and Disclosures Requiring Your Written Authorization

The following require your written authorization, which you may revoke at any time in writing, except to the extent we have already acted on it:

• Most uses and disclosures of psychotherapy notes

• Uses and disclosures for marketing purposes

• Any sale of your health information

• Any other use or disclosure not described in this Notice

WE DO NOT SELL YOUR HEALTH INFORMATION. WE DO NOT USE YOUR HEALTH INFORMATION FOR MARKETING PURPOSES WITHOUT YOUR WRITTEN AUTHORIZATION.

TEXAS LAW Texas law prohibits the sale of protected health information except in limited circumstances, and requires a separate authorization before certain electronic disclosures of your health information for purposes other than treatment, payment, health care operations, or as otherwise authorized by law.

Your Rights Regarding Your Health Information

Right to inspect and obtain a copy

You may inspect and obtain a copy of the health information we maintain about you. Requests should be made in writing to our Privacy Officer. We may charge a reasonable, cost-based fee for copying, supplies, and postage. We do not charge for searching for or retrieving your records.

TEXAS LAW If we use an electronic health record capable of fulfilling your request, we will provide your health information in electronic form no later than the fifteenth business day after we receive your written request, unless you agree to another format or timeframe. This is faster than the federal standard of thirty days.

Right to request an amendment

If you believe information in your record is incorrect or incomplete, you may request in writing that we amend it. We will respond within sixty days. If we deny your request, we will tell you why in writing, and you may submit a statement of disagreement that will become part of your record.

Right to an accounting of disclosures

You may request a list of certain disclosures we have made of your health information in the six years before your request. This does not include disclosures for treatment, payment, or health care operations, disclosures to you, or certain other exceptions. The first accounting in any twelve-month period is free.

Right to request restrictions

You may ask us to limit how we use or disclose your health information. We are not required to agree, except that we must agree to withhold information from a health plan when you have paid for the service in full out of pocket and the disclosure would be for payment or health care operations.

Right to confidential communications

You may ask us to contact you in a specific way or at a specific location. We will accommodate reasonable requests and will not ask you to explain why.

Right to a paper copy of this Notice

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

Right to be notified of a breach

We will notify you if a breach occurs that may have compromised the privacy or security of your health information.

Right to choose someone to act for you

If you have given someone medical power of attorney, or if someone is your legal guardian, that person may exercise your rights and make choices about your health information. We will verify that the person has this authority before we act.

Our Responsibilities

• We are required by law to maintain the privacy and security of your health information

• We will notify you promptly if a breach occurs that may have compromised your information

• We must follow the duties and privacy practices described in this Notice and give you a copy of it

• We will not use or share your information other than as described here unless you tell us we may in writing

• If you tell us we may, you may change your mind at any time by notifying us in writing

• We will not retaliate against you for filing a complaint or exercising any right described in this Notice

How to Complain

If you believe your privacy rights have been violated, you may complain to us or to the Secretary of the United States Department of Health and Human Services. We will not retaliate against you for filing a complaint.

To complain to us

Rebecca Russ, RN, BSN

Privacy Officer, Innate Wellness DFW LLC

17130 Dallas Parkway, Suite 220, Dallas, TX 75248

Phone: (903) 617-9061 Email: rebecca@innate-dfw.com

To complain to the federal government

Office for Civil Rights, U.S. Department of Health and Human Services. Complaints may be filed by mail, by telephone, or online at the Office for Civil Rights website. Complaints must generally be filed within 180 days of when you knew the violation occurred.

To complain to the State of Texas

Complaints regarding health information privacy may also be directed to the Office of the Attorney General of Texas. Complaints regarding the conduct of a licensed provider may be directed to that provider’s licensing board.

Changes to This Notice

We may change this Notice at any time. Changes will apply to all health information we maintain, including information we created or received before the change. The current Notice will be posted in our office and on our websites, and a copy is available on request. The effective date appears at the top of this Notice.

Questions

If you have any question about this Notice or about how we handle your health information, please contact our Privacy Officer. The Practice may also be reached at (469) 340-0572 or info@innate-dfw.com.

Rebecca Russ, RN, BSN

Privacy Officer, Innate Wellness DFW LLC

17130 Dallas Parkway, Suite 220, Dallas, TX 75248

Phone: (903) 617-9061 Email: rebecca@innate-dfw.com