HIPAA Notice of Privacy Practices

Our Commitment to Your Privacy

SIVAYA Health is committed to protecting the privacy of your protected health information (PHI) as required by the Health Insurance Portability and Accountability Act (HIPAA). This Notice of Privacy Practices describes how we may use and disclose your PHI and your rights regarding that information.

How We May Use and Disclose Your Health Information

For Treatment

We may use and disclose your PHI to provide, coordinate, or manage your medical weight loss care. For example, we may share information with other healthcare providers involved in your treatment, such as pharmacies that fulfill your prescriptions.

For Payment

We may use and disclose your PHI to bill and collect payment for services provided to you. For example, we may share information with payment processors or billing services.

For Healthcare Operations

We may use and disclose your PHI for our internal operations, including quality assessment, provider training, and compliance activities.

Other Permitted Uses and Disclosures

We may also use or disclose your PHI without your authorization in certain circumstances, including:

• As required by law or court order
• To public health authorities for reporting communicable diseases
• To report suspected abuse, neglect, or domestic violence
• To oversight agencies conducting audits or investigations
• In response to law enforcement requests as permitted by law
• To prevent a serious threat to health or safety
• For research purposes, subject to required safeguards
• To coroners, medical examiners, or funeral directors
• For organ donation purposes
• To workers' compensation programs where applicable

Uses and Disclosures Requiring Your Authorization

Other uses and disclosures of your PHI will be made only with your written authorization, including:

• Most uses and disclosures of psychotherapy notes
• Uses and disclosures of PHI for marketing purposes
• Sale of your PHI
• Any other uses or disclosures not described in this Notice

You may revoke any authorization you provide to us in writing at any time, except where we have already taken action in reliance on that authorization.

Your Rights Regarding Your Health Information

Right to Access

You have the right to inspect and receive a copy of your PHI. We may charge a reasonable fee for copies.

Right to Amend

You have the right to request an amendment to your PHI if you believe it is incorrect or incomplete. We may deny your request in certain circumstances.

Right to an Accounting of Disclosures

You have the right to request an accounting of disclosures of your PHI made by us, with certain exceptions.

Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your PHI. We are not required to agree to all restrictions, but we will comply with any restriction that you request regarding disclosures to your health plan if you pay for the service out of pocket.

Right to Confidential Communications

You have the right to request that we communicate with you about your health information in a specific way or at a specific location.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this Notice of Privacy Practices at any time, even if you have agreed to receive it electronically.

Our Duties

SIVAYA Health is required by law to:

• Maintain the privacy of your PHI
• Provide you with this Notice of our legal duties and privacy practices
• Abide by the terms of this Notice currently in effect
• Notify you in the event of a breach of your unsecured PHI

We reserve the right to change this Notice and to make the revised Notice effective for PHI we already have about you as well as any information we receive in the future. We will post the current Notice on our website with its effective date.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with SIVAYA Health or with the U.S. Department of Health and Human Services Office for Civil Rights. To file a complaint with us, please contact us using the information below. We will not retaliate against you for filing a complaint.

To file a complaint with the Office for Civil Rights: 1-800-368-1019 or visit www.hhs.gov/ocr/privacy/hipaa/complaints

Contact Our Privacy Officer

For questions about this Notice or to exercise any of your rights, please contact us: