Effective Date: June 18th, 2025

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.

A&E IV Wellness is committed to protecting your health information. This Notice of Privacy Practices explains how we may use and disclose your protected health information (PHI) and outlines your rights under the Health Insurance Portability and Accountability Act (HIPAA).

We are required by law to:

• Maintain the privacy of your protected health information
  
  
• Provide you with this notice of our legal duties and privacy practices
  
  
• Abide by the terms of this notice
  
  
• Notify you if a breach of your unsecured PHI occurs
  
  

We may use and disclose your PHI for the following purposes without your written permission:

To provide, coordinate, or manage your care and related services (e.g., consulting with a supervising medical provider).

To bill and collect payment for services, including disclosing necessary information to your health plan or payment processor.

For business activities such as quality assessment, training, and licensing.

When required by federal, state, or local law, including public health activities or law enforcement requests.

We may use or disclose your information when necessary to prevent a serious threat to your health and safety or that of the public.

We will obtain your written permission before using or disclosing your PHI for:

• Marketing purposes
  
  
• Sale of PHI
  
  
• Most sharing of psychotherapy notes
  
  

You may revoke any authorization in writing at any time.

You have the right to:

• Request Restrictions: Ask us not to use or disclose certain health information. We are not required to agree, but we will comply when possible.
  
  
• Receive Confidential Communications: Request that we contact you in a specific way or at a specific location.
  
  
• Inspect and Copy: Obtain a copy of your health record, with limited exceptions.
  
  
• Request an Amendment: Request corrections to your medical record if you believe it is incomplete or inaccurate.
  
  
• Receive an Accounting of Disclosures: Get a list of disclosures we made of your PHI (excluding disclosures for treatment, payment, healthcare operations, or with your authorization).
  
  
• Obtain a Paper Copy of This Notice: You may request a paper copy at any time, even if you agreed to receive it electronically.
  
  

If you have questions or believe your privacy rights have been violated, you may contact us:

Privacy Officer
A&E IV Wellness
Phone: (631) 557-5117
Email: aeivwellness@gmail.com

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. You will not be penalized for filing a complaint.