NOTICE OF PRIVACY PRACTICES FOR SERENEVILLE HEALTH

Effective Date: July 1, 2025

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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.

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OUR COMMITMENT TO YOUR PRIVACY: At SereneVille Health, we understand that medical information about you and your health is personal. As a solo practitioner utilizing a HIPAA-compliant Electronic Medical Record (EMR) and patient portal, we are committed to protecting the privacy of your protected health information (PHI). This Notice of Privacy Practices describes how we, as a Covered Entity, may use and disclose your PHI to carry out treatment and healthcare operations, and for other purposes that are permitted or required by law. It also describes your rights regarding your PHI. We are required by law to maintain the privacy of your PHI and to provide you with this notice of our legal duties and privacy practices. We are also required to notify you following a breach of your unsecured PHI.

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WHO WILL FOLLOW THIS NOTICE: This Notice describes the privacy practices of SereneVille Health, as the sole practitioner and responsible party, regarding all protected health information maintained by this practice.

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UNDERSTANDING YOUR HEALTH RECORD/INFORMATION: Your health record contains personal information about your past, present, or future health or condition, the provision of healthcare to you, and the record of payments for that healthcare. This information is called Protected Health Information (PHI). PHI includes individually identifiable health information that is created or received by us and that relates to your physical or mental health.

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HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI): As a solo, cash-pay practice seeing only adult patients (18 years of age and older), our primary uses and disclosures of your PHI are directly related to providing you care and managing our clinic. We strive to maintain the highest level of privacy for your health information.

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For Treatment: We will use your PHI to provide, coordinate, and manage your healthcare. This includes documenting your health history, diagnoses, treatments, and plans within our secure EMR system. If a referral to another healthcare provider is deemed necessary for your care, we will obtain your specific written authorization before sending any of your PHI to that provider.

Example: We will document your symptoms, diagnosis, and treatment plan in your electronic health record. If we need to refer you to a specialist, we will ask for your consent to share relevant information with them.

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For Healthcare Operations: We may use your PHI for activities necessary to run SereneVille Health, improve the quality of care, and manage administrative functions. Since we are a solo practice, these operations are primarily internal. This includes maintaining your records within our HIPAA-compliant EMR and patient portal, and internal reviews to ensure quality of care.

Example: We may review your health information (along with others) to assess and improve the effectiveness of the services provided at SereneVille Health.

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As a Cash-Pay Practice (Payment): SereneVille Health is a cash-pay practice and does not bill any insurance companies for services rendered. Therefore, disclosures for "payment" purposes are limited to our direct interactions with you. We will use your PHI to manage your account, process payments from you, and provide you with statements or receipts for services rendered. We will not disclose your PHI to insurance companies for billing purposes.

Example: We will use your health information to generate a statement detailing the services you received and the amount due, for your direct payment.

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Appointment Reminders/Treatment Alternatives/Health-Related Benefits and Services: We may use and disclose PHI to contact you via our secure patient portal app, phone call, or text message to remind you that you have an appointment, or to tell you about possible treatment options, alternatives, or health-related benefits and services offered by SereneVille Health that may be of interest to you.

Example: Our patient portal may send you an automated reminder about your upcoming appointment.

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Individuals Involved in Your Care (with your consent): We value your privacy. We will only disclose PHI to a family member, other relative, close personal friend, or any other person you identify who is involved in your care if you provide explicit permission (verbally or in writing). If you are not present or are incapacitated, and we determine that it is in your best interest, we may make such disclosures to facilitate your care, including informing them of your location and general condition.

Example: If you wish for a family member to discuss your treatment with us, you would need to inform us and provide permission.

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Required by Law: We will disclose PHI about you when required to do so by federal, state, or local law.

Example: We may be required to report certain communicable diseases to public health authorities, or to respond to a court order.

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Public Health Activities: We may disclose PHI for public health activities and purposes to a public health authority that is authorized by law to collect or receive the information.

Example: Reporting information about certain diagnoses if mandated by public health regulations.

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Food and Drug Administration (“FDA”): We may disclose PHI related to adverse events with FDA-regulated products (drugs, devices, foods, and supplements) or to enable product recalls, repairs, or replacement.

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Health Oversight Activities: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.

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Lawsuits and Disputes: If you are involved in a lawsuit or dispute, we may disclose PHI in response to a court or administrative order. We may also disclose PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

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Law Enforcement: We may release PHI if asked to do so by a law enforcement official under specific circumstances, such as in response to a court order, to identify or locate a suspect, or in emergency circumstances to report a crime, or to assist in locating missing persons.

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Disaster Relief: We may use and disclose your PHI to certain entities for purposes of disaster relief efforts (e.g., American Red Cross or similar federal, state, or local disaster relief agency or authority) to help the agency locate persons affected by a disaster.

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Coroners, Medical Examiners, and Funeral Directors: We may release PHI to a coroner or medical examiner as authorized by law (e.g., to identify a deceased person or determine the cause of death). We may also release PHI to funeral directors as necessary to carry out their duties.

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Research: We may use and disclose your PHI for research purposes but only if certain conditions are met, such as a formal review board has determined and documented that such use or disclosure of PHI involves no more than a minimal risk to your privacy, or if the information is anonymized.

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Fundraising: While SereneVille Health does not currently engage in fundraising using your PHI, should we decide to use or disclose your PHI to communicate with you about fundraising efforts, we will provide you with an opportunity to opt-out of such communications.

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To Prevent a Serious Threat to Health or Safety: We may use and disclose PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

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Victims of Abuse or Neglect: We may disclose PHI about you to a government authority if we reasonably believe you are a victim of abuse or neglect. We will only disclose this type of information to the extent required or permitted by law, or if you agree to the disclosure.

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Specific Florida State Laws: Be aware that Florida state laws may require or permit additional disclosures in certain situations, such as mandatory reporting of child abuse, elder abuse, or certain types of wounds or diseases, which may supersede or be more stringent than federal HIPAA requirements. We will comply with all applicable Florida laws.

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USES AND DISCLOSURES REQUIRING YOUR SPECIFIC WRITTEN AUTHORIZATION: Other uses and disclosures of your PHI not described in this Notice will be made only with your specific written Authorization. This includes, but is not limited to:

• Uses and disclosures for marketing purposes (e.g., if we wished to use your testimonial beyond internal operations).

• Disclosures that constitute a sale of your PHI.

• Disclosures to outside parties not directly involved in your treatment, payment processing, or our internal healthcare operations, such as for research purposes (unless anonymized).
   

You may revoke any such Authorization in writing at any time. If you revoke your Authorization, we will no longer use or disclose PHI about you for the reasons covered by your written Authorization. We are unable to take back any disclosures we have already made with your Authorization.

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YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION: You have the following rights regarding the PHI we maintain about you:

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Right to Inspect and Copy: You have the right to inspect and obtain a copy of your PHI that we maintain about you in our secure EMR system, which may be used to make decisions about your care. If we maintain your PHI electronically, you can ask for a copy of the PHI in an electronic format. You may also ask us to send a copy of your PHI to other individuals or entities that you designate in writing. To request access to your records, you must submit your request in writing to SereneVille Health at the contact information provided below. We may charge a reasonable, cost-based fee for the costs of copying (if paper copies are requested), mailing, or other supplies associated with your request. We will generally provide access within 15 business days (as per recent federal guidelines) but may extend this if documented appropriately.

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Right to Amend: If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, you must submit your request in writing, along with a reason that supports your request, to SereneVille Health at the contact information provided below.

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Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures." This is a list of certain disclosures we have made of your PHI outside of treatment, payment, and healthcare operations. To request this list, you must submit your request in writing to SereneVille Health. If you request such a list more than once a year, we may charge a fee.

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Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment or healthcare operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care, like a family member or friend. While we are not generally required to agree to your request for a restriction, we must agree to a request to restrict disclosure of your PHI to a health plan (insurance company) if the disclosure is for the purpose of payment or healthcare operations and pertains to a healthcare item or service for which you have paid out-of-pocket in full. As a cash-pay practice where you pay for all services directly, we will comply with your request not to disclose such information to your health plan, provided the disclosure is not otherwise required by law (e.g., for public health reporting or court order).

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Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you only at work or through the patient portal. Please note, if you choose to receive communications from us through email or other electronic means outside of our secure patient portal, those communications may not be secure, and your PHI could be intercepted and read by unauthorized third parties. To request confidential communications, you must make your request in writing to SereneVille Health. Your request must tell us how or where you would like to be contacted. We will accommodate all reasonable requests.

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Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice. You may ask us for a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy. You may obtain a copy at our office or on our website, https://www.serenevillehealth.com/npp

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CHANGES TO THIS NOTICE: We reserve the right to change this Notice at any time. The revised Notice will be effective for all PHI that we already have about you as well as any PHI we receive in the future. We will post a copy of the current Notice in our office and on our website, if applicable. You may request a copy of the current Notice from SereneVille Health at any time.

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COMPLAINTS:

If you believe your privacy rights have been violated, you may file a complaint directly with SereneVille Health or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with SereneVille Health, please contact:

Privacy Officer, SereneVille Health
300 E University Ave, Ste 180 Gainesville, FL 32601.
Ph : (352) 354-3559
Email: care@SerenevilleHealth.com

You will not be retaliated against for filing a complaint.

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CONTACT PERSON:

If you have any questions about this Notice, please contact:

Privacy Officer, SereneVille Health
300 E University Ave, Ste 180 Gainesville, FL 32601 Ph : (352) 354-3559
Email : care@SerenevilleHealth.com