HIPAA Notice of Privacy Practices

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.

Juniper Vitality ("we," "us," "our") is required by federal law (the Health Insurance Portability and Accountability Act, or "HIPAA") to maintain the privacy of your protected health information (PHI), to provide you with this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How we use and disclose your health information

For treatment

We use your health information to provide you with care, coordinate with other healthcare providers involved in your treatment, and consult with specialists. For example, with your authorization, we may share information with your oncology team, primary care physician, or other clinicians involved in your care.

For payment

Juniper Vitality is a cash-pay practice and does not bill insurance directly. However, we provide superbills you may submit to your insurance for possible reimbursement. If you choose to do so, the superbill will contain diagnosis codes, procedure codes, and provider information necessary for the insurer to evaluate your claim.

For healthcare operations

We may use your health information to operate our practice — for example, to evaluate the quality of care, conduct internal audits, or train staff. We minimize the use of identifiable information for these purposes whenever possible.

Other permitted uses and disclosures

We may use or disclose your health information without your written authorization in certain situations permitted or required by law, including:

• Public health activities (such as reporting communicable diseases as required by law)
• Reporting suspected abuse, neglect, or domestic violence
• Health oversight activities by government agencies
• Judicial and administrative proceedings (such as in response to a court order or subpoena)
• Law enforcement purposes when required by law
• To coroners, medical examiners, and funeral directors
• For organ and tissue donation, when applicable
• Research purposes that have been approved by an institutional review board
• To avert a serious threat to health or safety
• For workers' compensation claims, if applicable

Uses requiring your written authorization

Other uses and disclosures of your health information will require your written authorization, including:

• Most uses and disclosures of psychotherapy notes
• Uses and disclosures for marketing purposes
• Sale of your health information

You may revoke a written authorization at any time, in writing, except to the extent we have already taken action in reliance on it.

Your rights regarding your health information

Right to access your records

You have the right to inspect and obtain a copy of your health information in our records. Requests should be submitted in writing to info@junipervitality.com. We will respond within 30 days. A reasonable, cost-based fee may apply for copies.

Right to request amendment

If you believe information in your record is incorrect or incomplete, you may request an amendment in writing. We may deny the request under certain circumstances, in which case we will provide a written explanation.

Right to an accounting of disclosures

You have the right to request a list of certain disclosures of your health information made by us, other than for treatment, payment, or healthcare operations. The first request in any 12-month period is free; reasonable fees may apply for additional requests.

Right to request restrictions

You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to all requested restrictions, but we will accommodate them when reasonably possible.

Right to request confidential communications

You have the right to request that we communicate with you about your health information in a particular manner or at a particular location (for example, by email rather than mail, or at a work address rather than home).

Right to a paper copy of this notice

You have the right to receive a paper copy of this notice upon request, even if you have agreed to receive electronic communications.

Right to be notified of a breach

You have the right to be notified if we discover a breach of unsecured protected health information that affects you.

Our responsibilities

We are required to:

• Maintain the privacy and security of your protected health information
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your information
• Follow the duties and privacy practices described in this notice and provide you with a copy
• Not use or disclose your health information except as described in this notice or as you direct in writing

Changes to this notice

We may change the terms of this notice at any time, and the changes will apply to all health information we have about you. The effective date at the top of this notice will be updated when changes are made. Updated notices will be posted on the Website and available on request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us by emailing info@junipervitality.com, or with the U.S. Department of Health and Human Services Office for Civil Rights at:

200 Independence Avenue SW
Washington, DC 20201
www.hhs.gov/hipaa/filing-a-complaint

You will not be retaliated against for filing a complaint.

Contact

For questions about this notice or to exercise any of the rights described above, contact us at info@junipervitality.com.

This HIPAA Notice is provided as a starting framework and should be reviewed by qualified legal counsel and your HIPAA Privacy Officer before final publication. Specific operational practices (such as your appointed Privacy Officer's contact information) may need to be added.