Last updated May 12, 2025

This Notice describes how your medical information may be used and disclosed, and how you can access this information. Please review it carefully.

Our Legal Duty

We are legally required by the Health Insurance Portability and Accountability Act (HIPAA) to maintain the privacy and security of your protected health information (PHI). We must provide you with this notice of our legal duties and privacy practices, follow the terms of this notice, and notify you promptly if a breach occurs that may have compromised the privacy or security of your information.

What Is Protected Health Information (PHI)?

PHI includes any individually identifiable health information, whether oral, written, or electronic, that relates to:

• Your past, present, or future physical or mental health condition,
• The healthcare services provided to you, and
• Payment for such healthcare services.

How We May Use and Disclose Your PHI

We may use or disclose your PHI for the following purposes without your written authorization:

1. Treatment

To provide, coordinate, or manage your healthcare. For example, we may share information with a hospital if you fall seriously ill or with a mental health professional if you’re at risk of self-harm or harm to others.

2. Payment

To obtain reimbursement for services or determine eligibility for coverage. This includes sharing PHI with your health insurance provider.

3. Healthcare Operations

For activities necessary to run our practice, such as quality assessment, staff performance reviews, training, and auditing.

4. Business Associates

With contracted service providers (e.g., billing companies, IT providers) who are legally required to protect your information.

5. Appointment Reminders & Health Communications

To remind you of appointments or inform you about treatment alternatives or other health-related benefits.

6. Family, Friends, or Others Involved in Your Care

Unless you object, we may share limited PHI with individuals involved in your care or payment for care. You may opt out at any time.

7. Emergency or Serious Threats

To prevent serious threats to your health or safety or the safety of others.

8. Public Health and Safety

To public health authorities for purposes such as disease reporting, product recalls, or exposure notifications.

9. Legal and Government Purposes

As required by law, including:

• Court orders or subpoenas,
• Law enforcement requests (e.g., to locate a suspect or report a crime on our premises),
• National security or intelligence matters,
• Health oversight (audits, investigations),
• Compliance with workers’ compensation laws,
• Organ/tissue donation, or with coroners and funeral directors,
• Military or veterans’ services,
• Correctional institutions (if you are an inmate).

10. Disaster Relief

To disaster relief organizations to help coordinate your care or inform family members of your location or status.

Uses and Disclosures Requiring Written Authorization

We will not use or share your PHI for purposes such as:

• Marketing
• Sale of your PHI
• Disclosures of psychotherapy notes

without your explicit written permission. You may revoke your authorization at any time in writing.

Special Protections for Sensitive Information

We apply additional privacy safeguards for sensitive PHI such as:

• HIV/AIDS status,
• Mental health treatment,
• Substance use disorder records,
• Genetic information.

Please contact our Privacy Officer for more details about these protections.

Your Rights Regarding Your PHI

You have the right to:

1. Access Your Medical Records

Request to inspect and receive copies of your PHI, including in electronic format. We may charge a reasonable fee for copies or mailing.

2. Request Corrections

Ask us to correct or amend your PHI if you believe it is incorrect or incomplete. We may deny the request but will provide a written explanation.

3. Request Confidential Communications

Ask us to contact you in a specific way (e.g., at work instead of home) or at a specific location.

4. Request Restrictions

Ask us to restrict how we use or disclose your PHI. While we are not required to agree in all cases, we will comply when required by law (e.g., you paid out-of-pocket in full and request not to share with your health plan).

5. Receive an Accounting of Disclosures

Request a list of disclosures made of your PHI over the past six years, excluding those made for treatment, payment, healthcare operations, or where authorized by you.

6. Receive Notification of a Breach

Be notified in the event of a breach involving your unsecured PHI.

Complaints

If you believe your privacy rights have been violated, you may file a complaint without fear of retaliation.

To File a Complaint with Us:

Privacy Officer
Serenity Infuse Health & Wellness, LLC
80 Mill River St., Suite 1500
Stamford, CT 06902
Phone: (203) 595-5340
Email: [email protected]

To File a Complaint with the U.S. Department of Health and Human Services:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Online: www.hhs.gov/ocr/privacy/hipaa/complaints/

Changes to This Notice

We may revise this notice at any time. Any changes will apply to all PHI we maintain. An updated notice will be available at our office and on our website.