HIPAA Notice of Privacy Practices

1. About this notice

Southland Wellness Clinic ("we," "us," "our") is required by law to protect the privacy of your protected health information, to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

"Protected health information" means information about you, including basic identifying details, that relates to your past, present, or future physical or mental health, the care you receive from us, or payment for that care.

2. How we may use and share your health information

For treatment

We may use your health information to provide and coordinate your care, and share it with other providers involved in your treatment — for example a laboratory that runs your bloodwork, a pharmacy that prepares a prescription, or another clinician you are referred to.

For payment

Southland Wellness Clinic is a self-pay practice. We do not bill health insurance for the services described on this website. We may use your health information to bill you and collect payment — for example to process a card payment or to discuss a balance with you. Because we do not submit claims to health plans, we do not send your information to an insurer for claims processing, prior authorization, or benefit determination.

For health care operations

We may use your health information to run the practice — for example to review the quality of care we provide, to train staff, or to handle business and administrative matters.

Appointment reminders and follow-up

We may contact you to remind you of an appointment, to follow up after a visit, or to tell you about treatment options or services that may be relevant to your care. You may ask us to contact you a particular way, or to stop contacting you a particular way, and we will accommodate reasonable requests.

When the law requires or permits it

We may use or share your health information without your authorization in a limited set of circumstances defined by law, including:

• when required by federal, state, or local law
• for public health activities, such as reporting a communicable disease or a reaction to a medication
• to report suspected abuse, neglect, or domestic violence
• for health oversight activities such as audits, licensure, or investigations
• in response to a court or administrative order, subpoena, or other lawful process
• to law enforcement in the limited circumstances the law allows
• to prevent a serious and imminent threat to your health or safety or that of another person
• to a coroner, medical examiner, or funeral director as necessary for their duties
• for workers' compensation claims, to the extent the law requires
• to an organ procurement organization, where applicable

3. Uses that always require your written permission

We will not use or share your health information for any of the following without your written authorization:

• marketing communications, other than the limited exceptions the law allows
• the sale of your health information
• most sharing of psychotherapy notes, where such notes exist
• any other purpose not described in this notice

If you give us written authorization, you may withdraw it at any time in writing. Withdrawing it stops any future use or sharing under that authorization, but it does not undo anything we already did while it was in effect.

4. Your rights

Get a copy of your record

You may ask to see or receive a copy of your medical and billing records. We will provide a copy, usually within 30 days of your request, and may charge a reasonable, cost-based fee.

Ask us to correct your record

If you believe information in your record is incorrect or incomplete, you may ask us to amend it. We may say no, and if we do we will tell you why in writing, usually within 60 days.

Request confidential communications

You may ask us to contact you at a specific phone number or address — for example a work address rather than a home address. We will accommodate reasonable requests and will not ask you why.

Ask us to limit what we use or share

You may ask us not to use or share certain information for treatment, payment, or our operations. We are not required to agree, and may say no if it would affect your care.

Get a list of who we shared it with

You may ask for an accounting of the times we shared your health information in the six years before the date you ask. This list does not include sharing for treatment, payment, or health care operations, or sharing you authorized. We will provide one accounting per year at no charge.

Get a paper copy of this notice

You may ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. We will provide one promptly.

Choose someone to act for you

If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will verify that person's authority before we act.

Be told if your information is breached

We will notify you if a breach occurs that may have compromised the privacy or security of your health information.

File a complaint

You may complain if you believe we have violated your privacy rights. See section 6 below. We will not retaliate against you for filing a complaint.

5. Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised it.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us in writing that we may. If you tell us we may, you may change your mind at any time in writing.

6. Complaints

If you believe your privacy rights have been violated, you may contact us using the details in section 8, and we will look into it.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, at 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-877-696-6775, or at hhs.gov/ocr/privacy/hipaa/complaints. Filing a complaint will not affect the care you receive from us.

7. Changes to this notice

We may change this notice, and the changes will apply to information we already hold as well as information we receive in the future. The current notice will always be posted on this page with its effective date, and a copy is available at the clinic.

8. Contact us

Southland Wellness Clinic
2336 Keith Street NW, Cleveland, TN 37311
Phone: (423) 641-0247

Effective date: August 11, 2026