HIPAA Notice of Privacy Practices

Last Updated: January 1, 2026 | Effective Date: January 1, 2026

Our Legal Duty

Flochelles Wellness Center, LLC (hereinafter "Flochelles," "we," "our") is required by law 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 abide by the terms of the Notice currently in effect.

We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations to protect the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information.

How We May Use and Disclose Your Health Information

For Treatment

We may use or disclose your PHI to provide, coordinate, or manage your mental health treatment and any related services. For example, we may share your information with a psychiatrist who prescribes medication as part of your treatment plan, or with another mental health provider to whom we refer you.

For Payment

We may use or disclose your PHI so that services you receive may be billed and payment collected from you, an insurance company, Ohio Medicaid, or another third party. For example, we may send claims to your insurance company that include information about the services you received.

For Healthcare Operations

We may use or disclose your PHI in connection with our healthcare operations including quality assurance, staff training and supervision, compliance activities, and business management functions necessary to run our center.

Uses and Disclosures That Require Your Authorization

The following uses and disclosures require your written authorization unless an exception applies:

• Most uses and disclosures of psychotherapy notes
• Uses and disclosures of PHI for marketing purposes
• Disclosures that constitute a sale of PHI
• Any other use or disclosure not described in this Notice

You may revoke any authorization you have given us at any time, in writing. The revocation will be effective except to the extent that we have already acted in reliance on your authorization.

Special Protections for Mental Health Information

As a behavioral health provider, we apply additional protections to your mental health records beyond standard HIPAA requirements, including:

• Psychotherapy notes are stored separately from the rest of your medical record and require specific written authorization for most disclosures
• Information related to substance use disorders may be protected by additional federal regulations (42 CFR Part 2)
• We will not disclose mental health records to employers, family members, or others without your written consent, except as required by law

Disclosures Required or Permitted by Law

We may use or disclose your PHI without your authorization in the following circumstances:

• As required by law — including mandatory reporting of child abuse, elder abuse, or dependent adult abuse
• To prevent serious threat — if we believe disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or the health or safety of another person
• Public health activities — as required by public health authorities
• Law enforcement — as required by law or court order
• Workers' compensation — to the extent required by workers' compensation laws

Your Rights Regarding Your Health Information

Right to Inspect and Copy

You have the right to inspect and copy your PHI maintained in our records. We may charge a reasonable fee for copying. To request access, submit a written request to our office.

Right to Request Amendment

If you believe your health information is incorrect or incomplete, you may request that we amend your record. We may deny your request if we determine that the information is accurate and complete.

Right to an Accounting of Disclosures

You have the right to request a list of disclosures of your PHI that we have made, except for disclosures for treatment, payment, healthcare operations, and certain other disclosures.

Right to Request Restrictions

You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to your requested restriction, but if we do agree, we are bound by that agreement.

Right to Confidential Communications

You have the right to request that we communicate with you about your health information in a specific way or at a specific location. For example, you may ask us to contact you only at your work address.

Right to a Copy of This Notice

You have the right to receive a paper copy of this Notice upon request at any time.

Right to File a Complaint

If you believe your privacy rights have been violated, you may file a complaint with our center or with the U.S. Department of Health and Human Services Office for Civil Rights. To file a complaint with our center, contact:

• Flochelles Wellness Center, LLC — Privacy Officer
• 550 W. 14th Street, Suite A, Lorain, OH 44052
• Phone: (440) 000-0000
• Email: info@flochelleswc.com

You will not be penalized or retaliated against for filing a complaint.

Changes to This Notice

We reserve the right to change this Notice and to make the new Notice provisions effective for all PHI that we maintain. We will post the current Notice on our website and make paper copies available at our office upon request.

Contact Our Privacy Officer

For questions about this Notice or to exercise your rights, contact:

• Flochelles Wellness Center, LLC — Privacy Officer
• 550 W. 14th Street, Suite A, Lorain, OH 44052
• Phone: (440) 000-0000
• Email: info@flochelleswc.com