HIPAA Notice of Privacy Practices

Effective Date: May 1, 2026

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.

Our Commitment to Your Privacy

Claritiv Health LLC ("Claritiv Health," "we," "us," or "our") is committed to protecting the privacy of your health information. We are required by law to:

Maintain the privacy of your protected health information (PHI)
Provide you with this Notice of our legal duties and privacy practices
Follow the terms of the Notice currently in effect
Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed

What is Protected Health Information (PHI)?

PHI is information that identifies you and relates to your:

Past, present, or future physical or mental health condition
Provision of health care services
Payment for health care services

How We May Use and Disclose Your Health Information

For Treatment

We may use and disclose your PHI to provide, coordinate, or manage your health care and related services. This includes consultation with other health care providers regarding your treatment and referral to other providers.

Example: Your provider may share your medical history with an anesthesiologist or consulting psychiatrist to ensure safe ketamine infusion therapy.

For Payment

We may use and disclose your PHI to bill and collect payment for services provided to you. This may include disclosures to your insurance company, health plan, or third-party payer.

Example: We may submit claims to your insurance company that include diagnoses, treatment dates, and procedure codes.

For Health Care Operations

We may use and disclose your PHI for our health care operations, including quality improvement, training, business planning, and administrative functions.

Example: We may use de-identified patient outcomes data to evaluate the effectiveness of our treatment protocols.

Other Permitted and Required Uses and Disclosures

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

When Required by Law: When disclosure is required by federal, state, or local law.
Public Health Activities: To report disease, injury, or vital events; to conduct public health surveillance, investigations, or interventions.
Victims of Abuse, Neglect, or Domestic Violence: When required or authorized by law to report abuse, neglect, or domestic violence to appropriate authorities.
Health Oversight Activities: To health oversight agencies for audits, investigations, inspections, or licensing purposes.
Judicial and Administrative Proceedings: In response to a court order, subpoena, or other lawful process.
Law Enforcement: When required by law or in response to a valid subpoena or court order; to report certain injuries or crimes.
Coroners, Medical Examiners, and Funeral Directors: For identification, cause of death determinations, or to carry out their duties.
Serious Threat to Health or Safety: When necessary to prevent or lessen a serious and imminent threat to your health or safety or that of others.
Military and Veterans: If you are a member of the armed forces, as required by military command authorities.
Workers' Compensation: For workers' compensation or similar programs providing benefits for work-related injuries or illness.
Research: For research purposes when approved by an Institutional Review Board or Privacy Board, with appropriate safeguards.
Business Associates: To third-party service providers (e.g., billing companies, IT vendors, EHR providers) who perform services on our behalf and have agreed in writing to safeguard your PHI.

Uses and Disclosures That Require Your Authorization

Other than as described above, we will not use or disclose your PHI without your written authorization. Specific situations requiring authorization include:

Most uses and disclosures of psychotherapy notes
Uses and disclosures for marketing purposes
Disclosures that constitute a sale of PHI

You may revoke any authorization in writing at any time. The revocation will not affect any uses or disclosures already made with your permission.

Your Rights Regarding Your Health Information

Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your PHI for treatment, payment, or health care operations. We are not required to agree to your request except in limited circumstances (e.g., if you pay out-of-pocket in full and request we not disclose to your health plan).

Right to Receive Confidential Communications

You have the right to request that we communicate with you about your health information in a certain way or at a certain location. For example, you may request that we contact you only at work or by mail. We will accommodate reasonable requests.

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your medical record and billing records. We may charge a reasonable fee for copying and mailing costs. We may deny your request in limited circumstances; if so, you may request a review of the denial.

Right to Amend

If you believe your health information is incorrect or incomplete, you may request an amendment. We may deny your request if the information was not created by us, is not part of our records, is not part of the information you would be permitted to inspect, or is accurate and complete. If denied, you may submit a written statement of disagreement.

Right to an Accounting of Disclosures

You have the right to request an "accounting of disclosures" — a list of certain disclosures we have made of your PHI. This does not include disclosures for treatment, payment, health care operations, disclosures made to you, or disclosures made with your authorization.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this Notice at any time, even if you have agreed to receive it electronically. You may obtain a copy by contacting our Privacy Officer or downloading it from our website at www.claritivhealth.com/hipaa-notice.

Right to Notification of a Breach

You have the right to be notified if we discover a breach of your unsecured PHI.

How to Exercise Your Rights

To exercise any of the rights described above, please submit a written request to:

Privacy Officer
Claritiv Health LLC
468 North Parkway, Suite [TBD]
Jackson, TN 38305
Email: privacy@claritivhealth.com
Phone: (731) 256-5333

Changes to This Notice

We reserve the right to change this Notice at any time. Any changes will apply to all PHI we maintain. We will post the current Notice in our clinic and on our website at www.claritivhealth.com/hipaa-notice. The effective date will appear in the top right corner.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services (HHS). You will not be retaliated against for filing a complaint.

To file a complaint with Claritiv Health:

Privacy Officer
Email: privacy@claritivhealth.com
Phone: (731) 256-5333

To file a complaint with HHS:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Online: www.hhs.gov/ocr/privacy/hipaa/complaints/

Contact Information

If you have questions about this Notice or our privacy practices, please contact:

Claritiv Health LLC
468 North Parkway, Suite [TBD]
Jackson, TN 38305
Phone: (731) 256-5333
Email: info@claritivhealth.com
Website: www.claritivhealth.com

This Notice of Privacy Practices is provided in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable state law.