Notice of Privacy Practices

Effective Date: January 1, 2020

Contact Information:

Privacy Officer: Dr. Ryan Adami

Address: 2506 S. Macdill Ave, Suite A, Tampa, FL 33629

Phone: 813-605-1977 | Fax: 813-378-3004 | www.xcelsiorhealth.com

When you visit a healthcare provider, a record of your care is created. This record may include details such as your symptoms, test results, diagnoses, treatment plans, and billing information, collectively referred to as Protected Health Information (PHI).

This notice explains how we may use and disclose your PHI, your rights regarding this information, and our legal responsibilities to protect it.

Maintain Privacy We are legally required to protect your PHI and provide details of our privacy practices.

Follow This Notice We adhere to the terms described in this document.

Notify of Changes We may update this notice and apply the changes to all PHI we maintain.

Copies of this notice are available in our reception area and on our website.

1. For Treatment We use your PHI to coordinate and manage your care, sharing it with healthcare providers and personnel as necessary. For example, we may share information with labs, imaging centers, or other specialists involved in your treatment.

2. For Payment We may use your PHI to bill and collect payment from you, your insurance, or third-party payers.

3. For Healthcare Operations Your PHI may be used to improve care quality, conduct audits, support business operations, or fulfill legal and licensing requirements.

4. With Business Associates (BAs) We may share PHI with BAs who provide services like billing or software support. BAs are contractually obligated to protect your information.

5. Breach Notification If a breach of unsecured PHI occurs, you will be notified within 60 days, along with any required reports to state or federal agencies.

Marketing We may contact you for limited marketing.

Individuals Involved in Your Care With your consent, we may share information with friends or family involved in your care.

Certain disclosures are permitted or required by law, such as:

• Public health and safety reports
• Legal and law enforcement requests
• Oversight agencies
• Military or national security purposes
• Abuse or neglect reporting

1. Access and Copies You have the right to inspect and request copies of your medical records. Requests must be in writing, and reasonable fees may apply.

2. Request Amendments If you believe your records are incomplete or incorrect, you can request an amendment in writing.

3. Accounting of Disclosures You can request a record of certain disclosures made of your PHI. The first request within a 12-month period is free; fees may apply to subsequent requests.

4. Request Restrictions You may request limitations on how your PHI is used or disclosed. This includes requests to restrict information shared with your health plan for services paid out-of-pocket.

5. Confidential Communications You may request that we contact you at specific locations or through alternative means.

To exercise your rights, please submit requests in writing to our Privacy Officer.

If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or with the Secretary of Health and Human Services. Complaints must be submitted in writing within 180 days of the incident. Retaliation for filing a complaint is strictly prohibited.