Synergy Therapeutics Notice of Privacy Practices

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.

Synergy Therapeutics, 1245 Charnelton Street, Eugene, OR 97401

Effective date: August 18, 2024

Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get a copy of your health records. You can ask to see or get a copy of your health records and other health information we have about you, on paper or electronically. Ask us how to do this. We'll provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your records. You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say no, but we'll tell you why in writing within 60 days.

Request confidential communications. You can ask us to contact you in a specific way (for example, by cell phone or email) or to send mail to a different address. We will say yes to all reasonable requests.

Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say no if it would affect your care. If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or our operations. We will say yes unless a law requires us to share it.

Get a list of those we've shared information with. You can ask for a list (accounting) of the times we've shared your health information for six years before the date you ask, who we shared it with, and why. We will include all disclosures except those about treatment, payment, and our operations, and certain other disclosures (such as any you asked us to make). We'll provide one list a year for free, but will charge a reasonable, cost-based fee if you ask for another within 12 months.

Get a copy of this notice. You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically. We will provide it 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 make sure the person has this authority before we take any action.

File a complaint if you feel your rights are violated. You can complain to us using the contact information at the end of this notice. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk to us. Tell us what you want us to do, and we will follow your instructions.

You have both the right and the choice to tell us to:

  • Share information with your family, close friends, or others involved in your care or in paying for your care.

  • Share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

We never share your information in these cases unless you give us written permission:

  • Marketing purposes.

  • Sale of your information.

Our uses and disclosures

How do we typically use or share your health information?

  • To treat you. We use your health information to plan and provide your massage therapy, and we may share it with other professionals who are treating you. Example: Your therapist reviews your intake form and past session notes before your appointment, or a doctor treating your injury asks about your care with us.

  • To bill for your services. We use and share your health information to bill and get payment from health plans or other payers. Example: We give information about you to your health insurance plan, or to an auto insurer handling your injury claim, so it will pay for your sessions.

  • To run our practice. We use your health information to run our practice, improve your care, and contact you when necessary. Example: We use your information to schedule appointments, send reminders, and review the quality of our services.

Some of the companies that help us run our practice, such as our scheduling, records, and billing services, handle your information on our behalf. They are required by written agreement to protect it.

How else can we use or share your health information?

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

  • Help with public health and safety issues, such as reporting suspected abuse, neglect, or domestic violence, or preventing a serious threat to anyone's health or safety.

  • Do research, under conditions set by law.

  • Comply with the law, including sharing information with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.

  • Respond to organ and tissue donation requests.

  • Work with a medical examiner or funeral director when an individual dies.

  • Address workers' compensation, law enforcement, and other government requests, including for workers' compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services.

  • Respond to lawsuits and legal actions, in response to a court or administrative order, or in response to a subpoena when the law's conditions are met.

For any other use or sharing not described in this notice, we will ask for your written permission. If you give us permission, you can change your mind at any time by letting us know in writing. Changing your mind won't affect anything we already did with your permission.

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 the privacy or security of your information.

  • 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 we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the terms of this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.

Contact us

If you have questions about this notice, want to exercise any of your rights, or want to file a complaint with us, contact our privacy officer:

Kes Wilder · Synergy Therapeutics 1245 Charnelton Street, Eugene, OR 97401 541-329-1119 · info@synergylmt.com