Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed, how you can get access to it, your rights with respect to it, and how to file a complaint concerning a violation of its privacy or security. Please review this notice carefully. You have a right to a copy of this notice and to discuss it with Magnolia Meadows at compliance@magnoliameadows.com if you have any questions.

This Notice of Privacy Practices ("Notice") applies to Magnolia Meadows, its employees and workforce members ("we," "our," and "us"). Your health information is protected by federal law, including your protected health information ("PHI") under HIPAA. If you receive or seek substance use disorder treatment and diagnosis services from us, your substance use disorder patient records ("Substance Use Disorder Records") are also protected by the federal "Part 2" regulations. We refer to PHI and Substance Use Disorder Records collectively as your "Health Records."

I. How We May Use and Disclose Your Health Records

We will obtain your written authorization to use and disclose your Health Records unless we are permitted to use or disclose your information without authorization under applicable law. Part 2 has stringent requirements on how we use and disclose Substance Use Disorder Records; HIPAA governs disclosures for those who do not receive substance use disorder services.

II. Substance Use Disorder Records (Part 2)

Without your written consent, we may disclose to/for:

• You or your personal representative
• Within our facilities and programs
• Medical emergencies
• Business associates / Qualified Service Organizations
• Research, audit, and evaluation activities
• Public health (after de-identification)
• Crimes on the premises
• Child abuse and neglect reporting
• Court orders and lawsuits
• Deceased patients (vital statistics reporting)

Requiring your written consent:

• Treatment, payment, and health care operations
• Multiple enrollments (central registry checks)
• Disclosures to the criminal justice system that referred you
• Disclosures to Prescription Drug Monitoring Programs, if required by law
• Counseling notes

III. PHI Under HIPAA

Without written authorization, for:

• Treatment, payment, and health care operations
• Business associates / Qualified Service Organizations
• Facility directory, unless you opt out
• Individuals involved in your care, payment, or notification
• Research, public health activities, and as required by law
• Serious threats to health or safety
• Workers' compensation purposes
• Specialized government functions, health oversight, law enforcement, and judicial proceedings
• Limited data sets and de-identified data

Other uses and disclosures — including most uses of psychotherapy notes, substance use disorder counseling notes, and marketing — require your written permission, which is revocable in writing at any time (prospectively only).

IV. Your Health Information Rights

To exercise any right below, submit a written request to 1750 Halls Creek Rd., Waverly, TN 37185, or email compliance@magnoliameadows.com.

• Right to Inspect and Copy
• Right to Request an Amendment
• Right to an Accounting of Disclosures
• Right to a List of Disclosures by an Intermediary
• Right to Request Restrictions
• Right to Request Confidential Communications
• Right to a Paper Copy of This Notice
• Right to Notification of a Breach
• Right to Discuss This Notice
• Right to Not Receive Fundraising Communications

V. Changes to This Notice

We may change our practices and this Notice at any time. Material changes will be posted at the facility and on this website, and made available on request.

VI. Complaints or Information Requests

File a complaint with our Compliance Officer, or with the U.S. Department of Health and Human Services Office for Civil Rights: 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201 · 1-877-696-6775 · hhs.gov/ocr/privacy/hipaa/complaints. We will not penalize or retaliate against you for filing a complaint.

VII. Our Contact Information

Magnolia Meadows, Attn: Compliance Officer
1750 Halls Creek Rd., Waverly, TN 37185
Email: compliance@magnoliameadows.com
Phone: 931-465-2658