Effective Date: January 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.

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO), and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.

Uses and Disclosures of Protected Health Information

Your protected health information may be used and disclosed by your provider, our office staff, and others outside of our office who are involved in your care and treatment, for the purpose of providing health care services to you, supporting the operation of the practice, and any other use required by law.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a compounding pharmacy or laboratory involved in your care, or to a physician to whom you have been referred, to ensure they have the necessary information to diagnose or treat you.

Payment: We may use and disclose your protected health information to bill and collect payment for services provided to you. This may include preparing and sending invoices or superbills, processing payments, and pursuing collection of unpaid balances as described in our financial policies.

Healthcare Operations: We may use or disclose, as needed, your protected health information to support the business activities of the practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training, licensing, and conducting or arranging for other business activities. For example, we may use a sign-in sheet at the registration desk, or call you by name in the waiting room. We may also use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We may use or disclose your protected health information in the following situations without your authorization: as required by law; public health issues as required by law; communicable diseases; health oversight; abuse or neglect; Food and Drug Administration requirements; legal proceedings; law enforcement; coroners, funeral directors, and organ donation; research; criminal activity; military activity and national security; workers' compensation; and other required uses and disclosures. Under the law, we must make disclosures to you and, when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the requirements of Section 164.500.

Other permitted and required uses and disclosures will be made only with your consent, authorization, or opportunity to object, unless required by law. You may revoke an authorization at any time, in writing, except to the extent that we have already taken action in reliance on it.

Your Rights

• Right to inspect and copy your protected health information. Under federal law, you may not inspect or copy psychotherapy notes, information compiled in reasonable anticipation of or for use in a civil, criminal, or administrative proceeding, or PHI subject to a law prohibiting access.
• Right to request a restriction on how we use or disclose your protected health information for treatment, payment, or healthcare operations, including restricting disclosure to family or friends involved in your care. We are not required to agree to a requested restriction.
• Right to request confidential communications by alternative means or at an alternative location.
• Right to obtain a paper copy of this notice upon request, even if you've agreed to receive it electronically.
• Right to request an amendment to your protected health information. If we deny your request, you have the right to file a statement of disagreement, and we may prepare a rebuttal, a copy of which will be provided to you.
• Right to receive an accounting of certain disclosures we have made of your protected health information.

We reserve the right to change the terms of this notice and will inform you by mail of any changes. Updated notices will also be posted at our office and on our website.

Complaints

If you have questions about this notice or believe your privacy rights have been violated, please contact our Privacy Officer, Tonia Christian, at Elite Health and Wellness, 411 Old Mill Rd, Suite A, Winchester, TN 37398, 931-313-8724.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, 1-877-696-6775, or at www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information.

---

AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION (PHI)

By signing this form, I agree, in accordance with the Federal Government Privacy Rules implemented through the Health Insurance Portability and Accountability Act of 1996 (HIPAA), to authorize Elite Health and Wellness, PLC to release any and all medical records concerning my care to any physician, hospital, or other health care professional providing care to me at any time.

---

ACKNOWLEDGEMENT OF PRIVACY PRACTICES NOTICE RECEIPT

By signing this form, I understand that under HIPAA I have certain rights to privacy regarding my protected health information (PHI). I understand that this information can be used to conduct, plan, and direct my treatment and follow-up among the healthcare providers involved in my care, and to conduct normal healthcare operations such as quality assessments and provider certifications.

I have received, read, and understand the Notice of Privacy Practices containing a more complete description of the uses and disclosures of my PHI. I understand that this organization has the right to change its Notice of Privacy Practices from time to time, and that I may contact this organization at any time to obtain a current copy.