Matrix Reformed, LLC

Notice of Privacy Practices

Last Updated: 02/01/2025

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. Who We Are

This Notice of Privacy Practices (“Notice”) describes the privacy practices of Matrix Reformed and its affiliates, including certain affiliated professional entities and their healthcare providers, practitioners, and other personnel (“we” or “us”).

II. Our Privacy Obligations

We are required by law to maintain the privacy of your health information (“Protected Health Information” or “PHI”) and to provide you with this Notice detailing our legal duties and privacy practices with respect to your PHI. We are also obligated to notify you in the event of a Breach of unsecured PHI. When we use or disclose your PHI, we are required to follow the terms of this Notice (or other notice in effect at the time of the use or disclosure).

III. Permissible Uses and Disclosures Without Your Written Authorization

In certain situations, which we describe in Section IV, we must obtain your written authorization to use or disclose your PHI. However, in other instances, as described below, we are permitted to use and disclose your PHI without your written consent:

A. Uses and Disclosures for Treatment, Payment, and Health Care Operations

Treatment – We may use and disclose your PHI to provide, coordinate, or manage your healthcare. For example, we may share your PHI with other healthcare providers to help diagnose and treat you.

Payment – We may use and disclose your PHI to obtain payment for services provided to you.

Healthcare Operations – We may use and disclose your PHI for healthcare operations, including internal administration, quality improvement, and planning. For example, we may use PHI to evaluate our healthcare practitioners’ performance and improve our services.

Additionally, we may disclose your PHI to other healthcare providers for their treatment, payment, or certain healthcare operations, such as quality assessment and improvement activities, as allowed by law.

B. Disclosure to Relatives, Close Friends, and Other Caregivers

We may disclose your PHI to family members, close friends, or others involved in your care if:

We obtain your agreement;

We provide you the opportunity to object and you do not object; or

We reasonably infer that you do not object to the disclosure.

In cases of emergency or incapacity, we may use our judgment to determine if a disclosure is in your best interest. Disclosures to family members or friends are limited to information relevant to their involvement in your healthcare.

C. Public Health Activities

We may disclose your PHI for public health activities, such as:

Reporting to public health authorities to prevent or control disease.

Reporting child abuse or neglect.

Reporting to the FDA regarding products under its jurisdiction.

Alerting individuals who may be at risk of contracting or spreading diseases.

Reporting information required by law to employers on work-related illnesses or injuries.

D. Victims of Abuse, Neglect, or Domestic Violence

If we reasonably believe that you are a victim of abuse, neglect, or domestic violence, we may disclose your PHI to authorized government or social service agencies as permitted by law.

E. Health Oversight Activities

We may disclose your PHI to health oversight agencies for activities authorized by law, such as audits, investigations, and licensure activities.

F. Judicial and Administrative Proceedings

We may disclose your PHI in response to a court order, subpoena, or other lawful process in the course of judicial or administrative proceedings.

G. Law Enforcement Officers

We may disclose your PHI to law enforcement officials as required by law or in response to a court order or subpoena.

H. Decedents

We may disclose PHI to a coroner, medical examiner, or funeral director as needed to carry out their duties.

I. Research

We may use or disclose your PHI for research purposes without your consent if an Institutional Review Board or Privacy Board has approved a waiver of authorization.

J. Health or Safety

We may use or disclose your PHI to prevent or reduce a serious and imminent threat to an individual or public health and safety.

K. Specialized Government Functions

We may disclose your PHI to governmental units with special functions, such as the U.S. military or the Department of State, under certain conditions.

L. Workers’ Compensation

We may disclose your PHI as authorized by and necessary to comply with state laws regarding workers’ compensation.

M. As Required By Law

We may use and disclose your PHI as required by law.

IV. Uses and Disclosures Requiring Your Written Authorization

A. Use or Disclosure with Your Authorization

We must obtain your written authorization to use or disclose your PHI for marketing purposes or any disclosures constituting the sale of PHI. Additionally, uses and disclosures not outlined in this Notice will be made only with your written permission.

B. Uses and Disclosures of Your Highly Confidential Information

Special protections apply to certain types of sensitive health information, known as “Highly Confidential Information.” We will only disclose this information as permitted by law or with your explicit written authorization.

C. Revocation of Your Authorization

You may revoke your authorization at any time by submitting a written statement to our Privacy Officer (contact information below). Revocation does not affect any actions we have taken in reliance on your prior authorization.

V. Your Rights Regarding Your Protected Health Information

A. For Further Information and Complaints

If you have questions about your privacy rights or believe your privacy rights have been violated, you may contact Matrix Reformed Compliance and Privacy Officer. You may also file a complaint with the Office for Civil Rights at the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

B. Right to Request Additional Restrictions

You have the right to request additional restrictions on the use or disclosure of your PHI. We are not required to agree to all requests but will try to accommodate reasonable requests. For restrictions related to self-paid services, we are required to honor your request to restrict disclosure to your health plan.

C. Right to Receive Confidential Communications

You may request to receive communications about your PHI by alternative means or at alternative locations, and we will accommodate reasonable requests.

D. Right to Inspect and Copy Your Health Information

You may request access to inspect or obtain copies of your PHI maintained by Matrix Reformed. Requests can be made by submitting a completed Release of Information Form to [email protected]. There may be a fee for copying and postage, if applicable.

E. Right to Request to Amend Your Records

You may request an amendment to your PHI if you believe it is incorrect or incomplete. Submit your request to [email protected].

F. Right to Receive an Accounting of Disclosures

You have the right to request an accounting of certain disclosures of your PHI made in the past six years. There may be a fee if you request more than one accounting in a 12-month period.

G. Right to Receive a Copy of this Notice

You may request a copy of this Notice at any time by contacting our Privacy Officer or by visiting our website.

VI. Effective Date and Duration of This Notice

A. Effective Date

This Notice is effective as of 02/01/2025.

B. Right to Change Terms of This Notice

We may change the terms of this Notice at any time. If we make material changes, we will post the updated Notice on our website at www.matrixformed.com/npp. You may also request a new copy by contacting [email protected].

VII. Privacy Officer

You may contact the Privacy Officer at:

Matrix Reformed

ATTN: Privacy Officer

7901 4th St N #25584; St. Petersburg, FL 33702

Email: [email protected]