AVENSIA WELLNESS
NOTICE OF PRIVACY PRACTICES

Effective Date: October 12, 2026

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, HOW YOU CAN GET ACCESS TO THIS INFORMATION, AND YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices (“Notice”) applies to Avensia Wellness PLLC (“Avensia Wellness,” “Avensia,” “we,” “us,” or “our”) and describes how we may use and disclose your Protected Health Information (“PHI”) and the rights you have regarding that information.

PHI includes information about your past, present, or future physical or mental health, healthcare services you receive, or payment for healthcare that identifies you or could reasonably be used to identify you.

Your Rights

You have certain rights regarding your health information. You may:

• Request access to or a paper or electronic copy of your medical records.
• Ask us to correct health information that you believe is incorrect or incomplete.
• Ask us to communicate with you in a particular way or at a particular location.
• Ask us to limit certain uses or disclosures of your health information.
• Request an accounting of certain disclosures of your health information.
• Request a paper copy of this Notice at any time, even if you agreed to receive it electronically.
• Authorize another person, such as a legal guardian or healthcare power of attorney, to exercise your rights on your behalf.
• File a complaint if you believe your privacy rights have been violated.

How to Exercise Your Rights

To exercise any of the rights described in this Notice, contact the Avensia Wellness Privacy Officer using the contact information at the end of this Notice.

We may ask you to submit certain requests in writing and may take reasonable steps to verify your identity or the authority of a personal representative before acting on a request.

For access requests, we generally will provide a copy or summary of your health information within 30 days as required by applicable law.

If we deny your amendment request, we will explain the reason in writing within 60 days, as required by applicable law.

Accessing Your Medical Records

You may ask to inspect or obtain an electronic or paper copy of your medical record and other PHI maintained by Avensia Wellness.

We will respond to requests within the time required by applicable law. In most circumstances, HIPAA requires access to be provided within 30 days. We may charge a reasonable, cost-based fee when permitted by law.

Certain limited information may be excluded from access when permitted or required by law.

Correcting Your Medical Record

If you believe information in your medical record is incorrect or incomplete, you may request an amendment.

We may deny the request in certain circumstances, such as when the information was not created by Avensia Wellness or we determine that the existing record is accurate and complete.

If we deny your amendment request, we will explain the reason in writing within 60 days, as required by applicable law.

Confidential Communications

You may ask us to contact you in a specific manner or at a particular address or telephone number.

For example, you may ask us to contact you only on your mobile telephone or to send correspondence to an alternative mailing address.

We will accommodate reasonable requests.

Requests to Restrict Uses or Disclosures

You may ask us not to use or disclose certain PHI for treatment, payment, or healthcare operations.

We generally are not required to agree to such requests, although we will consider them.

If you pay for a healthcare service completely out of pocket, you may ask us not to disclose information regarding that service to your health plan for payment or healthcare operations purposes. We will honor that request unless disclosure is required by law.

If we agree to a requested restriction, we will follow that restriction except where disclosure is necessary to provide emergency treatment or otherwise permitted or required by applicable law.

Accounting of Disclosures

You may request a list of certain disclosures of your health information made during the six years before your request.

The accounting generally will not include disclosures made for treatment, payment, healthcare operations, disclosures you authorized, or other disclosures excluded from accounting requirements under HIPAA.

We will provide one accounting during a 12-month period without charge. A reasonable fee may apply for additional requests during the same period.

Your Choices Regarding Disclosure

In certain circumstances, you may tell us whether and how you would like us to disclose your health information.

This may include sharing appropriate information with family members, friends, caregivers, or others involved in your care or payment for your care.

If you are unable to communicate your preference, we may disclose information when we reasonably believe doing so is in your best interest or when necessary to prevent or lessen a serious and imminent threat to health or safety.

Avensia Wellness does not maintain a hospital patient directory.

Fundraising

Avensia Wellness does not currently use patient information for fundraising. Before any future fundraising use of Part 2 records, we will provide clear, conspicuous advance notice and a choice to opt out. Declining fundraising communications will not affect your treatment or payment for care.

Uses Requiring Your Written Authorization

Except where otherwise permitted or required by law, we will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice.

Your written authorization generally is required for uses or disclosures involving marketing, the sale of PHI, and most uses or disclosures of psychotherapy notes if Avensia maintains such notes.

If you provide written authorization, you may revoke that authorization in writing at any time. Revocation will not affect actions already taken in reliance upon a valid authorization.

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your healthcare.

For example, an Avensia Wellness provider may share relevant health information with another physician, laboratory, pharmacy, specialist, or healthcare professional involved in your treatment.

Payment

We may use and disclose PHI as necessary to obtain payment for healthcare services.

This may include communications with insurers, payment processors, or other entities responsible for payment, when applicable.

Healthcare Operations

We may use and disclose health information as necessary to operate Avensia Wellness and improve the care we provide.

Healthcare operations may include quality assessment, clinical review, training, credentialing, auditing, compliance, business planning, customer service, and administrative functions.

We may also use PHI to contact you regarding appointments, follow-up care, treatment alternatives, health-related services, or other matters related to your care.

Business Associates

Avensia Wellness may engage outside companies or individuals to perform services that involve access to PHI.

Examples may include electronic health record providers, billing services, IT providers, patient communication systems, secure scheduling systems, laboratories, call management providers, and other healthcare-support vendors.

When HIPAA requires it, these organizations are considered Business Associates and must enter into appropriate agreements requiring them to safeguard PHI and use it only as permitted.

Public Health and Safety

We may disclose PHI for public health and safety activities permitted or required by law.

These may include preventing or controlling disease, reporting certain adverse medication or product events, responding to product recalls, reporting suspected abuse or neglect, and preventing or reducing a serious threat to health or safety.

Research

We may use or disclose health information for research when permitted by HIPAA and other applicable laws.

Research involving PHI may require your authorization or approval from an appropriate institutional review or privacy process unless another lawful exception applies.

Required by Law

We may disclose PHI when federal, state, or local law requires us to do so.

We may also provide information to the U.S. Department of Health and Human Services when necessary to demonstrate our compliance with federal privacy requirements.

Health Oversight Activities

We may disclose PHI to health oversight agencies for activities authorized by law, such as audits, investigations, inspections, licensing activities, or regulatory proceedings.

Workers’ Compensation

We may disclose health information as authorized by and to the extent necessary to comply with workers’ compensation or similar programs.

Law Enforcement and Government Activities

We may disclose PHI to law enforcement or government authorities when permitted or required by law.

We may also disclose information for certain specialized government functions, including national security, military activities, protective services, or other lawful governmental purposes.

Judicial and Administrative Proceedings

We may disclose PHI in response to a valid court or administrative order or, where legally permitted, a subpoena, discovery request, or other lawful process.

Any disclosure will be limited and handled in accordance with applicable privacy laws.

Coroners, Medical Examiners, and Funeral Directors

We may disclose PHI to coroners, medical examiners, or funeral directors when authorized by law and necessary for them to perform their duties.

Organ and Tissue Donation

If applicable, we may disclose PHI to organizations involved in organ, eye, or tissue donation and transplantation when permitted by law.

Substance Use Disorder Records

If we create, receive, or maintain substance use disorder records protected by 42 CFR Part 2, the additional Part 2 protections limit every use and disclosure described in this Notice. A HIPAA permission alone does not override those protections.

Part 2 allows you to give one written consent covering future treatment, payment, and healthcare operations. HIPAA covered entities and business associates receiving records under that consent may redisclose them as HIPAA permits, subject to the protections against use in proceedings against you.

We will not use or disclose Part 2 records, or testimony about their contents, in civil, criminal, administrative, or legislative investigations or proceedings against you without your specific written consent or a qualifying court order and a subpoena or similar legal mandate. A subpoena alone is insufficient. Consent for these proceedings must be separate from consent for other purposes.

Separately maintained SUD counseling notes require separate consent and are not covered by a general treatment, payment, and operations consent, except where a specific legal exception applies.

You may revoke consent in writing, subject to actions already taken in reliance on it, and request restrictions on treatment, payment, or operations disclosures. Your HIPAA access, amendment, confidential-communication, and applicable accounting rights described above remain available. The additional Part 2 accounting right for treatment, payment, and operations disclosures takes effect on the compliance date established by HHS.

You may report a Part 2 privacy violation to our Privacy Officer or HHS Office for Civil Rights through the complaint process below without retaliation.

Our Responsibilities

Avensia Wellness is required by law to maintain the privacy and security of your PHI.

We must provide you with this Notice explaining our legal duties and privacy practices and must follow the terms of the Notice currently in effect.

If a breach occurs involving unsecured PHI that requires notification under applicable law, we will notify affected individuals as required.

We will not use or disclose your information in ways not described in this Notice unless you authorize us in writing or another use or disclosure is permitted or required by law.

Changes to This Notice

We reserve the right to change this Notice and our privacy practices.

Changes may apply to PHI we already maintain as well as information we receive in the future.

When a material change is made, the revised Notice will be available on our website, in our office, and upon request. We will provide a paper copy promptly when requested.

Complaints

If you believe your privacy rights have been violated, you may file a complaint directly with Avensia Wellness by contacting the Privacy Officer using the information below.

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by mail at:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201

You may also use the HHS Office for Civil Rights complaint process for HIPAA or Part 2 privacy complaints.

Avensia Wellness will not retaliate against you for filing a complaint or exercising your privacy rights.

Privacy Contact

For questions regarding this Notice, requests involving your health information, or privacy complaints, please contact:

Avensia Wellness PLLC
Privacy Officer: Dr. Eric Ibegbu
330 South York Street
Gastonia, NC 28052
Phone: (980) 243-7743
Email: [email protected]
Website: www.avensiawellness.com