Birch Medical & Wellness Notice of Privacy Practices
Effective: 09/2022 and until further notice

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. If you have any questions about this Notice, please contact the Birch Medical & Wellness team at (682) 688-5989.

This notice will be followed by Tung Tran, MD and all Birch Medical & Wellness providers and employees.
We understand that medical information about you and your health is personal and are committed to protecting this information. When you receive care at Birch Medical & Wellness, a record of the care and services you receive is made. Typically, this recordcontains your treatment plan, history and physical, test results, and billing record. This record serves as a:

• Basis for planning your treatment and services;
• Means of communication among the physicians and other health care providers involved in your care;
• Means by which you or a third-party payor can verify that services billed were actually provided;
• Source of information for public health officials, and
• Tool for assessing and continually working to improve the care rendered.

This Notice tells you the ways we may use and disclose your Protected Health Information (referred to herein as “medical information”). It also describes your rights and our obligations regarding the use and disclosure of medical information.

Our Responsibilities
Birch Medical &  Wellness shall:
• Make every effort to maintain the privacy of your medical information;
• Provide you with notice of our legal duties and privacy practices with respect to information we collect and maintain about you;
• Abide by the terms of this Notice;
• Notify you if we are unable to agree to a requested restriction; and
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
 • Birch Medical & Wellness will notify you, and the Department of Health & Human Services, of any unauthorized acquisition, access, use or disclosure of your unsecured medical information that presents a significant risk of financial, reputational or other harm to you to the extent required by law. Unsecured medical information means medical information not secured by technology that renders the information unusable, unreadable, or indecipherable as required by law.

The Methods in which we May Use and Disclose Medical Information About You

The following categories describe different ways we may use and disclose your medical information. The examples provided serve only as guidance and do not include every possible use or disclosure.

For Treatment. We will use and disclose your medical information to provide, coordinate, or manage your health care and any related service. For example, we may share your information with your primary care physician or other specialist to whom you are referred for follow-up care.

For Payment. We will use and disclose medical information about you so that the treatment and services you receive may be billed and payment may be collected from you, an insurance company, or a third party.

For Health Care Operations. We may use and disclose medical information about you for office operations. These uses and disclosures are necessary to run Birch Medical & Wellness in an efficient manner and provide that all patients receive quality care. For example, your medical records and health information may be used in the evaluation of services, and the appropriateness and quality of health care treatment. In addition, medical records are audited for timely documentation and correct billing.

Appointment Reminders. We may use and disclose medical information in order to remind you of an appointment. For example, Birch Medical & Wellness may provide a written or telephone reminder that your next appointment is coming up with Birch Medical & Wellness.

Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the treatment outcome of all patients for whom one type of procedure is used to those for whom another procedure is used for the same condition. All research projects, however, are subject to a special approval process. Prior to using or disclosing any medical information, the project must be approved through this research approval process. We will ask for your specific authorization if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care.

As Required by Law. We will disclose medical information about you when required to do so by federal or Texas laws or regulations.

To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you to medical or law enforcement personnel when necessary to prevent a serious threat to your health and safety or the health and safety of another person.

Sale of Practice. We may use and disclose medical information about you to another health care facility or group of physicians in the sale, transfer, merger, or consolidation of our practice.

Special Situations

Organ and Tissue Donation. If you have formally indicated your desire to be an organ
donor, we may release medical information to organizations that handle procurement
of organ eye, tissue, and transplants.
Military and Veterans. If you are a member of the armed forces, we may release
medical information about you as required by military command authorities. Worker's
Compensation. We may release medical information about your workers'
compensation or similar programs. These programs provide benefits for work related
injuries or illness.
Qualified Personnel. We may disclose medical information for a management audit.
Financial audit, or program evaluation, but the personnel may not directly or indirectly
identify you in any report of the audit or evaluation, or otherwise disclose your identity
in any manner.
Public Health Risks. We may disclose medical information about you for public health
activities. These activities generally include the following activities:
- To prevent or control disease, injury, or disability;
- To report reactions to medications or problems with products;
- To notify people of recalls of products they may be using;
- To notify a person who may have been exposed to a disease or may be at risk for
contracting
or spreading a disease or condition; and
- To notify the appropriate government authority if we believe you have been the
victim of abuse, neglect, or domestic violence.
All such disclosures will be made in accordance with requirements of Texas and
Federal laws and regulations.
Health Oversight Activities. We may disclose medical information to a health oversight
agency for activities authorized by law. Health oversight agencies include public and
private agencies authorized by law to oversee the health system. These oversight
activities include, for example, audits, investigations, inspections, and licensure.
These activities are necessary for the government to monitor the health care system,
government programs, eligibility or compliance, and to enforce health-related civil

rights and criminal laws.
Lawsuits and Disputes. If you are involved in certain lawsuits or administrative
disputes, we may disclose medical information about you in response to a court or
administrative order.
Law Enforcement. We may release medical information if asked to do so by a law
enforcement official:
- In response to a court order or subpoena; or
- If Birch Medical & Wellness determines there is a probability of imminent physical
injury to you or another person, or immediate mental or emotional injury to you.
Coroner, Medical Examiners and Funeral Directors. We may release medical
information to a coroner or medical examiner when authorized by law (e.g., to
identify a deceased person or determine the cause of death). We may also release
medical information about patients to funeral directors.
Inmates. If you are an inmate of a correctional facility, we may release medical
information about you to the correctional facility for the facility to provide you treatment.
Other Uses or Disclosures. Any other use or disclosure of PHI will be made only upon
your individual written authorization. You may revoke an authorization at any time
provided that it is in writing and we have not already relied on the authorization.
Your Rights Regarding Medical Information About You.

You have the following rights regarding medical information collected and maintained
about you:
Right to Inspect and Copy. You have the right to inspect and copy medical information
that may be used to make decisions about your care. Usually, this includes medical
and billing records.
To inspect and copy medical information that may be used to make decisions about
you, you must submit your request in writing to the Privacy Officer for Birch Medical &

Wellness. If you request a copy of the information, Birch Medical & Wellness may
charge a fee established by the Texas Medical Board for the cost of copying, mailing,
or summarizing your records.
Birch Medical & Wellness. may deny your request to inspect and copy in certain very
limited circumstances. If you are denied access to medical information, you may
request that the denial be reviewed. Another licensed health care professional chosen
by Birch Medical & Wellness will review your request. Birch Medical & Wellness will
comply with the outcome of the review.
Right to Amend. If you feel that medical information maintained about you is incorrect
or incomplete, you may ask Birch Medical & Wellness to amend the information. You
have the right to request an amendment for as long as the information is kept by Birch
Medical & Wellness.
To request an amendment, your request must be made in writing and
submitted to Birch Medical & Wellness. In addition, you must provide a reason
that supports your request.
Birch Medical & Wellness may deny your request for an amendment if it is not in writing
or does not include a reason to support the request. In addition, Birch Medical &
Wellness may deny your request if you ask us to amend information that:
- Was not created by Birch Medical & Wellness., unless the person that created the
information is no longer available to make the amendment; Is not part of the medical
information kept by Birch Medical & Wellness
- Is not part of the information which you would be permitted to inspect and
copy; or - Is accurate and complete.
Right to an Accounting of Disclosures. You have the right to request and "accounting
of disclosures." This is a list of the disclosure made of your medical information for
purposes other than treatment, payment, or health care operations.
Birch Medical & Wellness is not required to agree to the request, unless it pertains
solely to a healthcare item or service for which Birch Medical & Wellness has been

paid out of pocket in full.
Should Birch Medical & Wellness agree to your request, Birch Medical & Wellness
will comply with your request unless the information is needed to provide you
emergency treatment.
To request restrictions you must make your request in writing to Birch Medical &
Wellness in your request, you may indicate: (1) what information you want to limit;
(2) whether you want to limit Birch Medical & Wellness use and/or disclosure; and
(3) to whom you want the limits to apply.
Right to Request Confidential Communications. You have the right to request that Birch
Medical & Wellness communicate with you about medical matters in a certain way or at
a certain location. For example, you can ask that Birch Medical & Wellness contact you
only at work or by mail.
To request that Birch Medical & Wellness communicate in a certain manner, you must
make your request in writing to the Privacy Officer. You do not have to state a reason
for your request. Birch Medical & Wellness will accommodate all reasonable requests.
Your request must specify how or where you wish to be contacted.
Changes to This Notice
We reserve the right to change our practices and to make the new provisions effective
for all PHI we maintain. Should our information practice change, we will post the
amended Notice of Privacy Practices in our office and on our website. You may request
that a copy be provided to you by contacting the Privacy Officer.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with
Birch Medical & Wellness with the Office for Civil Right, U.S. Department of Health and
Human Services. To file a complaint with Birch Medical & Wellness, contact the
Business Director at (682) 688-5989. Your complaint must be filed within 180 days of
when you knew or should have known that the act occurred. The address for the Office
of Civil Rights is:

Secretary of Health & Human Services
Region VI, Office for Civil Rights
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202
All Complaints should be submitted in writing.
You will NOT be penalized for filing a complaint.