Balance Hormone and Wellness

Notice of Privacy Practices

Effective Date October 27, 2026

Privacy Officer / Privacy Contact

Vanessa Armenise

Balance Hormone & Wellness

Mailing address: 8295 Tournament Drive, Suite 150

Memphis, TN 38125

Phone: 901-648-1728

Email: privacy@balancehormonewellness.com

About This Notice

We are required by law to maintain the privacy of Protected Health Information and to give you

this Notice explaining our privacy practices with regard to that information. You have certain

rights – and we have certain legal obligations – regarding the privacy of your Protected Health

Information, and this Notice explains your rights and our obligations. We are required to abide by

the terms of the current version of this Notice.

What is Protected Health Information?

“Protected Health Information” is information that individually identifies you and that we create or

get from you or from another health care provider, health plan, your employer, or a health care

clearinghouse and that relates to (1) your past, present, or future physical or mental health or

conditions, (2) the provision of health care to you, or (3) the past, present, or future payment for

your health care.

How We May Use and Disclose Your Protected Health Information

We may use and disclose your Protected Health Information in the following circumstances:

For Treatment. We may use or disclose your Protected Health Information to give you

medical treatment or services and to manage and coordinate your medical care. For example,

your Protected Health Information may be provided to a physician or other health care

provider (e.g., a specialist or laboratory) to whom you have been referred to ensure that the

physician or other health care provider has the necessary information to diagnose or treat

you or provide you with a service.

For Payment. We may use and disclose your Protected Health Information so that we can bill

for the treatment and services you receive from us and can collect payment from you, a

health plan, or a third party. This use and disclosure may include certain activities that your

health insurance plan may undertake before it approves or pays for the health care services

we recommend for you, such as making a determination of eligibility or coverage for

insurance benefits, reviewing services provided to you for medical necessity, and undertaking

utilization review activities. For example, we may need to give your health plan information

about your treatment in order for your health plan to agree to pay for that treatment.

For Health Care Operations. We may use and disclose Protected Health Information

for our health care operations. For example, we may use your Protected Health

Information to internally review the quality of the treatment and services you receive

and to evaluate the performance of our team members in caring for you. We also may

disclose information to physicians, nurses, medical technicians, medical students, and

other authorized personnel for educational and learning purposes.

Appointment Reminders/Treatment Alternatives/Health-Related Benefits and

Services. We may use and disclose Protected Health Information to contact you to

remind you that you have an appointment for medical care, or to contact you to tell

you about treatment options or alternatives or health related benefits and services

that may be of interest to you.

We may use and disclose your Protected Health Information for research

purposes, but we will only do that if the research has been specially approved by an

authorized institutional review board or a privacy board that has reviewed the

research proposal and has set up protocols to ensure the privacy of your Protected

Health Information. Even without that special approval, we may permit researchers to

look at Protected Health Information to help them prepare for research, for example,

to allow them to identify patients who may be included in their research project, as

long as they do not remove, or take a copy of, any Protected Health Information. We

may use and disclose a limited data set that does not contain specific readily

identifiable information about you for research. However, we will only disclose the

limited data set if we enter into a data use agreement with the recipient who must

agree to (I) use the data set only for the purposes for which it was provided, (2)

ensure the confidentiality and security of the data, and (3) not identify the

information or use it to contact any individual.

As Required by Law. We will disclose Protected Health Information about you when

required to do so by international, federal, state, or local law.

To Avert a Serious Threat to Health or Safety. We may use and disclose Protected

Health Information when necessary to prevent a serious threat to your health or

safety or to the health or safety of others. But we will only disclose the information to

someone who may be able to help prevent the threat.

Business Associates. We may disclose Protected Health Information to our business associates

who perform functions on our behalf or provide us with services if the Protected Health

Information is necessary for those functions or services. For example, we may use another

company to do our billing, or to provide transcription or consulting services for us. All of our

business associates are obligated, under contract with us, to protect the privacy and ensure the

security of your Protected Health Information.

Organ and Tissue Donation. If you are an organ or tissue donor, we may use or disclose your

Protected Health Information to organizations that handle organ procurement or transplantation

– such as an organ donation bank – as necessary to facilitate organ or tissue donation and

transplantation.

Military and Veterans. If you are a member of the armed forces, we may disclose Protected

Health Information as required by military command authorities. We also may disclose Protected

Health Information to the appropriate foreign military authority if you are a member of a foreign

military.

Workers’ Compensation. We may use or disclose Protected Health Information for workers’

compensation or similar programs that provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose Protected Health Information for public health activities.

This includes disclosures to: (1) a person subject to the jurisdiction of the Food and Drug

Administration (“FDA”) for purposes related to the quality, safety or effectiveness of an FDA-

regulated product or activity; (2) prevent or control disease, injury or disability; (3) report births

and deaths; (4) report child abuse or neglect; (5) report reactions to medications or problems

with products; (6) notify people of recalls of products they may be using; and (7) a person who

may have been exposed to a disease or may be at risk for contracting or spreading a disease or

condition.

Abuse, Neglect, or Domestic Violence. We may disclose Protected Health Information to the

appropriate government authority if we believe a patient has been the victim of abuse, neglect,

or domestic violence and the patient agrees or we are required or authorized by law to make that

disclosure.

Health Oversight Activities. We may disclose Protected Health Information to a health oversight

agency for activities authorized by law. These oversight activities include, for example, audits,

investigations, inspections, licensure, and similar activities that are necessary for the government

to monitor the health care system, government programs, and compliance with civil rights laws.

Data Breach Notification Purposes. We may use or disclose your Protected Health Information

to provide legally required notices of unauthorized access to or disclosure of your health

information.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Protected

Health Information in response to a court or administrative order. We also may disclose

Protected Health Information in response to a subpoena, discovery request, or other legal

process from someone else involved in the dispute, but only if efforts have been made to tell

you about the request or to get an order protecting the information requested We may also use

or disclose your Protected Health Information to defend ourselves in the event of a lawsuit.

Law Enforcement. We may disclose Protected Health Information, so long as applicable legal

requirements are met, for law enforcement purposes.

Military Activity and National Security. If you are involved with military, national security or

intelligence activities or if you are in law enforcement custody, we may disclose your Protected

Health Information to authorized officials, so they may carry out their legal duties under the law.

Coroners, Medical Examiners, and Funeral Directors. We may disclose Protected Health

Information to a coroner, medical examiner, or funeral director so that they can carry out their

duties.

If you are an inmate of a correctional institution or under the custody of a law enforcement

official. we may disclose Protected Health Information to the correctional institution or law

enforcement official if the disclosure is necessary (I) for the institution to provide you with

health care; (2) to protect your health and safety or the health and safety of others; or (3) the

safety and security of the correctional institution.

Uses and Disclosures That Require Us to Give You an Opportunity to Object and Opt Out

Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may

disclose to a member of your family, a relative, a close friend or any other person you identify,

your Protected Health Information that directly relates to that person’s involvement in your

health care. If you are unable to agree or object to such a disclosure, we may disclose such

information as necessary if we determine that it is in your best interest based on our

professional judgment.

Disaster Relief. We may disclose your Protected Health Information to disaster relief

organizations that seek your Protected Health Information to coordinate your care or notify

family and friends of your location or condition in a disaster. We will provide you with an

opportunity to agree or object to such a disclosure whenever we practicably can do so.

Right to Get Notice of a Breach. You have the right to be notified upon a breach of any of

your unsecured Protected Health Information.

Right to Request Amendments. If you feel that the Protected Health Information we have is

incorrect or incomplete, you may ask us to amend the information. You have the right to

request an amendment for as long as the information is kept by or for us. A request for

amendment must be made in writing to the Privacy Officer at the address provided at the

beginning of this Notice and it must tell us the reason for your request. In certain cases, we

may deny your request for an amendment. If we deny your request for an amendment, you

have the right to file e a statement of disagreement with us and we may prepare a rebuttal

to your statement and will provide you with a copy of any such rebuttal.

Right to an Accounting of Disclosures. You have the right to ask for an “accounting of

disclosures,

” which is a list of the disclosures we made of your Protected Health

Information. This right applies to disclosures for purposes other than treatment, payment or

healthcare operations as described in this Notice. It excludes disclosures we may have

made to you, for a resident directory, to family members or friends involved in your care, or

for notification purposes. The right to receive this information is subject to certain

exceptions, restrictions and limitations. Additionally, limitations are different for electronic

health records. The first accounting of disclosures you request within any 12-month period

will be free. For additional requests within the same period, we may charge you for the

reasonable costs of providing the accounting. We will tell what the costs are, and you may

choose to withdraw or modify your request before the costs are incurred.

Right to Request Restrictions. You have the right to request a restriction or limitation on

the Protected Health Information we use or disclose for treatment, payment, or health care

operations. You also have the right to request a limit on the Protected Health Information we

disclose about you to someone who is involved in your care or the payment for your care,

like a family member or friend. To request a restriction on who may have access to your

Protected Health Information, you must submit a written request to the Privacy Officer. Your

request must state the specific restriction requested and to whom you want the restriction

to apply. We are not required to agree to your request, unless you are asking us to restrict

the use and disclosure of your Protected Health Information to a health plan for payment or

health care operation purposes and such information you wish to restrict pertains solely to

a health care item or service for which you have paid us “out-of-pocket” in full. If we do

agree to the requested restriction, we may not use or disclose your Protected Health

Information in violation of that restriction unless it is needed to provide emergency

treatment.

Out-of-Pocket Payments. If you paid out-of-pocket in full for a specific item or service, you have

the right to ask that your Protected Health Information with respect to that item or service not be

disclosed to a health plan for purposes of payment or health care operations, and we will honor

that request.

Right to Request Confidential Communications. You have the right to request that we

communicate with you online in certain ways to preserve your privacy. For example, you may

request that we contact you by mail at a specific address or call you only at your work number.

You must make any such request in writing and you must specify how or where we are to contact

you. We will accommodate all reasonable requests. We will not ask you the reason for the request.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice, even if you

have agreed to receive this Notice electronically. You may request a copy of this Notice at any

time.

How to Exercise Your Rights

To exercise your rights described in this Notice, send your request, in writing, to our Privacy Officer at

the address listed on the first page of this Notice. We may ask you to fill out a form that we will supply.

To exercise your right to inspect and copy your Protected Health Information, you may also contact

your provider directly. To get a paper copy of this Notice, contact our Privacy Officer by phone or mail.

Changes to This Notice

We reserve the right to change this Notice. We reserve the right to make the changed Notice effective

for Protected Health Information we already have as well as for any Protected Health Information we

create or receive in the future. A copy of our current Notice is posted on our website.

Complaints

You may file a complaint with us or with the Secretary of the United States Department of Health and

Human Services if you believe your privacy rights have been violated. To file a complaint with us,

contact our Privacy Officer at the address listed at the beginning of this Notice. All complaints must

be made in writing and should be submitted within 180 days of when you knew or should have known

of the suspected violation. There will be no retaliation against you for filing a complaint. To file a

complaint with the Secretary, mail it to: Secretary of the U.S. Department of Health and Human

Services 200 Independence Ave, S.W., Washington, D.C. 20201. Call (202) 619-0257 (or toll free (877)

696-6775) or go to the website of the Office for Civil Rights, www.hhs.gov/ocr/hipaa/, for more

information. There will be no retaliation against you for filing a complaint.

Page 12 | Revised: October 2026