SPRINGFIELD NEPHROLOGY ASSOCIATES, INC.

NOTICE OF PRIVACY PRACTICES
Reviewed: September 2, 2025

This notice describes your rights regarding your medical information and explains how medical information about you may be used and disclosed. Please review it carefully. This notice applies to Springfield Nephrology Associates, Inc. facilities and clinics (“SNA”).

SNA’s Duties

By law, SNA must keep your protected health information (“PHI”) private. PHI includes any information (verbal, electronic, or paper) created or received by SNA for providing health care and for billing/payment, such as test results, notes from clinicians, and general information (name, address, telephone) contained in your medical and billing records. SNA is required to give you this notice and follow the notice currently in effect.

Health Care Providers Covered by This Notice

This notice covers SNA and its employees, volunteers, students, and trainees. It also covers other health care providers who come to SNA facilities and clinics to care for patients (e.g., physicians, physician assistants, therapists) unless those providers give you their own notice of privacy practices.

Use and Disclosure of PHI Without Your Permission

For Treatment

We may share PHI about you with people involved in your care. For example, a doctor may need to review your medical history before treating you.

For Payment

We may use and disclose PHI for billing purposes. For example, we may share your PHI with your insurance company to receive payment for services SNA provides to you, and with an ambulance company so it may bill for services provided to bring you to SNA.

For Health Care Operations

We may use and disclose PHI for operations such as evaluating the performance of our clinicians in caring for you.

For Research

We may share your PHI with researchers when their research has been approved by an institutional review board (IRB) and does not require patient permission. Your permission is required for other types of research.

Other Uses and Disclosures Required or Permitted by Law

• Public health activities, such as reporting communicable diseases.
• Reporting information about victims of abuse, neglect, or domestic violence.
• Health oversight activities (e.g., Medicare and Medicaid program activities).
• Legal proceedings (e.g., in response to a subpoena or court order).
• Law enforcement purposes (e.g., to police or other officials pursuing a criminal suspect).
• With medical examiners, coroners, and funeral directors.
• For organ and tissue donation purposes.
• To avert a serious health or safety threat.
• To comply with workers’ compensation laws.
• With entities legally authorized to assist in disaster relief efforts (e.g., American Red Cross).
• For other purposes as required by law.

Permissive Uses or Disclosures

We may use or share your PHI for the purposes below unless you request in writing that we do not. Provide your written request to your care provider or the Health Information Management Office listed at the end of this notice.

• Appointment reminders.
• Information about or recommendations for possible treatment options or alternatives that may be of interest to you.
• Patient directory information (name, room location, and general condition such as “fair” or “stable”) to people who ask for you by name.
• Information about SNA-sponsored activities including fundraising programs and events. If you do not want your information used for fundraising, contact the SNA Foundation office listed below. Your care will not be affected by your decision.
• PHI shared with a friend, family member, personal representative, or any individual you identify who is involved in your care or paying for your care.

Uses and Disclosures Requiring Your Written Permission

For any purpose other than those listed above, we will use or disclose your PHI only with your written permission (authorization).

• Psychotherapy Notes: We must obtain your written permission for most uses and disclosures of psychotherapy notes.
• Marketing: Before we receive financial payment for marketing activities using your PHI, we must obtain your written permission. We may, however, communicate with you about products or services related to your treatment, case management, care coordination, or alternative treatments, therapies, providers, or care settings without your permission. Permission is also not needed for small promotional items and face-to-face communications.
• Sale of PHI: We may not sell your PHI without your written permission, except we may be paid our cost to provide PHI for certain purposes permitted by HIPAA (e.g., public health).

Revoking Your Authorization

If you give written permission to use or disclose your PHI, you may revoke it at any time by telling us in writing. We will stop using or sharing your information from that point forward, but we cannot take back information already disclosed.

Your Rights

Right to Request Restrictions

If you pay in full (cash) for a health care item or service and request that SNA not share PHI about that service with your health plan, we will not disclose PHI about that service to the health plan unless required by law.

Right to Request Confidential Communications

You may request that we communicate with you in a certain way or at a specific location (e.g., not at work). Requests must be in writing. We will agree to reasonable requests and honor them until you notify us in writing to change them.

Right to Inspect and Receive a Copy of Your PHI

You have the right to review your PHI and receive a paper or electronic copy. Requests must be in writing. We may charge a fee for copies. In rare cases, a licensed health care professional may deny access if access is determined to pose a serious risk of harm.

Right to Request a Change (Amendment) to Your PHI

You may request a correction if you believe your PHI contains a mistake or is missing information. Include the reason for the change in writing using the request form available from your provider or the Health Information Management Office. SNA may deny your request if: (1) it is not in writing or lacks a reason; (2) the information was not created by SNA; (3) it is not part of SNA’s medical record; (4) it is not information you are permitted to inspect or copy; or (5) the record is accurate and complete.

Right to Notice of a Breach

We are required by law to notify you if there is a breach of your PHI (for example, when safeguards fail).

Right to an Accounting of Disclosures

You may request an accounting of disclosures of your PHI that we have made, with some exceptions. Requests must be in writing and state the time period requested (not to exceed six years from the date of your request). You have the right to one free accounting every 12 months; additional requests may incur a reasonable fee.

Right to Receive a Copy of This Notice

You may view and print a copy of this notice on our website at SNA.net. To receive a paper copy by mail, or to exercise any of your rights, send a written request to the Practice Administrator listed below.

Privacy Questions or Complaints

If you have questions about this notice or concerns about the privacy of your PHI, please contact the Privacy Officer for the SNA provider where you obtained services (listed below). You also have the right to file a complaint with the Office for Civil Rights (OCR). Filing a complaint with SNA or OCR will not affect your ability to obtain care at SNA.

Changes to This Notice

We may change this notice at any time. Changes may apply to all PHI that we maintain, and will comply with applicable laws. The most recent copy of this notice will be available on our website.

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