HIPAA Notice of Privacy Practices — Synergy MD Clinic

⚠️ Important Notice

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

Our Duties

Synergy MD Clinic is required by law to maintain the privacy of your Protected Health Information (PHI), to provide you with notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

How We May Use and Disclose Your PHI

For Treatment

We may use or disclose your PHI to provide you with medical treatment or services and to coordinate your care. For example, we may share information with other providers involved in your treatment.

For Payment

We may use or disclose your PHI to obtain payment for services. For example, we may submit claims to your health insurance company.

For Health Care Operations

We may use or disclose your PHI for operational purposes such as quality assessment, training, and accreditation activities.

Special Protections for Addiction Treatment Records

42 CFR Part 2 — Enhanced Protection

Records related to substance use disorder treatment at Synergy MD Clinic are protected by federal law under 42 CFR Part 2. This law provides stronger protections than standard HIPAA. We cannot disclose your addiction treatment records to anyone — including family members, employers, law enforcement, or other healthcare providers — without your explicit written consent.

This means your addiction treatment at Synergy MD Clinic is completely private unless you specifically authorize disclosure in writing.

Your Rights Regarding Your PHI

Right to Inspect and Copy — You have the right to inspect and copy your PHI. We may charge a reasonable fee for copies.
Right to Amend — If you believe your PHI is incorrect or incomplete, you may request an amendment.
Right to an Accounting of Disclosures — You have the right to request a list of disclosures of your PHI we have made in the past six years.
Right to Request Restrictions — You have the right to request restrictions on certain uses and disclosures of your PHI.
Right to Confidential Communications — You have the right to request that we communicate with you in a specific way or at a specific location.
Right to a Paper Copy of this Notice — You have the right to a paper copy of this notice upon request.
Right to Revoke Authorization — You have the right to revoke any authorization you have given us at any time, in writing.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

Synergy MD Clinic Privacy Officer: +1 469-520-4180 | privacy@synergymdclinic.com
U.S. Department of Health and Human Services Office for Civil Rights: 1-800-368-1019 | www.hhs.gov/ocr

We will not retaliate against you for filing a complaint.

Changes to This Notice

We reserve the right to change this notice and to apply the revised notice to PHI we already have. The current notice will always be posted in our office and on our website. If we make a significant change, we will notify patients through the patient portal.

Contact Our Privacy Officer

Synergy MD Clinic — Privacy Officer
399 W Campbell Rd, Richardson, TX 75080
Phone: +1 469-520-4180
Email: privacy@synergymdclinic.com