Notice of Privacy Practices of Wayspring

This notice describes:

HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION

YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH OUR PRIVACY OFFICER AT 888-483-2403 or privacy@wayspring.com IF YOU HAVE ANY QUESTIONS.

This notice applies to Wayspring, which includes Axial Healthcare, Inc. and its affiliates, including the Wayspring Clinics. In providing services to you, Wayspring will create and receive records about you and the treatment and services we provide you. Your health information is protected by federal law and regulations, including the Health Insurance Portability and Accountability Act (“HIPAA”) and its implementing regulations and federal regulations that protect the confidentiality of substance use disorder patient records. Your information may be stored and disclosed electronically and on paper.

Your Rights

You have the following rights regarding your health information we maintain about you. If you have given another individual a medical power of attorney, if another individual is appointed as your legal guardian or if another individual is authorized by law to make health-care decisions for you (known as a “personal representative”), that individual may exercise any of the rights below for you.

Right to Access: You have the right to get an electronic or paper copy of your health information or ask us to send records stored in an electronic record to a third party you designate. You may request a copy by contacting us in writing at the contact information listed at the end of this Notice. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Right to Correct Your Record: You can ask us to correct health information about you that you think is incorrect or incomplete. You may request a correction by using the contact information listed at the end of this Notice. We may say “no” to your request, but we’ll tell you why in writing within 60 days of receiving your request.

Right to an Accounting: You can ask for a list (accounting) of when we have disclosed your health information for six years prior to the date you ask. We will include all the disclosures except for those about treatment, payment, and health-care operations, and certain other disclosures (such as any you asked us to make) that we are not required by law to include. We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. You may request an accounting by using the contact information listed at the end of this Notice.

Right to List of Disclosures by an Intermediary: If you consent under a general designation to the disclosure of your health information to another person (other than us or an entity covered by HIPAA) who has a treating provider relationship with you, that other person is required to provide you with a list of disclosures they make for the past 3 years.

Right to Request Restrictions: You can ask us not to use or disclose certain health information for treatment, payment, or our operations, including when you have previously signed a written consent for such disclosures. We are not required to agree to your request unless the disclosure is not required by law, would be to a health plan for purposes of either payment or health-care operations and applies to health information for an item or service for which you have already paid us in full out-of-pocket. You may request a restriction by using the contact information listed at the end of this Notice.

Right to Confidential Communications: You have the right to request to receive communications from Wayspring in a specific way or to a different address. For example, you may request that we only contact you at work or by mail. We will agree to all reasonable requests. You may request confidential communications by using the contact information listed at the end of this Notice.

Right to Receive a Copy of this Notice: You have the right to a paper or electronic copy of this Notice upon request even if you have already requested to receive this Notice electronically. You may request a copy of this Notice by using the contact information listed at the end of this Notice.

Right to Not Receive Fundraising Communications: You have the right to elect not to receive communications about our fundraising activities by using the contact information listed at the end of this Notice.

Right to Discuss This Notice: You have the right to discuss this Notice with us. You can do so by contacting us using the contact information provided at the end of this Notice.

Right to Complain: You have the right to complain to us if you believe your privacy rights have been violated. To file a complaint with us, please use the contact information listed at the end of this Notice. You may also file a complaint with the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Uses and Disclosures of Your Health Information Without Your Written Consent

We may use and disclose your health information for the following purposes without your written consent:

To you or your personal representative: We may disclose your health information to you or your personal representative, including if you or they request access, as described above.
Between and Among Wayspring: We may use and disclose your health information between and among our staff and any entities with direct administrative control over our programs that need the information to perform their job duties related to providing diagnosis, treatment, or referral for treatment of substance use disorders.

Child Abuse and Neglect: We may use and disclose your health information as required by state law to report to appropriate state or local authorities incidents of suspected child abuse and neglect. We may not, however, disclose the original substance use disorder patient records we maintain unless otherwise permitted or required by law, including disclosures for civil or criminal proceedings that arise out of a report of suspected child abuse and neglect.

Medical Emergencies: We may use and disclose your health information in the event of a bona fide medical emergency in which your prior informed consent cannot be obtained, including disclosures to the Food and Drug Administration.

Business Associates: We may disclose your health information to business associates (sometimes called Qualified Service Organizations) with whom we contract to provide services to us. Examples of business associates include administrative and management services, medical records, IT vendors, consultants, accountants, attorneys, medical transcriptionists, and third-party billing companies. We will only make these disclosures if we have received assurance that the business associate will properly safeguard your health information.

Research: In certain limited circumstances permitted by applicable law, we may use and disclose your health information for research purposes. For example, we may use or disclose health information for research as authorized by a privacy waiver.

Crimes on the Premises: We may disclose your health information to law enforcement agencies or officials that is directly related to the commission of a crime on our premises or against a staff member or a threat to commit such a crime. The disclosure must be limited to information related to the circumstances of the incident, including the individual’s status as a patient at Wayspring, name and address and last known whereabouts.

Court Orders and Lawsuits: We may use and disclose your health information if required by a valid court order. A court order must be accompanied by a subpoena or similar legal mandate compelling disclosure before health information is used or disclosed. Your health information, or testimony relaying the contents of those records, will not be used or disclosed in any civil, administrative, criminal, or legislative proceedings against you unless based on your specific written consent or based on a court order. If required by law, your records will only be used or disclosed based on a court order after you receive notice and an opportunity to be heard.

Public Health: We may disclose your health information to public health authorities provided your health information is first de-identified in accordance with the HIPAA standards for de-identification.

Audit and Evaluation Activities: We may use and disclose your health information for certain audit and evaluation activities, such as if Wayspring is audited by a government agency.

Deceased Patients: We may use and disclose health information related to the cause of death of a patient under applicable laws requiring the collection of death or other vital statistics or permitting inquiry in the cause of death.

If information we maintain is not protected by federal substance abuse federal regulations that protect the confidentiality of substance use disorder patient records, we can also use and disclose health information without your written consent for purposes permitted by HIPAA, including treatment, payment and heath care operations.

Uses and Disclosures of Your Health Information with Your Written Consent

For any purpose other than those described in this Notice, we will obtain your written consent before using or disclosing your health information. You may revoke any consent you give at any time by contacting us using the contact information provided at the end of this Notice. For example we can use and disclose your information with your consent for the following purposes:

Treatment, Payment and Healthcare Operations: We may use or disclose your health information for treatment, payment and healthcare operations purposes. Treatment includes using or disclosing your health information to provide you with medical treatment and services. Payment includes using and disclosing your health information so that we can obtain payment for the services we provide you. Healthcare operations includes using or disclosing your health information for our daily operational activities, including quality assurance activities, arranging for legal services, and training staff. You may provide a single consent for all future uses and disclosures for treatment, payment, and healthcare operations purposes.

Multiple Enrollments: We may disclose your health information to a central registry or to any withdrawal management or maintenance treatment program within 200 miles of Wayspring to ensure that you are not enrolled in multiple substance use disorder treatment programs.

To Persons within the Criminal Justice System who Referred You. We may disclose your health information to those persons within the criminal justice system who have made participation in our program a condition of the disposition of any criminal proceedings against you or a condition of your parole or other release from custody.

Disclosures to Prescription Drug Monitoring Programs. If required by law, we may report substance use disorder medication Wayspring prescribes or dispenses to applicable state prescription drug monitoring programs.

Health information that is disclosed to a federally-assisted substance use disorder program or a covered entity or business associate under HIPAA for treatment, payment, and healthcare operations may be further disclosed by that entity without your consent if permitted by HIPAA. Your information still cannot be used in legal proceedings against you unless (1) you consent or (2) based on a court order and a subpoena (or similar legal requirement) that complies with federal regulations that protect the confidentiality of substance use disorder patient records.

When health information is disclosed pursuant to HIPAA, it is possible that the information could be re-disclosed by the recipient and no longer be protected by HIPAA.
HIPAA permits health information to be used or disclosed for treatment, payment and health care operations, public health and safety, research, health oversight, as required by law (including to the government to investigate privacy law violations), organ and tissue donation, as needed by a medical examiner or funeral director, workers’ compensation, law enforcement, other government requests, lawsuits and legal actions and when incidental to a permitted disclosure, subject to applicable conditions and restrictions.

Our Duties

We are required by law to maintain the privacy and security of your health information.
We are required by law to provide you notice of our legal duties and privacy practices with respect to your health information.
We are required to notify affected individuals following a breach of unsecured health information.
We are required to abide by the terms of this Notice currently in effect. We reserve the right to change the terms of this Notice at any time and to make any new provisions effective for all health information we maintain. We will make the new Notice available to you upon request at our clinic and on our website.

How to Contact Us

Phone: 615-345-3555

Email: privacy@wayspring.com

Website: www.wayspring.com

Address: 209 10^th Avenue South, Suite 350, Nashville, TN 37203

Notice Effective Date: 7/10/2026