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Notice of Privacy Practices

Maple Health & Wellness Clinic
Effective Date: August 15, 2026

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.

Maple Health & Wellness Clinic ("Maple Health & Wellness Clinic," "we," "us," or "our") is committed to protecting the privacy and security of your health information.

We are required by applicable federal and California law, including the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and the California Confidentiality of Medical Information Act ("CMIA"), to maintain the privacy of your Protected Health Information ("PHI"), provide you with this Notice of Privacy Practices, and follow the privacy practices described in this notice.

This notice explains how we may use and disclose your PHI, your rights regarding your PHI, and our responsibilities with respect to your health information.

1. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

We may use or disclose your PHI without obtaining your separate written authorization for certain purposes permitted or required by law, including the following:

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your health care and related services.

For example, we may share relevant health information with another health care provider involved in your care when necessary to coordinate your treatment.

Payment

We may use and disclose your PHI as necessary to obtain payment for health care services we provide.

For example, we may provide information to a health plan or other entity responsible for payment of your care when applicable.

Health Care Operations

We may use and disclose your PHI as necessary to operate our practice and support the quality and effectiveness of the services we provide.

Examples may include quality assessment, reviewing our services, administrative activities, compliance activities, and practice management.

Appointment Reminders and Health-Related Communications

We may use your PHI to contact you regarding appointments, scheduling, treatment-related information, treatment alternatives, or other health-related services or benefits that may be of interest to you.

As Required by Law

We may use or disclose your PHI when required to do so by applicable federal, state, or local law.

Public Health Activities

We may disclose PHI for certain public health activities permitted or required by law, such as reporting certain diseases or conditions, preventing or controlling disease, or other activities authorized by applicable law.

Health Oversight Activities

We may disclose PHI to appropriate governmental authorities for activities authorized by law relating to oversight of the health care system, government programs, or compliance with applicable laws and regulations.

Legal Proceedings and Law Enforcement

We may disclose PHI in response to appropriate legal processes, court orders, subpoenas, warrants, or other lawful requests, and for certain law-enforcement purposes as permitted or required by law.

Serious Threats to Health or Safety

We may use or disclose PHI when necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, when permitted by applicable law.

Abuse, Neglect, or Domestic Violence

We may disclose PHI to appropriate government authorities when required or permitted by law to report suspected abuse, neglect, or domestic violence.

Workers' Compensation

We may disclose PHI as authorized by and to the extent necessary to comply with laws relating to workers' compensation or similar programs.

Other Uses and Disclosures Required or Permitted by Law

We may use or disclose PHI for other purposes specifically authorized or permitted by applicable federal or California law.

Where California law provides greater privacy protection than federal law, we will comply with the more protective applicable requirement.

2. USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION

Except as otherwise permitted or required by law, we will obtain your written authorization before using or disclosing your PHI for purposes not described in this notice.

Examples may include certain uses or disclosures for:

Marketing;
Sale of PHI; or
Other uses and disclosures for which applicable law requires your authorization.

If you provide a written authorization, you may revoke that authorization in writing at any time, except to the extent that we have already relied upon it.

3. PROTECTION OF SENSITIVE HEALTH INFORMATION

Certain categories of health information may receive additional protection under federal or California law.

Where applicable, Maple Health & Wellness Clinic will comply with additional legal requirements governing specially protected information, including information relating to substance use disorder treatment, mental health or psychotherapy records, HIV/AIDS-related information, reproductive health information, and other specially protected categories.

The extent of these protections and the circumstances under which information may be disclosed depend on the applicable law and the particular circumstances.

4. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding your PHI, subject to certain limitations and exceptions under applicable law.

Right to Inspect and Obtain a Copy

You generally have the right to inspect and obtain a copy of PHI that may be used to make decisions about you.

California law provides specific requirements regarding the timing and handling of requests for access to medical records.

You may be responsible for reasonable copying or administrative fees where permitted by law.

Right to Request an Amendment

If you believe information we maintain about you is incorrect or incomplete, you may request that we amend the information.

Your request must generally be made in writing and explain why you believe the information should be amended.

We may deny an amendment request in certain circumstances permitted by law. If we deny your request, we will provide you with information regarding your rights to respond or disagree with the decision.

Right to an Accounting of Certain Disclosures

You generally have the right to request an accounting of certain disclosures of your PHI made by us during the period permitted by law.

This right does not include all disclosures, including certain disclosures for treatment, payment, and health care operations.

Right to Request Restrictions

You may request restrictions or limitations on how we use or disclose your PHI.

We are not required to agree to every requested restriction.

However, if you pay for a health care item or service entirely out of pocket and request that we not disclose information about that item or service to your health plan for payment or health care operations purposes, we will generally honor that request when required by applicable law.

Right to Request Confidential Communications

You may request that we communicate with you about your health information in a particular way or at a particular location.

For example, you may request that we contact you at a particular telephone number, email address, or mailing address.

We will accommodate reasonable requests as required by applicable law.

Right to Receive a Paper Copy

You have the right to request a paper copy of this Notice of Privacy Practices at any time, even if you have agreed to receive the notice electronically.

5. OUR RESPONSIBILITIES

Maple Health & Wellness Clinic is required by law to:

Maintain the privacy of your PHI;
Provide you with this notice describing our legal duties and privacy practices;
Follow the terms of the Notice of Privacy Practices currently in effect;
Notify affected individuals as required by applicable law following a breach of unsecured PHI; and
Comply with applicable federal and California privacy laws.

We reserve the right to change our privacy practices and this notice.

If we materially change this notice, we will make the revised notice available as required by applicable law, including by posting the updated notice on our website.

The revised notice will apply to PHI we maintain as permitted by applicable law.

6. YOUR RIGHT TO FILE A COMPLAINT

If you believe that your privacy rights have been violated, you may file a complaint with Maple Health & Wellness Clinic or with the U.S. Department of Health and Human Services.

You will not be retaliated against, penalized, or otherwise disadvantaged for filing a privacy complaint.

To Contact Maple Health & Wellness Clinic

Privacy Officer: Cynthia Hall
Practice: Maple Health & Wellness Clinic
Address: San Diego, CA 92129
Phone: 619-376-3858
Email: info@maplewellnessclinic.com

To Contact the U.S. Department of Health and Human Services

You may submit a complaint to the Office for Civil Rights of the U.S. Department of Health and Human Services.

Information about filing a complaint is available through the U.S. Department of Health and Human Services, Office for Civil Rights.

This Notice of Privacy Practices is intended to describe Maple Health & Wellness Clinic's general privacy practices and patient rights. It should be reviewed by qualified legal/privacy counsel before final publication to ensure that it accurately reflects the clinic's actual operations, technology platforms, communications practices, and applicable federal and California law.

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