NOTICE OF PRIVACY PRACTICES
HOLISTIC WELLNESS SOLUTIONS LLC
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Holistic Wellness Solutions LLC (“HWS,” “Practice,” “we,” “our,” or “us”) is committed to protecting the privacy and confidentiality of your Protected Health Information (“PHI”). PHI includes information that identifies you and relates to your mental or physical health, treatment, or payment for healthcare services.
This Notice describes:
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how we may use and disclose your PHI,
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your rights regarding your PHI,
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and our responsibilities under federal and state law.
YOUR RIGHTS
You have the right to:
Request access to your records
You may request an electronic or paper copy of your medical records and other PHI. Reasonable fees may apply as permitted by law.
Request corrections
You may request corrections to information you believe is incorrect or incomplete. We may deny certain requests as permitted by law.
Request confidential communication
You may ask us to contact you in a specific way (for example, only by phone or email).
Request restrictions
You may request limitations on how we use or disclose your PHI. We are not always required to agree to requested restrictions.
Request an accounting of disclosures
You may request a list of certain disclosures of your PHI made by the Practice.
Obtain a copy of this Notice
You may request a paper or electronic copy of this Notice at any time.
Choose someone to act for you
If you have provided someone with medical power of attorney or legal guardianship authority, that individual may exercise your rights consistent with applicable law.
File a complaint
You may file a complaint if you believe your privacy rights have been violated.
You may contact:
Holistic Wellness Solutions LLC
Privacy Officer: Alicja Matusiak
4770 Indianola Ave, Suite 107
Columbus, OH 43214
Phone: (614) 371-2303 ext. 0
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights: https://www.hhs.gov/ocr/privacy/hipaa/complaints/
You will not be retaliated against for filing a complaint.
HOW WE MAY USE AND DISCLOSE YOUR INFORMATION
We may use or disclose your PHI for purposes including:
Treatment
To coordinate your care with healthcare providers, pharmacies, hospitals, laboratories, or other professionals involved in your treatment.
Payment
To bill and receive payment from insurance companies, managed care organizations, or other responsible parties.
Healthcare Operations
To operate our practice, improve services, conduct quality assurance, train staff, manage scheduling, and communicate with you regarding appointments or services.
Appointment Reminders & Communication
We may contact you by phone, voicemail, text message, email, or patient portal regarding:
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appointments,
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scheduling,
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billing,
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prescription issues,
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or operational matters.
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Electronic communication may not always be fully secure.
USES AND DISCLOSURES REQUIRED OR PERMITTED BY LAW
We may disclose PHI without your authorization when required or permitted by law, including:
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suspected abuse or neglect,
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risk of harm to yourself or others,
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court orders or subpoenas,
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law enforcement requests,
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public health reporting,
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healthcare oversight activities,
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workers’ compensation claims,
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emergencies,
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national security or military requirements,
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and other legal obligations.
We may also share PHI with business associates who perform services on our behalf and are required to protect your information.
SUBSTANCE USE DISORDER RECORDS (42 CFR PART 2)
If applicable, certain substance use disorder treatment records may receive additional protection under federal law (42 CFR Part 2). These records generally require your specific written authorization for disclosure unless otherwise permitted or required by law.
YOUR AUTHORIZATION
Uses and disclosures not described in this Notice will generally require your written authorization. You may revoke an authorization at any time in writing, except to the extent action has already been taken.
OUR RESPONSIBILITIES
Holistic Wellness Solutions LLC is required by law to:
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maintain the privacy and security of your PHI,
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provide you with this Notice,
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follow the terms currently in effect,
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and notify you if a breach affecting your PHI occurs.
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We reserve the right to update this Notice at any time. Updated versions will be available:
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in the office,
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through the patient portal,
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and on our website.
WEBSITE ACCESS
A current copy of this Notice is available at:
Effective Date: 5/11/26