HIPAA Notice of Privacy Practices
Your Information • Your Rights • Our Responsibilities
Effective Date: September 16, 2026
This notice describes how medical information about you or your child may be used and disclosed and how you can get access to this information. Please review it carefully.
Who This Notice Applies To
This Notice applies to health information maintained by Matrescence Lactation & Wellness, LLC in connection with services provided to mothers, infants, and other patients. References to “you” include the patient and, when permitted by law, the patient’s parent, guardian, or other personal representative.
Your Rights
You have the right to:
Get an electronic or paper copy of your medical record.
Ask us to correct your medical record.
Request confidential communications.
Ask us to limit what we use or share.
Get a list of certain disclosures of your information.
Get a paper or electronic copy of this Notice.
Choose someone to act for you.
File a complaint if you believe your privacy rights have been violated.
Get a Copy of Your Medical Record
You may ask to inspect or receive an electronic or paper copy of your medical record and other health information we maintain about you. We will usually provide a copy or summary within 30 days. We may charge a reasonable, cost-based fee as permitted by law.
Ask Us to Correct Your Record
You may ask us to correct health information you believe is incorrect or incomplete. We may deny the request in some circumstances, but we will explain the reason in writing, generally within 60 days.
Request Confidential Communications
You may ask us to contact you in a particular way, such as only by mobile phone, or to send mail to a different address. We will accommodate reasonable requests.
Ask Us to Limit What We Use or Share
You may ask us not to use or share certain health information for treatment, payment, or health care operations. We are not always required to agree. If we agree, we may still use or disclose the information if emergency treatment is needed or as otherwise permitted by law.
If you pay out of pocket in full for a service or item, you may ask us not to disclose information about that service or item to your health plan for payment or health care operations. We will agree unless a law requires disclosure.
Get a List of Certain Disclosures
You may request an accounting of certain disclosures made during the six years before your request. The accounting generally does not include disclosures for treatment, payment, or health care operations or disclosures you authorized. One accounting in a 12-month period is free; we may charge a reasonable, cost-based fee for additional requests.
Get a Copy of This Notice
You may ask for a paper copy at any time, even if you agreed to receive it electronically. The current Notice is also available on our website.
Choose Someone to Act for You
If a person has legal authority to act for you, such as a parent, legal guardian, or medical power of attorney, that person may exercise your rights. We will verify the person’s authority before acting.
File a Complaint
You may complain to our Privacy Officer using the contact information at the end of this Notice. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue SW, Washington, DC 20201; calling 1-877-696-6775; or visiting www.hhs.gov/hipaa/filing-a-complaint. We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you may tell us what you want us to share. Tell us your preference and we will follow your instructions when the law gives you that choice.
Share information with family, close friends, or others involved in your care or payment for care.
Share information in a disaster-relief situation.
If you cannot tell us your preference, we may share information if we believe it is in your best interest or is needed to lessen a serious and imminent threat to health or safety, as permitted by law.
We will obtain your written authorization before using or disclosing your information for marketing, selling your information, or most uses or disclosures of psychotherapy notes. We do not maintain a hospital directory and do not conduct fundraising using patient information.
How We Typically Use and Share Your Information
Treatment
We may use your health information and share it with other professionals involved in your or your child’s care. For example, we may coordinate with an obstetric clinician, pediatrician, therapist, pharmacist, laboratory, feeding therapist, or other treating professional.
Health Care Operations
We may use and share health information to run the practice, improve care, train or supervise personnel, conduct quality review, manage risk, obtain professional services, and contact you when necessary.
Payment
We may use and share health information to bill and obtain payment from you, a health plan, or another responsible entity. This may include eligibility checks, claims, utilization review, collections, and coordination of benefits.
Other Uses and Disclosures Permitted or Required by Law
We may use or disclose health information in other ways permitted or required by law. Conditions and safeguards may apply. These purposes may include:
Public health and safety activities, including preventing disease; reporting adverse reactions, abuse, neglect, or domestic violence; and preventing or reducing a serious threat to health or safety.
Health research when legal requirements are satisfied.
Compliance with federal or state law and oversight by the U.S. Department of Health and Human Services.
Organ and tissue donation requests.
Coroners, medical examiners, and funeral directors when a person dies.
Workers’ compensation, health oversight, law enforcement, and special government functions when applicable legal requirements are met.
Court or administrative orders, subpoenas, lawsuits, and other legal proceedings when authorized or required by law.
Substance Use Disorder Records
To the extent we receive or maintain substance use disorder patient records protected by 42 CFR Part 2, we will not use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a court order accompanied by a subpoena, as required by law. If fundraising communications would use Part 2 information, we will provide clear advance notice and an opportunity to opt out.
More Protective Laws
Some federal or Virginia laws may provide greater protection for particular information, including certain mental health, genetic, communicable-disease, or substance use disorder records. We will follow the law that provides the greater protection when it applies.
Electronic Services and Business Associates
We may use electronic health record, scheduling, communication, billing, payment, laboratory, clearinghouse, and other service providers to support our practice. When a service provider is a HIPAA business associate, we require appropriate written assurances that it will safeguard protected health information. Patient information may be available through the secure Jane portal. Ordinary website forms, email, social media, and Calendly should not be used to send detailed medical information.
Our Responsibilities
We are required by law to maintain the privacy and security of protected health information.
We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in the current Notice and provide you a copy.
We will not use or disclose your information other than as described in this Notice unless you authorize us in writing. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.
We will make reasonable efforts to use, disclose, and request only the minimum necessary information when that standard applies.
Changes to This Notice
We may change this Notice and make the revised terms apply to all health information we maintain, including information created or received before the change. The current Notice will be available upon request and posted on our website. Material changes will be reflected in a revised effective date.
Privacy Contact
Jessica Schafer, Owner and Privacy Officer
Matrescence Lactation & Wellness, LLC
[BUSINESS MAILING ADDRESS]
Phone: 757-517-8601