NOTICE OF PRIVACY PRACTICES OF INFINITY HEALTH

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.

We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties, privacy practices and your rights with respect to your medical information.  Your medical information includes your individually identifiable medical, insurance, demographic and medical payment information.  For example, it includes information about your diagnosis, medications, insurance status and policy number, medical claims history, address, and social security number.

This Notice describes the Privacy Practices of Infinity Health.

The following are the types of uses and disclosures we may make of your medical information without your permission.  However, any disclosures made by Infinity Health will follow the additional privacy protections described in Appendix A, which should be read as a supplement to this Notice. Additionally, where other State or federal law restricts one of the described uses or disclosures, we follow the requirements of such State or federal law.  These are general descriptions only.  They do not cover every example of disclosure within a category.

Treatment.  We will use and disclose your medical information for treatment. For example, we will share medical information about you with our nurses, your physicians and others who are involved in your care at Infinity Health.  We will also disclose your medical information to your physician and other practitioners, providers and health care facilities for their use in treating you in the future.  For example, if you are transferred to a hospital, we will send medical information about you to the hospital.

Payment.  We will use and disclose your medical information for payment purposes.  For example, we will use your medical information to prepare your bill and we will send medical information to your insurance company with your bill.  We may also disclose medical information about you to other medical care providers, medical plans and health care clearinghouses for their payment purposes.  For example, if you require ambulance transportation, the information collected will be given to the ambulance provider for its billing purposes.  If State law requires, we will obtain your permission prior to disclosing to other providers or health insurance companies for payment purposes.

Health Care Operations.  We may use or disclose your medical information for our health care operations.  For example, physicians may review your medical information for quality improvement purposes.  In some cases, we will furnish other qualified parties with your medical information for their health care operations.  The ambulance company, for example, may also want information on your condition to help them know whether they have done an effective job of providing care.  If State law requires, we will obtain your permission prior to disclosing your medical information to other providers or health insurance companies for their health care operations.

Business Associates.  We will disclose your medical information to our business associates and allow them to create, use and disclose your medical information to perform their services for us.  For example, we may disclose your medical information to an outside billing company who assists us in billing insurance companies.

Appointment Reminders.  We may contact you as a reminder that you have an appointment for treatment or medical services.

Treatment Alternatives.  We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fundraising.  We may contact you as part of a fundraising effort.  We may also use, or disclose to a business associate, certain medical information about you, such as your name, address, phone number, dates you received treatment or services, treating physician, outcome information and department of service (for example, cardiology or orthopedics), so that we or they may contact you to raise money for the organization.  Any time you are contacted, whether in writing, by phone or by other means for our fundraising purposes, you will have the opportunity to “opt out” and not receive further fundraising communications related to the specific fundraising campaign or appeal for which you are being contacted, unless we have already sent a communication prior to receiving notice of your election to opt out.

Information Received from Substance Use Disorder Programs. We may receive health information from a substance use disorder program. We will use and disclose that information in the same manner as your other health information we maintain, except that we will not use or disclose it in civil, criminal, administrative, or legislative proceedings against you, unless you consent to such use or disclosure or pursuant to a court order that has given you an opportunity to be heard and that is accompanied by a subpoena or other legal instrument that requires our disclosure.

Family, Friends or Others.  We may disclose your location or general condition to a family member, your personal representative or another person identified by you.  If any of these individuals are involved in your care or payment for care, we may also disclose such medical information as is directly relevant to their involvement.  We will only release this information if you agree, are given the opportunity to object and do not, or if in our professional judgment, it would be in your best interest to allow the person to receive the information or act on your behalf.  For example, we may allow a family member to pick up your prescriptions, medical supplies or X-rays.  We may also disclose your information to an entity assisting in disaster relief efforts so that your family or individual responsible for your care may be notified of your location and condition.

Required by Law.  We will use and disclose your information as required by federal, State or local law. Such disclosures include sharing your information with the Department of Health and Human Services if it wants to confirm that we are complying with federal privacy law.

Public Health Activities.  We may disclose medical information about you for public health activities.  These activities may include disclosures:

• To a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury or disability;
• To appropriate authorities authorized to receive reports of child abuse and neglect;
• To FDA-regulated entities for purposes of monitoring or reporting the quality, safety or effectiveness of FDA-regulated products;
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and
• With parent or guardian permission, to send proof of required immunization to a school.

Abuse, Neglect or Domestic Violence.  We may notify the appropriate government authority if we believe you been the victim of abuse, neglect or domestic violence.  Unless such disclosure is required by law (for example, to report a particular type of injury), we will only make this disclosure if you agree.

Health Oversight Activities.  We may disclose medical information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections and licensure.  These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

Judicial and Administrative Proceedings.  If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order.  We may also disclose medical information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if reasonable efforts have been made to notify you of the request or to obtain an order from the court protecting the information requested.

Law Enforcement.  We may release certain medical information if asked to do so by a law enforcement official:

• As required by law, including reporting certain wounds and physical injuries;
• In response to a court order, subpoena, warrant, summons or similar process;
• To identify or locate a suspect, fugitive, material witness or missing person;
• If you are the victim of a crime if we obtain your agreement or, under certain limited circumstances, if we are unable to obtain your agreement;
• To alert authorities of a death we believe may be the result of criminal conduct;
• Information we believe is evidence of criminal conduct occurring on our premises; and
• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Deceased Individuals.  We are required to apply safeguards to protect your medical information for 50 years following your death.  Following your death we may disclose medical information to a coroner, medical examiner or funeral director as necessary for them to carry out their duties and to a personal representative (for example, the executor of your estate).  We may also release your medical information to a family member or other person who acted as personal representative or was involved in your care or payment for care before your death, if relevant to such person’s involvement, unless you have expressed a contrary preference.

Organ, Eye or Tissue Donation:  We may release medical information to organ, eye or tissue procurement, transplantation or banking organizations or entities as necessary to facilitate organ, eye or tissue donation and transplantation.

Research:  Under certain circumstances, we may use or disclose your medical information for research, subject to certain safeguards.  For example, we may disclose information to researchers when their research has been approved by a special committee that has reviewed the research proposal and established protocols to ensure the privacy of your medical information.  We may disclose medical information about you to people preparing to conduct a research project, but the information will stay on site.

Threats to Health or Safety.  Under certain circumstances, we may use or disclose your medical information to avert a serious threat to health and safety if we, in good faith, believe the use or disclosure is necessary to prevent or lessen the threat and is to a person reasonably able to prevent or lessen the threat (including the target) or is necessary for law enforcement authorities to identify or apprehend an individual involved in a crime.

Specialized Government Functions.  We may use and disclose your medical information for national security and intelligence activities authorized by law or for protective services of the President.  If you are a military member, we may disclose to military authorities under certain circumstances.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose to the institution, its agents or the law enforcement official your medical information necessary for your health and the health and safety of other individuals.

Workers’ Compensation:  We may release medical information about you as authorized by law for workers’ compensation or similar programs that provide benefits for work-related injuries or illness.

Incidental Uses and Disclosures.  There are certain incidental uses or disclosures of your information that occur while we are providing service to you or conducting our business.  For example, after surgery the nurse or doctor may need to use your name to identify family members that may be waiting for you in a waiting area.  Other individuals waiting in the same area may hear your name called.  We will make reasonable efforts to limit these incidental uses and disclosures.

Health Information Exchange.  We participate in one or more electronic health information exchanges which permits us to electronically exchange medical information about you with other participating providers (for example, doctors and hospitals) and health plans and their business associates.  For example, we may permit a health plan that insures you to electronically access our records about you to verify a claim for payment for services we provide to you.  Or, we may permit a physician providing care to you to electronically access our records in order to have up to date information with which to treat you.  As described earlier in this Notice, participation in a health information exchange also lets us electronically access medical information from other participating providers and health plans for our treatment, payment and health care operations purposes as described in this Notice.  We may in the future allow other parties, for example, public health departments that participate in the health information exchange, to access your medical information electronically for their permitted purposes as described in this Notice.

Further Disclosure.  Information disclosed without your authorization as described in this Notice as well as information disclosed with your authorization may be subject to redisclosure by the recipient and no longer protected by HIPAA.

There are many uses and disclosures we will make only with your written authorization.  These include:

• Uses and Disclosures Not Described Above – We will obtain your authorization for any use of disclosure of your medical information that is not described in the preceding examples.
• Psychotherapy Notes – These are notes made by a mental health professional documenting conversations during private counseling sessions or in joint or group therapy. Many uses or disclosures of psychotherapy notes require your authorization.
• Marketing – We will not use or disclose your medical information for marketing purposes without your authorization. Moreover, if we will receive any financial remuneration from a third party in connection with marketing, we will tell you that in the authorization form.
• Sale of medical information – We will not sell your medical information to third parties without your authorization. Any such authorization will state that we will receive remuneration in the transaction.

If you provide authorization, you may revoke it at any time by giving us notice in accordance with our authorization policy and the instructions in our authorization form.  Your revocation will not be effective for uses and disclosures made in reliance on your prior authorization.

Request for Restrictions.  You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations or to persons involved in your care.  We are not required to agree to your request, with one exception explained in the next paragraph, and we will notify you if we are unable to agree to your request.

We are required to agree to your request that we not disclose certain health information to your health plan for payment or health care operations purposes, if you pay out-of-pocket in full for all expenses related to that service prior to your request, and the disclosure is not otherwise required by law.  Such a restriction will only apply to records that relate solely to the service for which you have paid in full.  If we later receive an Authorization from you dated after the date of your requested restriction which authorizes us to disclose all of your records to your health plan, we will assume you have withdrawn your request for restriction.

Several different covered entities listed at the start of this Notice use this Notice.  You must make a separate request to each covered entity from whom you will receive services that are involved in your request for any type of restriction.  Contact the Community Health Center at the address listed below if you have questions regarding which providers will be involved in your care.

Access to Medical Information.  You may inspect and copy much of the medical information we maintain about you, with some exceptions.  If we maintain the medical information electronically in one or more designated record sets and you ask for an electronic copy, we will provide the information to you in the form and format you request, if it is readily producible.  If we cannot readily produce the record in the form and format you request, we will produce it in another readable electronic form we both agree to.  We may charge a cost-based fee for producing copies or, if you request one, a summary.  If you direct us to transmit your medical information to another person, we will do so, provided your signed, written direction clearly designates the recipient and location for delivery.

Amendment.  You may request that we amend certain medical information that we keep in your records.  We are not required to make all requested amendments, but will give each request careful consideration.  If we deny your request, we will provide you with a written explanation of the reasons and your rights.

Accounting.  You have the right to receive an accounting of certain disclosures of your medical information made by us or our business associates for the six years prior to your request.  Your right to an accounting does not include disclosures for treatment, payment and health care operations and certain other types of disclosures, for example, as part of a facility directory or disclosures in accordance with your authorization.

Confidential Communications.  You may request that we communicate with you about your medical information in a certain way or at a certain location.  We must agree to your request if it is reasonable and specifies the alternate means or location.

Notification in the Case of Breach.  We are required by law to notify you of a breach of your unsecured medical information.  We will provide such notification to you without unreasonable delay but in no case later than 60 days after we discover the breach.

How to Exercise These Rights.  All requests to exercise these rights must be in writing.  We will respond to your request on a timely basis in accordance with our written policies and as required by law.  Contact the Infinity Health Compliance Officer at 641-446-2383 or email compliance@weareinfinityhealth.org for more information or to obtain request forms.

We are required to follow the terms of the Notice currently in effect.  We reserve the right to change our practices and the terms of this Notice and to make the new practices and notice provisions effective for all medical information that we maintain.  Before we make such changes effective, we will make available the revised Notice by posting it at the reception Desk_, where copies will also be available.  The revised Notice will also be posted on our website at __weareinfinityhealth.org_.  You are entitled to receive this Notice in written form.  Please contact __the Infinity Health Compliance Officer_ at the address listed below to obtain a written copy.

If you have concerns about any of our privacy practices or believe that your privacy rights have been violated, you may file a complaint using the contact information at the end of this Notice.  You may also submit a written complaint to the U.S. Department of Health and Human Services.  There will be no retaliation for filing a complaint.

Infinity Health Privacy Officer
302 NE 14^th St.
Leon, Iowa 50144
641-446-2383
compliance@weareinfinityhealth.org

EFFECTIVE DATE OF NOTICE:_February 16th, 2026.

Download Policy (PDF)

ATTENTION: If you do not speak English, free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. Call 1-641-446-2383 or speak to your provider.”

Việt

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中文

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አማርኛ

ማሳሰቢያ፦ አማርኛ የሚናገሩ ከሆነ፣ የቋንቋ ድጋፍ አገልግሎት በነፃ ይቀርብልዎታል። መረጃን በተደራሽ ቅርጸት ለማቅረብ ተገቢ የሆኑ ተጨማሪ እገዛዎች እና አገልግሎቶች እንዲሁ በነፃ ይገኛሉ። በስልክ ቁጥር 1-446-2383 ይደውሉ ወይም አገልግሎት አቅራቢዎን ያናግሩ።”

नेपाली

सावधान: यदि तपाईं नेपाली भाषा बोल्नुहुन्छ भने तपाईंका लागि नि:शुल्क भाषिक सहायता सेवाहरू उपलब्ध छन्। पहुँचयोग्य ढाँचाहरूमा जानकारी प्रदान गर्न उपयुक्त सहायता र सेवाहरू पनि निःशुल्क उपलब्ध छन्।  1-446-2383 मा फोन गर्नुहोस् वा आफ्नो प्रदायकसँग कुरा गर्नुहोस्।”

Kiswahili

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हिंदी

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Tagalog

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РУССКИЙ

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ไทย

หมายเหตุ: หากคุณใช้ภาษา ไทย เรามีบริการความช่วยเหลือด้านภาษาฟรี  นอกจากนี้ ยังมีเครื่องมือและบริการช่วยเหลือเพื่อให้ข้อมูลในรูปแบบที่เข้าถึงได้โดยไม่เสียค่าใช้จ่าย โปรดโทรติดต่อ 1-641-446-2383 หรือปรึกษาผู้ให้บริการของคุณ”

తెలుగు

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한국어

주의: [한국어]를 사용하시는 경우 무료 언어 지원 서비스를 이용하실 수 있습니다. 이용 가능한 형식으로 정보를 제공하는 적절한 보조 기구 및 서비스도 무료로 제공됩니다. 1-1-641-446-2383 번으로 전화하거나 서비스 제공업체에 문의하십시오.”

українська мова

УВАГА: Якщо ви розмовляєте українська мова, вам доступні безкоштовні мовні послуги. Відповідні допоміжні засоби та послуги для надання інформації у доступних форматах також доступні безкоштовно. Зателефонуйте за номером 1-641-446-2383  або зверніться до свого постачальника».

THIS NOTICE IS A SUPPLEMENT TO Infinity Health NOTICE OF PRIVACY PRACTICES AND APPLIES ONLY TO SUBSTANCE USE DISORDER AND RELATED RECORDS.

This notice describes:

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

YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH OUR PRIVACY OFFICE AT 641-446-2383 OR compliance@weareinfinityhealth.org IF YOU HAVE ANY QUESTIONS.

This is the Notice covering Substance Use, a department operated by Infinity Health. Substance Use provides substance use disorder diagnosis and treatment to patients and creates medical records related to its diagnostic and treatment activities (the “records”). Our specialized substance use disorder treatment program and the related records is subject to heightened federal privacy protections under 42 CFR Part 2. This Notice describes the privacy practices of Substance Use related to those records. Substance Use is also governed by HIPAA. To the extent Part 2 is not more stringent than HIPAA, we will follow our HIPAA notice.

Uses and disclosures that can be made without your consent. We may use and disclose your record without your consent in certain, limited ways. The following are ways we may do so. These are general descriptions only and do not cover every example of disclosures within a category:

• Within the Program. We may share your information to communicate with other staff within Substance Use who have a need for the information in connection with their duties to provide diagnosis, treatment, or referral for treatment. For example, our registration staff may have access to your information in order to register you for a new appointment.
• Medical emergencies. We may disclose your records to medical providers when necessary due to a medical emergency in which you are unable to consent or when we are closed due to a temporary state of emergency. We may also disclose your record to the FDA for notification purposes related to a product under the FDA’s jurisdiction. For example, if you become unresponsive while in our care, we may disclose your record to the EMTs who respond to our facility to transport you to the emergency room.
• Qualified Service Organizations. We may disclose your information to qualified service organizations providing services on our behalf who have agreed in writing to protect the information in the same way that we are required to protect the information.
• Scientific research. Under certain circumstances, we may use or disclose your record for research, subject to certain safeguards. For example, we may disclose information to researchers when a special committee who has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.
• Certain audits and evaluations. We may disclose your records, with certain limitations or conditions, for the purpose of an audit or evaluation, which can include activities by government entities, accreditation-type entities, or payors, to improve care or outcomes, ensure appropriate resource management, adjust payment policies to enhance care of coverage, and review of appropriateness and necessity of care or utilization of services. For example, we may disclose your record to the payor in their assessment of whether its members are utilizing available resources appropriately.
• Public health. We may disclose your record to a public health authority in a de-identified manner, so there is no way you will be identified as the patient. For example, we may disclose certain information from your record if we are required to report instances of possible overdose to the state of Iowa.
• Crimes. We may disclose limited information to law enforcement agencies or officials if you commit, or threaten to commit, a crime on our premises or against our personnel.
• Child abuse and neglect reports. We may disclose information to report suspected child abuse and neglect in accordance with state law.

Disclosures made by a TPO consent. We are permitted to require you to provide your consent as condition of receiving our services so that we can use and disclose your records for all treatment, payment, and health care operations (TPO) purposes. For example, as a condition of receiving our services we may require you to allow us to bill your insurer for your treatment and to allow us to disclose your record to your primary care physician.  We may do this in a single form that covers all TPO purposes.

Revocation of consent. You may revoke your consent at any time by sending your written revocation to our Privacy Office at the contact information listed above or below. We will comply with your revocation request and stop using or disclosing your record in such way. However, the revocation does not apply to any prior uses or disclosures we made in reliance on your consent.

Court orders. We will not use or disclose your records, or provide testimony relaying the content of such records, in any civil, administrative, criminal, or legislative proceedings against you unless based on your consent or a valid court order. To be valid, the consent or order must have provided you with an opportunity to be heard and must be accompanied by a subpoena or other legal mandate compelling our disclosure.

Other disclosures. Any other disclosures not described in this Notice require that we obtain your written consent before making such disclosures.  For example, we will not disclose any information without your consent to your family members if they ask whether you are a receiving services from our program.

Further use and disclosure of your records. In the event we disclose your records to another provider or certain contractors pursuant to your TPO consent, these records may be further disclosed by the recipient without further consent by you, but only to the extent the HIPAA regulations or other applicable law permit such disclosure.

Fundraising. We may use and disclose your health information in order to contact you for our fundraising campaigns, but before we do so, we must provide you with a clear and conspicuous opportunity to elect not to receive fundraising-related communications.

This section describes various rights you have over your record. To exercise your rights, you should contact the Privacy Office at the contact information above or below to understand what we may need from you to process your request.

Request for restrictions. You have the right to request a restriction or limitation on the records we use or disclose about you for treatment, payment or health care operations, including when you have previously signed a written consent for such disclosures. We are not required to agree to your request, with one exception explained in the next paragraph, and we will notify you regarding our decision about your request.

We are required to agree to your request that we not disclose certain records to your health plan for payment or health care operations purposes, if you pay out-of-pocket in full within 30 days for all expenses related to that service. Such a restriction will only apply to records that relate solely to the service for which you have paid in full. If we later receive a consent from you dated after the date of your requested restriction which authorizes us to disclose all of your records to your health plan, we will assume you have withdrawn your request for restriction.

Accounting. You have a right to receive an accounting of certain disclosures of your record made by us for the three years prior to your request. Your right to an accounting includes include disclosures for treatment, payment and health care operations only when such disclosures are made through an electronic health record. The first accounting in any 12-month period is free, and you may be charged a fee for each subsequent accounting you request within the same 12-month period.

If we have provided your record to an intermediary pursuant to your consent, you have the right to receive a list of disclosures made by the intermediary for the past three years prior to your request.

Discuss with the Privacy Officer. You can discuss this notice with our Privacy Officer at any time.

Elect not to receive fundraising communication. As further described above, if we wish to use your record for fundraising, we must provide you with an opportunity to opt out. You have the right to elect to not receive fundraising communication at any time.

We are required by law to maintain the privacy of your records and to provide you with this notice of our legal duties and privacy practice related to your records. You have the right to request a copy of this notice in paper or electronic format upon request to us through the contact information, below.

We are required to follow the terms of the Notice currently in effect. We reserve the right to change our practices and the terms of this Notice and to make the new practices and notice provisions effective for all health information that we maintain.

If you have concerns about any of our privacy practices or believe that your privacy rights have been violated, you may file a complaint with us using the contact information at the end of this Notice. You may also submit a written complaint to the U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint.

Infinity Health Privacy Officer
302 NE 14^th St.
Leon, Iowa 50144
641-446-2383
compliance@weareinfinityhealth.org

EFFECTIVE DATE OF NOTICE:_February 16th, 2026.

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