HIPAA Notice of Privacy Practices

Please note: This is a starting template and must be reviewed by a healthcare compliance attorney before use. It is provided to outline the structure of a Notice of Privacy Practices and does not constitute legal advice. Latched Beginnings will publish the final, attorney-approved version before this notice takes effect.

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.

Our Commitment to Your Privacy

At Latched Beginnings, caring for you and your baby includes caring for your privacy. We are committed to protecting the confidentiality of your health information, and we are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and related laws to maintain the privacy of your protected health information (PHI), to give you this notice of our legal duties and privacy practices, and to follow the terms of the notice currently in effect.

"Protected health information" means information that identifies you, or that could reasonably be used to identify you, and that relates to your past, present, or future physical or mental health, the care you receive from us, or payment for that care.

How We May Use and Disclose Your Health Information

The following describes the ways we may use and disclose your protected health information. Not every use or disclosure will be listed, but the ways we are permitted to use and disclose information will fall within one of these categories.

For Treatment

We may use and disclose your health information to provide, coordinate, and manage your care and any related services. For example, Dr. Kacie Culotta and our clinical team may share information about a tongue-tie, lip-tie, or feeding evaluation with one another, and we may share relevant details with your pediatrician, lactation consultant, bodyworker, or other providers involved in your baby's care so that everyone supporting your family is working from the same picture.

For Payment

We may use and disclose your health information so that we can bill for and receive payment for the care we provide. For example, we may share information with your health plan to confirm coverage, to obtain prior authorization, or to submit a claim or superbill for a release procedure or consultation.

For Health Care Operations

We may use and disclose your health information to run our practice and to make sure you and our other families receive quality care. For example, we may use information to review and improve our clinical care, to train team members, to schedule appointments and post-op follow-ups, and to conduct business management and administrative activities.

Other Permitted and Required Uses and Disclosures

We may also use or disclose your health information, without your authorization, in the following circumstances when permitted or required by law:

• Appointment reminders and care information. To remind you of upcoming appointments, share post-operative care instructions, or tell you about treatment options and services that may benefit your family.
• Individuals involved in your care.To a family member, partner, or other person you involve in your or your baby's care, when relevant to that person's involvement and consistent with your wishes.
• As required by law. When federal, state, or local law requires the use or disclosure.
• Public health and safety. To public health authorities for activities such as preventing or controlling disease, or to prevent a serious threat to health or safety.
• Health oversight, legal, and regulatory. To health oversight agencies, and in response to a court order, subpoena, or other lawful process.
• Workers' compensation, law enforcement, and similar. As authorized by and to the extent necessary to comply with applicable laws relating to workers' compensation or similar programs, and for specified law enforcement purposes.
• Business associates. To outside vendors who perform services on our behalf, such as billing or scheduling support, only under written agreements that require them to protect your information.

Most other uses and disclosures, including most uses and disclosures of psychotherapy notes, the use of your information for marketing, and the sale of your information, will be made only with your written authorization. You may revoke that authorization at any time, in writing, except to the extent we have already acted in reliance on it.

Your Rights Regarding Your Health Information

You have the following rights with respect to your protected health information:

• Right to access and copies. You have the right to inspect and request a copy of the health information we maintain about you and your baby, in a form and format you request when readily producible. We may charge a reasonable, cost-based fee.
• Right to request an amendment. If you believe information in your record is incorrect or incomplete, you may ask us to amend it. We may deny your request in certain cases and will explain our reasons in writing.
• Right to an accounting of disclosures. You have the right to request a list of certain disclosures we have made of your health information, other than those made for treatment, payment, health care operations, or with your authorization.
• Right to request restrictions. You have the right to ask us to limit how we use or disclose your information for treatment, payment, or health care operations. We are not required to agree to every request, but we will agree to restrict a disclosure to a health plan when you pay for the related service in full and out of pocket, as allowed by law.
• Right to confidential communications. You have the right to ask us to communicate with you about your health in a specific way or at a specific location, such as by a particular phone number or address. We will accommodate reasonable requests.
• Right to a paper copy of this notice. You have the right to a paper copy of this notice at any time, even if you have agreed to receive it electronically.
• Right to be notified of a breach. You have the right to be notified if there is a breach of your unsecured protected health information.
• Right to file a complaint. You have the right to file a complaint if you believe your privacy rights have been violated, as described below. You will not be penalized or retaliated against for filing a complaint.

To exercise any of these rights, please contact us using the information below. Some requests must be made in writing, and we will let you know what is needed.

Our Duties

We are required by law to maintain the privacy of your protected health information, to provide you with this notice of our legal duties and privacy practices, and to abide by the terms of the notice currently in effect. We reserve the right to change the terms of this notice and to make the new provisions effective for all health information we maintain. If we make a material change, we will post the revised notice in our office and on our website, and we will make copies available upon request.

Contact Us and How to File a Complaint

If you have questions about this notice, would like to exercise any of your rights, or believe your privacy rights have been violated, please contact our Privacy Officer at Latched Beginnings:

• By mail: Latched Beginnings, Attn: Privacy Officer, 1701 Simond Ave, Suite 107A, Austin, TX 78723
• By phone: (512) 814-7480
• By email: info@latchedbeginnings.com

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting the Office for Civil Rights complaint portal. We will never retaliate against you for filing a complaint.

Effective date: June 2026.