NOTICE OF PRIVACY PRACTICES

• Mohr Insurance Services and Consulting, partnered with Symmetry Financial Group.
• 204 Whitson Ave Suite 2C, Swannanoa, NC, 28778
• 865-484-3376
• contact@mohrprotection.com
• Effective date: 10/30/2025

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.

Your Rights

You have the following rights regarding your health information (PHI – Protected Health Information):

Right	What It Means
Get a copy	Request an electronic or paper copy of your health record.
Request correction	Ask us to correct inaccurate or incomplete information.
Request confidential communications	Ask us to contact you in a specific way (e.g., home vs. work phone) or at a different address.
Ask us to limit use/disclosure	Request restrictions (we are not required to agree except in specific cases).
List of disclosures	Get a list of times we shared your PHI for reasons other than treatment, payment, or operations (and certain other exceptions).
Get a paper copy	Request a paper copy of this notice at any time.
File a complaint	File a complaint if you feel your rights are violated (see contact info below).

Our Responsibilities

• We are required by law to maintain the privacy and security of your PHI.
• We will notify you promptly if a breach occurs that may have compromised your PHI.
• We must follow the duties and privacy practices described in this notice.
• We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time.

How We May Use and Disclose Your PHI

1. For Quoting and Underwriting

• Quoting: Share with underwriters involved in your care.
• Underwriting: Assistance in determining eligibility, premiums, and/or other underwriting necessities.

2. Other Permitted or Required Uses

Purpose	Example
Appointment reminders	Calls, texts, emails, or postcards.
Alternative services	Inform you about other services we offer.
Health-related benefits	Newsletters or fundraising (you can opt out).
Business associates	Vendors with a signed Business Associate Agreement (BAA).
Public health	Report diseases, births, deaths, or abuse.
Law enforcement	Respond to court orders or identify suspects.
Research	Only with IRB approval or de-identified data.
Required by law	FDA, workers’ comp, coroners, etc.

3. Uses Requiring Your Written Authorization

• Most psychotherapy notes
• Marketing (if we receive payment for it)
• Sale of PHI
• Other uses not described here

You may revoke authorization in writing at any time.

Special Situations

Situation	Disclosure Allowed?
Family/friends	Only with your verbal agreement or if we infer it’s in your best interest (e.g., unconscious).
Disaster relief	To Red Cross or similar agencies.
Organ donation	To organ procurement organizations.
Workers’ compensation	As required for claims.
Inmates	To correctional institutions.

Changes to This Notice

We reserve the right to change this notice. The new version will apply to all PHI we maintain. Revised notices will be posted on www.mohrprotection.com/hipaa-notice-of-privacy-practices.

Questions or Complaints

Contact us at:

• contact@mohrprotection.com
• 865-484-3376

If you believe your privacy rights have been violated:

1. File a written complaint with us (we will not retaliate).
2. File with the U.S. Department of Health & Human Services (HHS):
   Online: hhs.gov/ocr/complaints
   Mail: U.S. Department of Health & Human Services 200 Independence Ave., S.W. Washington, D.C. 20201

Acknowledgment of Receipt

We will ask you to sign a form confirming you received this notice (or document refusal).

Mohr Insurance Services and Consulting
Effective Date: 10/30/2025