Common use of Our Uses and Disclosures Clause in Contracts

Our Uses and Disclosures. We typically use or share your health information in the following ways.  Treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  Run our organization We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.  Bill for your services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx.  Help with public health and safety issues We can share health information about you for certain situations such as: Preventing disease, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.  Do research We can use or share your information for health research.  Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.  Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies.  Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services  Respond to lawsuits and legal actions We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities  We are required by law to maintain the privacy and security of your protected health information.  We will let you know 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 this notice and give you a copy of it.  We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Our Uses and Disclosures. We typically use or share your health information in the following ways.  • Treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  • Run our organization We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.  • Bill for your services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx.  • Help with public health and safety issues We can share health information about you for certain situations such as: Preventing disease, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.  • Do research We can use or share your information for health research.  • Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.  • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies.  • Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services  • Respond to lawsuits and legal actions We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities  • We are required by law to maintain the privacy and security of your protected health information.  • We will let you know 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 this notice and give you a copy of it.  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

Our Uses and Disclosures. We typically use or share your health information in the following ways.  Treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  Run our organization We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.  Bill for your services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx.  Help with public health and safety issues We can share health information about you for certain situations such as: Preventing disease, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.  Do research We can use or share your information for health research.  Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re we are complying with federal privacy law.  Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies.  Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services  Respond to lawsuits and legal actions We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities  We are required by law to maintain the privacy and security of your protected health information.  We will let you know 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 this notice and give you a copy of it.  We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. Changes to the Terms of this Notice This notice is effective 05/19/2020. We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. Xxxxxx Xxxx LPC, NCC Phone • (000) 000-0000 xxxxxxxxxx@xxxxxxxxx.xxx • xxx.xxxxxxxxxx.xxx This is to acknowledge that I have received Xxxxxx Xxxx’x Privacy Notice HIPPA Name Signature Date Xxxxxx Xxxx LPC, NCC Phone • (000) 000-0000 xxxxxxxxxx@xxxxxxxxx.xxx • xxx.xxxxxxxxxx.xxx Appointment Reminders Xxxxxx Xxxx is now offering the option for “Appointment Reminders.” You can receive an appointment reminder to your cell phone (via a text message), your email address, or your phone (via a computer-generated voice message) the day before your scheduled appointment. Please select ONE of the following options: Text Message: I authorize Xxxxxx Xxxx to send text message appointment reminders to me on my provided cell phone number. Text message charges from my cell phone provider may apply. Example of text message: “Do not reply-reminder-You have an appointment MON 01/11 at 4:00 PM – If you have any questions please call us at 000-000-0000 – Name of Counselor Cell phone number to send text messages to: ( ) - Email message: I authorize Xxxxxx Xxxx to send an email message appointment reminders to me on my provided email address. Example of email message from XxxxxxXxxxXxxxxxxx@xxxxxxxxXxxxxxx.xxx Hello, This is a reminder of your appointment on Monday – 01/11/2016 scheduled for 4:00 PM with XxXxxxx X. Xxxxx. If you have any questions regarding your appointment, please feel free to contact us at: 000-000-0000. Thank you. Email address to send reminder messages to: Automated Voice Messages: I authorize Xxxxxx Xxxx to send computer generated voice phone message appointment reminders to me on my provided phone number.

Our Uses and Disclosures. We typically may use or and share your health information in the following ways. as we:  Treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  Run our organization We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.  Bill Xxxx for your services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay  Improve care for your services. We are allowed or required to share your information in other ways – usually in ways that contribute to the public goodall our patients, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx. example by teaching  Help with public health and safety issues We can share health information about you for certain situations such as: Preventing disease, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.  Do research We can use or share your information for health research.  Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health  Respond to organ and Human Services if it wants to see that we’re complying with federal privacy law. tissue donation requests  Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies.  Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services  Respond to lawsuits and legal actions Your Rights When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Get an electronic or paper copy of your medical record  You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.  We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.  Ask us to correct your medical record  You can share ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.  We may say “no” to your request, but we’ll tell you why in response writing within 60 days.  Request confidential communications  You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a court different address.  We will say “yes” to all reasonable requests. Ask us to limit what we use or administrative ordershare  You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.  If you pay for a service or health care item out-of-pocket in response full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a subpoenalaw requires us to share that information. Our Responsibilities  Get a list of those with whom we’ve shared information  You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.  We are required by law will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to maintain make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. Get a copy of this privacy notice You can ask for a paper copy of this notice at any time, even if you have agreed to receive the privacy notice electronically. We will provide you with a paper copy promptly. Choose someone to act for you  If you have given someone a health care proxy, medical power of attorney or if someone is your legal guardian, that person can exercise your rights and security of make choices about your protected health information.  We will let make sure the person has this authority and can act for you know promptly before we take any action. File a complaint if a breach occurs that may you feel your rights are violated  You can complain if you feel we have compromised the privacy or security of violated your informationrights by contacting our Patient Relations Office at (000) 000-0000.  We must follow You can file a complaint with the duties U.S. Department of Health and privacy practices described in this notice and give you Human Services Office for Civil Rights by sending a copy of it. letter to 000 Xxxxxxxxxxxx Xxxxxx, X.X., Xxxxxxxxxx, X.X. 00000, calling 0-000-000-0000, or visiting: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxx/.  We will not use or share your information other than as described here unless retaliate against you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mindfor filing a complaint.

Our Uses and Disclosures. We typically use or share your health information in the following ways.  Treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  Run our organization We can may use and share your health information to run as we: • Treat you • Run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.  Bill organization • Xxxx for your services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx.  • Help with public health and safety issues We can share health information about you for certain situations such as: Preventing disease, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.  • Do research We can use or share your information for health research.  • Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health • Respond to organ and Human Services if it wants to see that we’re complying with federal privacy law.  tissue donation requests • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies.  • Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services  • Respond to lawsuits and legal actions Your Rights When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Get an electronic or paper copy of your medical record • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Ask us to correct your medical record • You can share ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. • We may say “no” to your request, but we’ll tell you why in response writing within 60 days. Request confidential communications • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a court different address. • We will say “yes” to all reasonable requests. Ask us to limit what we use or administrative ordershare • You can ask us not to use or share certain health information for treatment, payment, or in response to a subpoenaour operations. Our Responsibilities  We are not required by to agree to your request, and we may say “no” if it would affect your care. • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to maintain share that information. Get a list of those with whom we’ve shared information • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. Get a copy of this privacy notice You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. Choose someone to act for you • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and security of make choices about your protected health information.  • We will let make sure the person has this authority and can act for you know promptly before we take any action. File a complaint if you feel your rights are violated • You can complain if you feel we have violated your rights by contacting us using the information on the first page of this Notice. • You can file a breach occurs that may have compromised complaint with the privacy U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 000 Xxxxxxxxxxxx Xxxxxx, X.X., Xxxxxxxxxx, X.X. 00000, calling 1-877- 000-0000, or security of your information.  We must follow the duties and privacy practices described in this notice and give you a copy of it.  visiting xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxx/. • We will not use or share your information other than as described here unless retaliate against you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mindfor filing a complaint.

Our Uses and Disclosures. Serve You We typically use are allowed or required to share your health information in other ways – usually in ways that coordinate your services with the following wayscontracted or governing government agencies.  Treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  Run our organization We are allowed or required to share some Participant Employer data, billing and accounts receivable information with our bank, government tax auditors, and CPA auditors. We have to meet many conditions in the law before we can use and share your health service information to run our practice, improve your care, and contact you when necessaryfor other purposes. ExampleFor more information see: We use health information about you to manage your treatment and servicesxxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/ consumers/index.html.  Bill for your services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx.  Help with public health and safety issues We can share health information about you for certain situations such as: Preventing disease, reporting • Reporting suspected abuse, neglect, or domestic violence, and preventing violence • Preventing or reducing a serious threat to anyone’s health or safety.  Do research We can use or share your information for health research.  safety Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.  Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies.  Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you for you: • For workers’ compensation claims, for claims • For law enforcement purposes or with a law enforcement official, with health official • With oversight agencies for activities authorized by lawlaw Respond to covered County, and for special government functions such as militaryState or Federal program requests We can share service information about you in response to a covered request by the county, national security, and presidential protective services  state or federal program requests. Respond to lawsuits and legal actions We can share health service information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities  • We are required by law to maintain the privacy and security of your protected health information.  • We will let you know 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 this notice and give you a copy of it.  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/ noticepp.html.

Our Uses and Disclosures. We typically use or share your health information in the following ways.  • Treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  • Run our organization We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.  • Bill for your services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx.  • Help with public health and safety issues We can share health information about you for certain situations such as: Preventing disease, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.  • Do research We can use or share your information for health research.  • Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re we are complying with federal privacy law.  • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies.  • Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services  • Respond to lawsuits and legal actions We can share health information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities  • We are required by law to maintain the privacy and security of your protected health information.  • We will let you know 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 this notice and give you a copy of it.  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. Changes to the Terms of this Notice This notice is effective 05/19/2020. We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site. Xxxxxx Xxxx LPC, NCC Phone • (000) 000-0000 xxxxxxxxxx@xxxxxxxxx.xxx • xxx.xxxxxxxxxx.xxx This is to acknowledge that I have received Xxxxxx Xxxx’x Privacy Notice HIPPA Name Signature Date Xxxxxx Xxxx LPC, NCC Phone • (000) 000-0000 xxxxxxxxxx@xxxxxxxxx.xxx • xxx.xxxxxxxxxx.xxx Appointment Reminders Xxxxxx Xxxx is now offering the option for “Appointment Reminders.” You can receive an appointment reminder to your cell phone (via a text message), your email address, or your phone (via a computer-generated voice message) the day before your scheduled appointment. Please select ONE of the following options: Text Message: I authorize Xxxxxx Xxxx to send text message appointment reminders to me on my provided cell phone number. Text message charges from my cell phone provider may apply. Example of text message: “Do not reply-reminder-You have an appointment MON 01/11 at 4:00 PM – If you have any questions please call us at 000-000-0000 – Name of Counselor Cell phone number to send text messages to: ( ) - Email message: I authorize Xxxxxx Xxxx to send an email message appointment reminders to me on my provided email address. Example of email message from XxxxxxXxxxXxxxxxxx@xxxxxxxxXxxxxxx.xxx Hello, This is a reminder of your appointment on Monday – 01/11/2016 scheduled for 4:00 PM with XxXxxxx X. Xxxxx. If you have any questions regarding your appointment, please feel free to contact us at: 000-000-0000. Thank you. Email address to send reminder messages to: Automated Voice Messages: I authorize Xxxxxx Xxxx to send computer generated voice phone message appointment reminders to me on my provided phone number.

Our Uses and Disclosures. How do we typically use or share your health information? We typically use or share your health information in the following ways.  Treat you ⮚ We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  Run our organization ⮚ We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.  Bill Xxxx for your services ⮚ We can use and share your health information to bill xxxx and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information information, see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx.  XXX.XXX consumer home: xxxx://xxx.xxx.xxx/ocr/privacy/hipaa/understanding/consumers/index.html Help with public health and safety issues ⮚ We can share health information about you for certain situations such as: o Preventing disease, reporting disease o Helping with product recalls o Reporting adverse reactions to medications o Reporting suspected abuse, neglect, or domestic violence, and preventing violence o Preventing or reducing a serious threat to anyone’s health or safety.  safety Do research ⮚ We can use or share your information for health research.  research Comply with the law ⮚ We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.  Respond to organ and tissue donation requests ⮚ We can share health information about you with organ procurement organizations. Work with a medical examiner or funeral director ⮚ We can share health information with a coroner, medical examiner, or a funeral director when an individual diesthe patient has died.  Address workers’ compensation, law enforcement, and other government requests ⮚ We can use or share health information about you for you: o For workers’ compensation claims, for claims o For law enforcement purposes or with a law enforcement official, with official o With health oversight agencies for activities authorized by law, and for law o For special government functions such as military, national security, and presidential protective services  Respond to lawsuits and legal actions ⮚ We can share health information about you in response to a court or administrative order, or in response to a subpoenasubpoena Electronic Access The Georgia Center for Menopausal Medicine and Direct Primary Care, LLC provides electronic access to your health information via Atlas electronic medical record’s patient portal. Our Responsibilities  We are required by law to maintain A patient portal will be available in the privacy and security of your protected health information.  We will let you know 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 this notice and give you a copy of it.  We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mindfuture.

Our Uses and Disclosures. We typically use or share your health information in the following ways.  Treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  Run our organization We can may use and share your health information to run as we: • Serve you • Run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.  Bill organization • Xxxx for your services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx.  • Help with public health and safety issues We can share health information about you for certain situations such as: Preventing disease, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.  Do research We can use or share your information for health research.  • Comply with the law We will share information about you if • Respond to required county, state or and federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.  Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies.  program requests • Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services  • Respond to lawsuits and legal actions Your Rights When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Get an electronic or paper copy of your service record • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. • We will provide a copy or a summary of your service information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Ask us to correct your service record • You can share health ask us to correct any information about you that you think is incorrect or incomplete. Ask us how to do this. • We may say “no” to your request, but we’ll tell you why in response writing within 60 days. Request confidenTal communicaTons • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a court different address. • We will say “yes” to all reasonable requests. Ask us to limit what we use or administrative ordershare • You can ask us not to use or share certain information for services, payment, or in response to a subpoenaour operations. Our Responsibilities  We are not required by to agree to your request, and we may say “no” if it would affect your services or our legal obligation. • If you pay for a service or care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to maintain the privacy and security of your protected health share that information.  Get a list of those with whom we’ve shared informaTon • You can ask for a list (accounting) of the times we’ve shared your service information for six years prior to the date you ask, who we shared it with, and why. • We will let include all the disclosures except for those about services, payment, and health care operations, and certain other disclosures (such as any you know promptly asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost- based fee if a breach occurs that may have compromised the privacy or security of your informationyou ask for another one within 12 months.  We must follow the duties and privacy practices described in this notice and give you Get a copy of it.  We will not use or share your information other than as described here unless you tell us we this privacy noTce You can in writing. If you tell us we can, you may change your mind ask for a paper copy of this notice at any time. Let us know in writing , even if you change have agreed to receive the notice electronically. We will provide you with a paper copy promptly. Choose someone to act for you • If you have given someone power of attorney or if someone is your mindlegal guardian, that person can exercise your rights and make choices about your service information. • We will make sure the person has this authority and can act for you before we take any action.

Our Uses and Disclosures. We typically use or share your health information in the following ways.  Treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  Run our organization We can may use and share your health information to run as we: • Treat you • Run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.  Bill organization • Xxxx for your services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxx.  • Help with public health and safety issues We can share health information about you for certain situations such as: Preventing disease, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.  • Do research We can use or share your information for health research.  • Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health • Respond to organ and Human Services if it wants to see that we’re complying with federal privacy law.  tissue donation requests • Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies.  • Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services  • Respond to lawsuits and legal actions Your Rights When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you. Get an electronic or paper copy of your medical record • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Ask us to correct your medical record • You can share ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. • We may say “no” to your request, but we’ll tell you why in response writing within 60 days. Request confidential communications • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a court different address. • We will say “yes” to all reasonable requests. Ask us to limit what we use or administrative ordershare • You can ask us not to use or share certain health information for treatment, payment, or in response to a subpoenaour operations. Our Responsibilities  We are not required by to agree to your request, and we may say “no” if it would affect your care. • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to maintain share that information. Get a list of those with whom we’ve shared information • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. Get a copy of this privacy notice You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. Choose someone to act for you • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and security of make choices about your protected health information.  • We will let make sure the person has this authority and can act for you know promptly before we take any action. File a complaint if you feel your rights are violated • You can complain if you feel we have violated your rights by contacting us using the information on page 1. • You can file a breach occurs that may have compromised complaint with the privacy U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 000 Xxxxxxxxxxxx Xxxxxx, X.X., Xxxxxxxxxx, X.X. 00000, calling 0- 000-000-0000, or security of your information.  We must follow the duties and privacy practices described in this notice and give you a copy of it.  visiting xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxx/. • We will not use or share your information other than as described here unless retaliate against you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mindfor filing a complaint.

Our Uses and Disclosures. We typically use or share your health information in the following ways.  Treat you We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.  Run our organization We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.  Bill for your services We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services. Serve You We are allowed or required to share your information in other ways – usually in ways that contribute coordinate your services with the contracted or governing government agencies. Run our organization We are allowed or required to the public goodshare some Participant Employer data, such as public health billing and researchaccounts receivable information with our bank, government tax auditors, and CPA auditors. We have to meet many conditions in the law before we can share your service information for these other purposes. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/xxxxx.xxxxxxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/ consumers/index.html.  Xxxx for your services We can use and share your health information to xxxx and get payment from health plans or other entities. Help with public health and safety issues We can share health information about you for certain situations such as: Preventing disease, reporting • Reporting suspected abuse, neglect, or domestic violence, and preventing violence • Preventing or reducing a serious threat to anyone’s health or safety.  Do research We can use or share your information for health research.  safety Comply with the law We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.  Work with a medical examiner or funeral director We can share health information with a coroner, medical examiner, or funeral director when an individual dies.  Address workers’ compensation, law enforcement, and other government requests We can use or share health information about you for you: • For workers’ compensation claims, for claims • For law enforcement purposes or with a law enforcement official, with health official • With oversight agencies for activities authorized by lawlaw Respond to covered County, and for special government functions such as militaryState or Federal program requests We can share service information about you in response to a covered request by the county, national security, and presidential protective services  state or federal program requests. Respond to lawsuits and legal actions We can share health service information about you in response to a court or administrative order, or in response to a subpoena. Our Responsibilities  • We are required by law to maintain the privacy and security of your protected health information.  • We will let you know 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 this notice and give you a copy of it.  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: xxx.xxx.xxx/xxx/xxxxxxx/xxxxx/xxxxxxxxxxxxx/xxxxxxxxx/ noticepp.html.