CHIROPURE

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.

This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully.

Questions and Privacy Contact

You have the right to a paper or electronic copy of this notice and to discuss it with our Privacy Officer.

Your Rights

When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

You may ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. Ask us how to make the request.

We will ordinarily provide a copy or summary within 30 days of receiving your request. We may charge a reasonable, cost-based fee as permitted by law.

Ask us to correct your medical record

You may ask us to correct health information that you believe is incorrect or incomplete. Ask us how to submit the request.

We may deny the request in certain circumstances, but we will explain the reason in writing, ordinarily within 60 days.

Request confidential communications

You may ask us to contact you in a particular way, such as at a home, office, or mobile number, or to send mail to a different address.

We will agree to reasonable requests.

Ask us to limit what we use or share

You may ask us not to use or share certain health information for treatment, payment, or healthcare operations. We are generally not required to agree, and we may deny a request if it could affect your care. If we agree, we may still disclose the information if emergency treatment is required.

If you pay for a healthcare item or service completely out of pocket, you may ask us not to disclose information about that item or service to your health plan for payment or healthcare operations. We will agree unless the law requires us to disclose it.

Receive an accounting of disclosures

You may request a list, called an accounting, of certain disclosures of your health information made during the six years before your request, including who received the information and why.

The accounting will not include certain disclosures, such as those for treatment, payment, healthcare operations, or disclosures you authorized. One accounting in a 12-month period is free; we may charge a reasonable, cost-based fee for another accounting during that period.

Receive a copy of this notice

You may request a paper copy at any time, even if you agreed to receive it electronically. We will provide it promptly.

Choose someone to act for you

If a person has legal authority to act for you, such as through a medical power of attorney or guardianship, that person may exercise your rights and make choices about your health information.

We will verify that person's authority before taking action.

File a complaint if you believe your rights were violated

You may complain to ChiroPure by contacting our Privacy Officer using the information at the beginning of this notice.

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by mailing a letter to 200 Independence Avenue SW, Washington, DC 20201; calling 1-877-696-6775; or visiting https://www.hhs.gov/hipaa/filing-a-complaint/.

ChiroPure will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you may tell us your preferences about what we disclose. Tell us what you want us to do, and we will follow your instructions when the law gives you that choice.

You may tell us whether to

• Share information with family members, close friends, or others involved in your care or payment for your care.
• Share information during a disaster-relief situation.
• Include information in a facility directory, if ChiroPure ever maintains one.

If you cannot tell us your preference, such as when you are unconscious, we may disclose information when we believe doing so is in your best interest. We may also disclose information when necessary to lessen a serious and imminent threat to health or safety.

Written authorization is generally required

We will not use or disclose your health information for the following purposes unless you provide written authorization, except where the law permits otherwise:

• Marketing purposes.
• The sale of your health information.
• Most uses and disclosures of psychotherapy notes, if ChiroPure maintains any.

If you authorize a use or disclosure, you may revoke the authorization in writing at any time. A revocation will not affect actions already taken in reliance on the authorization.

Fundraising

ChiroPure does not currently use patient health information for fundraising. If that practice changes, we may contact you as permitted by law, and you may tell us not to contact you again. If we maintain substance use disorder patient records protected by 42 CFR Part 2, we will provide clear advance notice and a choice before using Part 2 information for fundraising communications.

How We Typically Use and Disclose Your Health Information

Treat you

We may use your health information and disclose it to other professionals who are treating you.

Example: A chiropractor may discuss your condition with another healthcare professional involved in your treatment.

Run our practice

We may use and disclose your health information to operate ChiroPure, improve care, evaluate services, train staff, manage quality, and contact you when necessary.

Example: We may review health information to coordinate your care or evaluate the quality of our services.

Bill for services

We may use and disclose your health information to bill and obtain payment from health plans or other responsible parties.

Example: We may provide information about your treatment to your health plan so it can process a claim.

Other Permitted or Required Uses and Disclosures

The law permits or requires us to use or disclose health information in other circumstances, usually for purposes that benefit the public. We must satisfy applicable legal conditions before doing so.

Public health and safety

We may disclose health information for certain public-health and safety activities, including:

• Preventing or controlling disease.
• Assisting with product recalls.
• Reporting adverse reactions to medications or products.
• Reporting suspected abuse, neglect, or domestic violence as permitted or required by law.
• Preventing or reducing a serious and imminent threat to a person's or the public's health or safety.

Research

We may use or disclose health information for research when applicable legal requirements are satisfied.

Compliance with law

We will disclose information when federal or state law requires it, including to the U.S. Department of Health and Human Services when it requests information to evaluate our compliance with federal privacy law. When North Carolina or another applicable law provides greater privacy protection, we will follow the more protective requirement.

Organ and tissue donation

We may disclose health information to organ-procurement organizations when applicable.

Coroners, medical examiners, and funeral directors

We may disclose health information to a coroner, medical examiner, or funeral director when an individual dies and the disclosure is permitted by law.

Workers' compensation, government, and law enforcement

We may use or disclose health information:

• For workers' compensation claims.
• For law-enforcement purposes or to a law-enforcement official when permitted or required by law.
• To health-oversight agencies for activities authorized by law.
• For special government functions, including military, national-security, and presidential-protective-service activities.

Lawsuits and legal proceedings

We may disclose health information in response to a court or administrative order or, when applicable legal requirements are satisfied, in response to a subpoena or other lawful process.

Substance Use Disorder Records

To the extent ChiroPure creates, receives, or maintains substance use disorder patient records protected by 42 CFR Part 2, additional confidentiality protections apply.

We will not use or disclose Part 2 records in a civil, criminal, administrative, or legislative investigation or proceeding against you unless you provide written consent or the use or disclosure is authorized by a court order accompanied by a subpoena or other legal mandate meeting Part 2 requirements.

Part 2 records disclosed under a valid consent for treatment, payment, or healthcare operations may be redisclosed as permitted by HIPAA, except for use in proceedings against you, which remains restricted as described above.

If Part 2 information is used for fundraising, we will provide clear and conspicuous notice in advance and an opportunity to opt out.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information, as required by law.
• We must follow the duties and privacy practices described in the notice currently in effect and provide you with a copy upon request.
• We will not use or disclose your information other than as described in this notice unless you authorize us in writing or the law otherwise permits or requires it.
• We will apply reasonable safeguards and limit uses, disclosures, and requests to the minimum necessary when the minimum-necessary standard applies.

Changes to This Notice

We may change the terms of this notice. Changes may apply to all health information we maintain, including information created or received before the revised notice takes effect. A revised notice will be available upon request, at our office, and on our website at https://chiropurenc.com/.

Contact Information

For questions, requests, or complaints concerning this notice or ChiroPure's privacy practices, contact:

ChiroPure • 8415 Pit Stop Court NW, Suite 102, Concord, NC 28027 • 704-970-7127