HIPAA Notice of Privacy Practices

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.

BRAINKLAST is committed to protecting the privacy of your protected health information ("PHI") in accordance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and its implementing regulations. This Notice describes our privacy practices and your rights regarding your health information.

Our Responsibilities

We are required by law to:

• Maintain the privacy of your PHI
• Provide you with this Notice describing our legal duties and privacy practices with respect to your PHI
• Follow the terms of the Notice currently in effect
• Notify you if a breach occurs that may have compromised the privacy or security of your PHI

How We May Use and Disclose Your Health Information

We may use and disclose your PHI for the following purposes without your written authorization:

• Treatment — to provide, coordinate, or manage your care and related services, including consultations between providers involved in your care.
• Payment — to obtain payment for services provided to you, including billing and collection activities.
• Healthcare Operations — for activities such as quality assessment, staff training, and practice management.
• As Required by Law — when disclosure is required by federal, state, or local law.
• Public Health & Safety — to prevent or control disease, report suspected abuse or neglect, or avert a serious threat to health or safety, where permitted by law.

Uses and disclosures not described in this Notice will be made only with your written authorization, which you may revoke at any time.

Your Rights Regarding Your Health Information

You have the right to:

• Access — request a copy of your medical and billing records.
• Amend — request a correction to your PHI if you believe it is inaccurate or incomplete.
• Request Restrictions — ask us to limit how we use or disclose your PHI for treatment, payment, or operations.
• Confidential Communications — request that we communicate with you about your health information in a specific way or at a specific location.
• Accounting of Disclosures — request a list of certain disclosures we have made of your PHI.
• Paper Copy — request a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
• File a Complaint — if you believe your privacy rights have been violated, you may file a complaint with our office or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Self-Pay Practice

BRAINKLAST operates primarily on a self-pay and membership basis. Because we generally do not bill insurance for services, disclosures of your PHI for payment purposes are typically limited to transactions directly between you and our practice.

How to Exercise Your Rights

To exercise any of the rights described above, or if you have questions about this Notice, please contact us using the information below. We will respond to your request in accordance with applicable law.

Changes to This Notice

We reserve the right to change the terms of this Notice and to make the revised Notice effective for PHI we already maintain, as well as any information we receive in the future. The current Notice will be posted on this page and available at our office.