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Summary of Notice of Privacy Practices Our practice is committed to maintaining the privacy of your protected health information (“PHI”), while providing high quality medical care. In accordance with the Health Insurance Portability & Accountability Act (“HIPAA”) we provide you with this Notice of Privacy Practices (the “Notice”), which describes how we may use and disclose your PHI, your privacy rights regarding your PHI and our obligations concerning the use and disclosure of your PHI. The following is a brief summary of what is detailed in the attached Notice. This summary is for your convenience and not a substitute for reading the entire Notice and does not modify the terms of the Notice. Uses and Disclosures of Your Health Information We may use and disclose your health information with others without your authorization to:   •  treat you   •   get paid for services we provide to you   •   run our medical practice   •  remind you of appointments   •   family and friends involved in your care   •   tell you about other health benefits and services Other Uses and Disclosures of Your Health Information We may also use and disclose your health information with others without your authorization for:   •   health and safety reasons   •   organ and tissue donation requests   •   military purposes   •   lawsuits   •   law enforcement requests   •   national security reasons   •   coroner, medical examiner or funeral director use   •   workers compensation requests All Other Uses and Disclosures of Your Health Information All other uses or disclosures of your protected health information, outside of those listed in the Notice, will only be made with your written authorization. Your Rights Regarding Your Health Information Subject to the terms and conditions described in the Notice, you have a number of rights under state and federal law to:   •  get a copy of your medical record   •  change your medical record if you think it’s wrong   •  get a list of whom we shared your health information with   •  ask us to limit the information we share   •  ask for a copy of our privacy notice   •  write a letter of complaint to our medical practice or the federal government if you believe your privacy rights have been violated Our Obligations Regarding Your Health Information We are required by federal law to:   •   maintain the privacy of your health information   •  provide you with this Notice   •  comply with the terms of the Notice, as currently in effect

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