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This notice describes how your medical information may be used and disclosed (provided to others) and how you can get access to this information. Please review this notice carefully.

This notice describes your privacy rights as they relate to information from your health records and explains the circumstances under which information from your health records may be shared with others. The information in this notice also applies to other individuals covered under your health plan, such as your spouse or children. If you do not understand the information in this notice, please ask for further explanation.

Under the law you have the right (with certain limitations) to:

• Inspect and request copies of your records or to appeal any denial of your request for inspection or copying. The Bay Clinic, Inc. (BCI) may charge a reasonable fee or record copies. If your request to inspect and copy the record is denied, we will inform you of the reason of the denial and the process of appeal.

• Request that your health care provider append information to your medical record.

• Receive a notice of your privacy rights by your health plan upon enrollment, annually and when their privacy practices are substantially amended.

• Obtain a copy of Bay Clinic’s privacy practices.

BCI is required, under specific circumstances, to use or disclose your protected health information without your written authorization. Examples include: 1. Public health activities; judicial & administrative proceedings; correctional institutions & other law enforcement situations.

2. Disclosure regarding victims of abuse, neglect or domestic violence; health oversight activities. 3. Law enforcement; military & veterans activities 4. Government programs providing public benefits & workers compensation.

Uses if Health Information

Bay Clinic, Inc. uses your protected health information to provide you with health care services. Under the law, BCI and such entities as health plans may use your health information for the following purposes:

• Treatment: We will use and disclose your protected health information to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. For example, your protected health information may be provided to a provider to whom you have been referred to ensure that the provider has the necessary information to diagnose or treat you.

• Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that our relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission. append information to your medical record.

• Health Care Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of our practice. These activities include, but are not limited to, quality assessment, employee review, and training of medical students, licensing, and conducting or arranging for other business activities. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your provider. We may also call you by name in the waiting room when your provider is ready to see you.

Uses of Protected Health Information

Bay Clinic, Inc. will not use or disclose your health information without your authorization except for the purposes described in this information sheet or in accordance with existing laws. You may authorize the use or disclosure of your health information for other purposes by completing a written authorization, which meets the requirements of law. If you choose to do so, you may revoke the authorization in writing at any time.

Limiting Disclosure of Your Protected Health Information

You have the right to limit the disclosure of your protected health information if you choose to not use any health insurance or other third party payments as payment for services, in which case, you may only limit disclosure if you have advised the provider prior to the delivery of services and have paid for the health care services yourself.

If you have any questions regarding your confidentiality rights, or if you wish to request a copy of this Notice of Privacy Practices and/or written procedures established to exercise your rights as stated above, please ask at our front desk at any location.