HIPAA Notice of Privacy Practices

We may use and disclose your protected health information (PHI) for the following purposes:

• Treatment. To provide, coordinate, or manage your health care and related services.
• Payment. To bill and collect payment for the services we provide.
• Health care operations. For quality improvement, training, accreditation, and similar activities.
• As required by law. When federal, state, or local law requires the disclosure.
• Public health and safety. To prevent or reduce a serious threat to anyone's health or safety.

Most uses and disclosures of psychotherapy notes, uses or disclosures for marketing purposes, and any sale of your PHI require your written authorization. You may revoke an authorization in writing at any time.

• Inspect and request a copy of your PHI.
• Request an amendment to your PHI.
• Request an accounting of certain disclosures.
• Request restrictions on certain uses and disclosures.
• Request confidential communications by a specific means or at a specific location.
• Receive a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Be notified following a breach of unsecured PHI.

We are required by law to maintain the privacy of your PHI, provide you with this notice, and follow the terms of the notice currently in effect. We reserve the right to change this notice and to make the new notice effective for all PHI we maintain.

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

HHS Office for Civil Rights: 200 Independence Avenue SW, Washington, DC 20201. Phone 1 877 696 6775. Online at hhs.gov/ocr/complaints.

Adeptus Health Privacy Officer, 220 East Las Colinas Boulevard, Suite 1000, Irving, Texas 75039. Email privacy@adeptushealth.com.