NOTICE OF PRIVACY PRACTICES

Lakes Region Direct Primary Care, PLLC

YOUR RIGHTS & OUR RESPONSIBILITIES REGARDING YOUR PROTECTED HEALTH

INFORMATION (PHI)

YOUR RIGHTS

You have the right to:

• Get a copy of your medical record – You may request an electronic or paper copy of your medical records. We will provide a copy within a reasonable time frame and may charge a reasonable fee.

• Request corrections to your medical record – If you believe your record is incorrect, you may request a correction.

• Request confidential communications – You can ask us to contact you in a specific way (e.g., at a different mailing address or phone number).

• Ask us to limit what we share – You can request that we not share certain information, though we are not required to agree if it affects your care.

• Get a list of disclosures – You can request a list of when and why we have shared your information for up to six years.

• Receive a copy of this Notice – You can request a paper or electronic copy at any time.

• Choose someone to act for you – If you have a legal guardian or power of attorney, that person can exercise your rights.

• File a complaint – If you feel your rights are violated, you can file a complaint with our office or with the U.S. Department of Health & Human Services Office for Civil Rights at www.hhs.gov/ocr or call 1-800-368-1019. You will not be penalized for filing a complaint.

HOW WE USE AND DISCLOSE YOUR INFORMATION

We may use or share your PHI in the following ways:

For Your Treatment:

We can use your health information and share it with other professionals involved in your care.

Example: A specialist treating you may need details about your condition.

For Payment and Operations:

Since we operate on a direct primary care model, we do not bill insurance. However, we may use your information for administrative purposes related to practice operations. Example: Internal audits to improve patient care.

With Your Written Authorization:

We will obtain your written permission before sharing your PHI for reasons not covered in this Notice, such as:

• Sharing psychotherapy notes

You can revoke your authorization at any time.

Other Situations Where We May Share Your Information:

• Public health and safety – To prevent disease, report adverse drug events, or

protect against serious threats.

• Legal compliance – If required by law, such as for court orders or law

enforcement requests.

• Research – Under specific conditions that protect your privacy.

• Organ and tissue donation – If applicable.

• Worker’s compensation, law enforcement, or national security needs – In limited

circumstances as required by law.

OUR RESPONSIBILITIES

• We are required by law to maintain the privacy of your health information.

• We will notify you if a breach occurs that may have compromised your PHI.

• We will follow the terms of this Notice and provide updates when necessary.

CHANGES TO THIS NOTICE

We may change our privacy practices and update this Notice accordingly. The updated Notice will be available in our office and on our website.

CONTACT INFORMATION

If you have any questions or concerns, please contact:

Lakes Region Direct Primary Care PLLC

290 Daniel Webster Hwy, Unit 1

Meredith, NH 03253

Ph: 603.207.5588, Fax: 603.207.5567