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.

This notice provides an overview of the basic rights and responsibilities for patients of Around The Block Health Care, outlines the general expectations of our practice, and describes how Around The Block Health Care manages your medical information. Please note that it is not a comprehensive description of all patient rights and responsibilities.

You have certain rights when it comes to your health information. You have the right to:

GET AN ELECTRONIC OR PAPER COPY OF YOUR MEDICAL RECORD. You can ask to see or get a copy of your medical record and other health information that we have about you. Most patient records are available for free through Around the Block Health Care’s patient portal. We may charge a reasonable, cost-based fee as allowed by law. In limited circumstances, Around the Block Health Care may determine that some portions of a patient’s file may not be available such as psychotherapy notes and information compiled in anticipation of, or for use in, civil, criminal, or administrative proceedings. If any part of your record cannot be shared, you will receive a written explanation in accordance with HIPAA regulations;

ASK US TO CORRECT YOUR MEDICAL RECORD. You may ask us to correct your medical record or health information about you that you think is incorrect or incomplete. Please submit a written request to our office manager or to your provider. We may say “no” to your request, but we’ll tell you why in writing within 60 days;

REQUEST DETAILED EXPLANATION OF BENEFITS OR RECEIPTS FOR ANY SERVICES YOU ARE BILLED FOR. Please request to speak to our billing team;

RIGHT TO ASK US TO LIMIT WHAT WE USE OR SHARE. You may ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay in full for a service or healthcare item out-of-pocket at the time of service, you have the right to request that we not share information about that service with your health insurer for payment or healthcare operations. We will honor your request unless we are legally required to disclose the information;

RIGHT TO GET A LIST OF THOSE WITH WHOM WE HAVE SHARED INFORMATION. You may request a list of those with whom we’ve shared information regarding your care. You may ask for a list of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any disclosures you have asked us to make). We will provide one report a year for free, and we will charge a reasonable, cost-based fee if you ask for another report within 12 months;

RIGHT TO A COPY OF OUR PRIVACY NOTICE. You may request a copy of our privacy notice. You can ask for a paper copy of such notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. If you choose to request a copy, please ask our administrative team or office manager;

RIGHT TO REQUEST COMMUNICATIONS BE SENT TO AN ALTERNATIVE LOCATION OR BY AN ALTERNATIVE MEANS. You can request that communications be sent to alternative locations or by alternative means to further protect your privacy. We will say yes to all reasonable requests;

RIGHT TO CHOOSE SOMEONE TO ACT FOR YOU. You may choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your patient rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action. We will require a copy of your notarized Power of Attorney document to be on file;

RIGHT TO BE FREE FROM DISCRIMINATION, HARASSMENT, AND ABUSE FROM OUR STAFF. If you feel that you have been treated poorly by any of our staff, please let another staff member know so that we can assist you. We strive to be a safe place for all of our patients to come and be respected for who they are (regardless of race, national origin, immigration status, religion, sex, gender, sexual orientation, disability, age, etc.);

RIGHT TO SEEK OTHER MEDICAL OPINIONS AND SEE OTHER MEDICAL PROVIDERS. We encourage self-advocacy from our patients and strive to provide you with the level of care you need. Some patients will require a higher level of care or different provider in order to achieve these results, and the

RIGHT TO FILE A COMPLAINT IF YOU FEEL YOUR RIGHTS ARE BEING VIOLATED. You may file a complaint if you feel your rights are violated. You can submit a complaint if you feel we have violated your rights by contacting us. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html. We will not retaliate against you for filing a complaint.

You have the responsibility to:

COMPLETE A WRITTEN REQUEST TO RELEASE INFORMATION. If you would like us to share information with, or request information from, another individual or organization, please complete and submit our Release of Information Form;

PAY PATIENT’S SHARE OF SERVICES. Failure to pay (or make payment arrangements) may result in not being able to make appointments, and

NOTIFY OUR OFFICE IN ADVANCE OF MISSING AN APPOINTMENT. A pattern of missed appointments may result in a patient not being able to make future appointments. In the event a patient no-shows for three (3) appointments during their tenure with the practice, Around the Block Health Care reserves the right to dismiss the patient from the practice and bar future services to be rendered.

Around the Block Health Care is required by law to maintain the privacy and security of your protected health information (“PHI”) and to provide you with notice of our legal duties and privacy practices. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: https://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html.

OUR USES AND DISCLOSURES:

TO RUN OUR ORGANIZATION. We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services;

TO BILL FOR YOUR SERVICES. We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services, and

We are allowed or required to share your information in other ways such as in ways that contribute to the public good, such as PUBLIC HEALTH AND RESEARCH. We have to meet certain conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

We may use or share your health information in the following ways:

TO HELP WITH PUBLIC HEALTH AND SAFETY ISSUES. We can share health information about you for certain situations such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and/or preventing or reducing a serious threat to anyone's health or safety;

TO DO RESEARCH. We can use or share your information for health research;

TO COMPLY WITH THE LAW. We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law;

TO WORK WITH A MEDICAL EXAMINER OR FUNERAL DIRECTOR. We can share health information with a coroner, medical examiner, or funeral director when an individual dies;

TO ADDRESS WORKERS' COMPENSATION, LAW ENFORCEMENT, AND OTHER GOVERNMENT REQUESTS. We can use or share health information about you for workers' compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and/or for special government functions such as military, national security, and presidential protective services, and

TO RESPOND TO LAWSUITS AND LEGAL ACTIONS. We can share health information about you in response to a court or administrative order, or in response to a subpoena.

USES AND DISCLOSURES REQUIRING YOUR AUTHORIZATION:

Certain uses and disclosures of your health information require your written authorization. These include:

Use or disclosure of psychotherapy notes;

Use or disclosure of your information for marketing purposes not involving face- to-face communication or promotional gifts;

Sale of your health information, and

Any other uses or disclosures of your health information not described in this notice.

If you authorize Around the Block Health Care to use or disclose your health information, you may revoke that authorization at any time, in writing, except to the extent that we have already taken action based on your authorization.

CHANGES TO THE TERMS OF THIS NOTICE & CONTACT INFORMATION:

Around the Block Health Care can change the terms of this notice, and the changes will apply to all information we have about you.

The new notice will be available upon request, in our office, and on our website.

You can contact the Director of Administrative Operations at:

Around The Block Health Care. 3220 N Academy Blvd, Ste 3, Colorado Springs, CO 80917, USA.

admin@aroundtheblockhealthcare.com

Phone: 719-747-2084

Fax: 719-931-1323

Last updated January 7, 2026.