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.

Our Commitment to Your Privacy

Cristi Jacobs Wellness is committed to protecting the privacy of your protected health information (“PHI”). PHI includes information about your health condition, treatment, and payment for healthcare services.

We are required by law to:

• Maintain the privacy of your PHI

• Provide you with this Notice of Privacy Practices

• Abide by the terms of this Notice

• Notify you in the event of a breach of unsecured PHI

How We May Use and Disclose Your Information

We may use and disclose your PHI for the following purposes:

1. Treatment

To provide, coordinate, or manage your healthcare and related services.

2. Payment

To bill and collect payment for services provided.

3. Healthcare Operations

For administrative, quality assurance, and practice management purposes.

Other Permitted or Required Uses

We may also use or disclose your PHI:

• As required by law

• For public health activities

• To report abuse or neglect

• For health oversight activities

• In response to a court order or legal process

• To avert a serious threat to health or safety

• For law enforcement purposes when legally required

Telehealth & Electronic Communication

Your PHI may be transmitted electronically during telehealth visits or secure messaging. Reasonable safeguards are used to protect your information; however, no electronic transmission is completely secure.

Controlled Substances & PDMP

If prescribed controlled medications, we may access state Prescription Drug Monitoring Programs (PDMP) as required by law.

Your Rights Regarding Your Health Information

You have the right to:

• Inspect and obtain a copy of your records

• Request amendments to your records

• Request restrictions on certain disclosures

• Request confidential communications

• Receive an accounting of disclosures

• Receive a paper copy of this Notice

Requests must be submitted in writing.

Breach Notification

You will be notified in the event of a breach of unsecured protected health information as required by law.

Changes to This Notice

We reserve the right to change this Notice at any time. The revised Notice will be posted on our website and available upon request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

Cristi Jacobs Wellness

420 Nichols Blvd, 2nd Floor

Kansas City, MO

You may also file a complaint with the U.S. Department of Health & Human Services:

U.S. Department of Health & Human Services

Office for Civil Rights

200 Independence Avenue, S.W.

Washington, D.C. 20201

1-877-696-6775

www.hhs.gov/ocr/privacy/hipaa/complaints/

You will not be retaliated against for filing a complaint.