Notice of Privacy Practices

Who Must Follow This Notice

This Notice applies to the privacy practices of PeakHealth MT, LLC ("PeakHealth MT," "we," "us," or "our"), including Wesley Hardin, PA-C, and any workforce members, contractors, or business associates who create, receive, maintain, or transmit health information on our behalf. PeakHealth MT provides medical weight management care exclusively by telehealth to adult residents of the State of Montana. We do not maintain a physical office where patients are seen in person.

Your Rights

When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities to help you.

Get a copy of your medical and billing records

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say "no" to your request, but we will explain our reasons in writing within 60 days.

Request confidential communications

• You can ask us to contact you in a specific way (for example, personal phone or secure patient portal message only) or to send correspondence to a different address.
• We will consider all reasonable requests and say "yes" to all reasonable requests.

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.

Get a list of those with whom we've shared information

• You can ask for a list (accounting) 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 disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this Notice of Privacy Practices

• You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. We will provide you with a paper copy promptly.

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 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.

File a complaint if you feel your rights are violated

• You can file a complaint with us using the contact information at the end of this notice.
• You can 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 www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care, or involved in helping pay for your care, unless you object.
• Share information in a disaster relief situation.

If you are not able to tell us your preference (for example, if you are unconscious), we may share your information if we believe it is in your best interest, or to reduce a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes.
• Sale of your information.

PeakHealth MT does not maintain psychotherapy notes and does not provide mental health treatment; the special protections that apply to psychotherapy notes under HIPAA are therefore not applicable to the care we provide.

Our Uses and Disclosures

We typically use or share your health information in the following ways.

Treat you

We can use and share your health information with other health care professionals involved in your care. For example, we may send your information to Quest Diagnostics to order and receive the results of laboratory testing required for your treatment, or to NovoCare Pharmacy or LillyDirect Pharmacy Solutions to fill a prescription we have written for you.

Run our organization

We can use and share your health information to run our practice, improve your care, and contact you when necessary. For example, we use CharmHealth, our electronic health record platform, to document and manage your care, and we may work with trained administrative staff or contractors, under appropriate confidentiality and business associate agreements, to help schedule appointments or answer general questions. These individuals are never authorized to access your health information for any purpose beyond the administrative task assigned, and are contractually prohibited from providing clinical advice.

Bill for services

PeakHealth MT is a cash-pay practice and does not bill health insurance. We can use and share your health information to process payment for the services we provide, including through our payment processor, Stripe.

How Else Can We Use or Share Your Health Information?

We are allowed or required to share your information in other ways, usually because it contributes to the public good, such as public health and research. We have to meet many 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.

• Help with public health and safety issues, such as preventing disease, reporting adverse reactions to medications or problems with products, and reporting suspected abuse, neglect, or domestic violence.
• Do research, when a research board has reviewed the request and established protocols to protect your health information.
• Comply with the law, including Montana state law and federal law, when we are required to do so.
• Address workers' compensation, law enforcement, and other government requests, when required by law.
• Respond to lawsuits and legal actions, such as in response to a subpoena or court order.
• Work with a medical examiner, coroner, or funeral director, or respond to organ or tissue donation requests, if applicable to your circumstances.

Our Responsibilities

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

Changes to the Terms of This Notice

We 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, posted on our website at peakhealthmt.com, and provided to you directly through our patient portal or by mail upon request.

Contact Information / To Report a Problem

If you have questions about this notice, would like to exercise any of the rights described above, or believe your privacy rights have been violated, please contact:

Wesley Hardin, PA-C — Privacy Officer, PeakHealth MT
Email: info@peakhealthmt.com
Phone: 406-272-2494
Mailing Address: c/o Northwest Registered Agent LLC, 522 W Riverside Ave STE N, Spokane, WA 99201

You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, as described in the "Your Rights" section above. We will not retaliate against you for filing a complaint.