NOTICE OF PRIVACY RIGHTS and 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.

Ephesians 5:25 Ministries is committed to protecting your personal health information. Personal health information includes any information created or received by Ephesians 5:25 Ministries during the course offend after treatment. This notice about protecting your health information is required by law. It tells you about your rights and how Ephesians 5:25 Ministries uses and discloses your health information. Your Health Information Rights You have certain rights regarding the health information Ephesians 5:25 Ministries has about you.

You have the right to:

• Request a restriction on certain uses and disclosures of your health information; however, Ephesians 5:25 Ministries is not required to approve your request.
• Request that Ephesians 5:25 Ministries notifies you about your health information in a way or at a location that will help you keep your health information confidential.
• Receive a list of disclosures Ephesians 5:25 Ministries has made of your health information. •In writing at any time, withdraw your permission for Ephesians 5:25 Ministries to disclose your health information, except for the information that Ephesians 5:25 Ministries disclosed before you stopped your permission.
• Review and obtain a copy of your own health information.
• Ask Ephesians 5:25 Ministries to change your health information if you believe it is incorrect or incomplete. Ephesians 5:25 Ministries may deny your request and, if so, will give you the reason(s) why the request was denied.

How Ephesians 5:25 Ministries May Use or Disclose Your Health Information The law permits Ephesians 5:25 Ministries to use or disclose your health information for the following purposes:

For Treatment, Ephesians 5:25 Ministries may use and disclose your health information to help you receive mental/medical health and services. For Example: Ephesians 5:25 Ministries may use your mental/medical health information to review and approve hospital care, or conduct treatment coordination with funding sources.

For Payment, Ephesians 5:25 Ministries may use and disclose your health information to sequester payment for services rendered. For Example: A third party may be contacted regarding the receipt of delinquent payments.