This notice describes how medical, dental, or other health information about you may
be used and disclosed, and how you can get access to this information. Please
review it carefully.

Lewis County Primary Care is required by law to maintain the privacy of your health care
information, and to provide you with a notice of Lewis County Primary Cares’ privacy
practices. While required to abide by the terms of the notice that is currently in effect,
Lewis County Primary Care reserves the right to change Lewis County Primary Cares’
privacy practices at any time. If Lewis County Primary Care’ privacy practices change,
Lewis County Primary Care will provide you with a revised notice at your next visit
following the change.

Use of Your Health Care Information

Lewis County Primary Care may use your information for treatment, payment, and health
care operations. For example: Your information may be used to develop a diagnosis and
treatment plan, or to coordinate referrals to another health care provider. Portions of your
information may be submitted to your insurance carrier or other third-party payor to secure
payment on your behalf. Your information may be used in the course of health care
operations, such as for quality assurance, evaluation, training, or audit activities.

Persons whom we contract with to perform services on Lewis County Primary Care; behalf
related to treatment, payment, or health care operations may also have access to your
information solely for the purpose of providing such services, provided that the business
associate has agreed in writing to maintain the confidentiality of such information.
Lewis County Primary Care may disclose information without your authorization as
permitted or required by applicable law, including any of the following: to comply with
public health statutes and rules; to make any required reports of abuse or neglect; to
comply with health oversight activities by government agencies (for example, licensure);
to comply with a court order, government subpoena, or other lawful process; for research
purposes; in the event of your death, to a medical examiner; to avert a serious threat to
health or safety; or for Workers’ Compensation purposes.

Lewis County Primary Care may use your information to contact you for appointment
reminders, or confirm appointments by telephone unless you give us restrictions in writing.
Lewis County Primary Care may disclose your health information to notify, or assist in the
notification of a family member, your personal representative or another person
responsible for your care.

Except as described above, Lewis County Primary Care will not use or disclose your
information, except with your written authorization. You may revoke your authorization at
any time by giving written notice of revocation to Lewis County Primary Care.

Your Rights

You have the right to request restrictions on the use and disclosure of your information.
However, Lewis County Primary Care is not required to agree to a requested restriction,
and it is Lewis County Primary Cares’ policy not to agree to such restrictions unless Lewis
County Primary Care determines, in Lewis County Primary Cares’ sole discretion, that a
compelling reason exists to do so.

You have the right to receive communications from Lewis County Primary Care in a
confidential manner. If you would like Lewis County Primary Care to use another address
or telephone number to contact you, you must request so in writing.

You have the right to receive an accounting of disclosures of your health care information
that you have not authorized. To receive such an accounting, please contact Lewis County
Primary Care at the address given below, allowing up to 30 days to process this request.
You have the right to inspect and copy your information. If you wish to do so, you will be
provided an opportunity to inspect your information within 30 days of receipt of your
written request. You may be charged reasonable costs of copying your information, or of
preparing any summaries that you request.

You have the right to amend your health care information. If you wish to do so, please
submit the proposed amendment in writing to Lewis County Primary Care at the address
given below.

You have the right to a copy of this Notice of Privacy Practices upon request.
You have the right to complain to Lewis County Primary Care and to the Secretary of the
U.S. Department of Health and Human Services if you believe your privacy rights have
been violated. To file a complaint, please contact Lewis County Primary Care as set forth
in this Notice. Nobody is permitted to retaliate against you for filing a complaint.
For further information about Lewis County Primary Cares’ privacy policies please contact:
Compliance Officer

Lewis County Primary Care

P.O. Box 550

Vanceburg , Ky 41179

606 -796-3029