HIPAA Notice of Privacy Practices

The Men's Clinic is a covered healthcare entity under the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). We are required by law to:

• Maintain the privacy of your Protected Health Information ("PHI").
• Provide you with this notice of our legal duties and privacy practices.
• Follow the terms of the notice currently in effect.
• Notify you in the event of a breach of unsecured PHI.

We may use and disclose your PHI without your written authorization for:

• Treatment: Providing, coordinating, or managing your healthcare, including sharing information with other providers involved in your care.
• Payment: Billing and collecting payment for the services provided, including verifying insurance coverage.
• Healthcare Operations: Quality assessment, staff training, audits, accreditation, and other administrative activities necessary to operate the clinic.
• As Required by Law: Public health activities, reporting of abuse or neglect, judicial or administrative proceedings, law enforcement, and other uses permitted or required by law.

Other uses and disclosures will be made only with your written authorization, which you may revoke at any time in writing.

You have the right to:

• Access: Inspect and obtain a copy of your PHI in our designated record set.
• Amend: Request an amendment to your PHI if you believe it is incorrect or incomplete.
• Restrict: Request restrictions on certain uses and disclosures of your PHI. We are not required to agree to every restriction.
• Confidential Communications: Request that we communicate with you in a specific way or at a specific location.
• Accounting of Disclosures: Receive a list of certain disclosures we have made of your PHI.
• Paper Copy: Obtain a paper copy of this notice upon request.
• Complain: File a complaint if you believe your privacy rights have been violated.

You may file a complaint with our Privacy Officer (see below) or directly with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights:

U.S. Department of Health and Human Services
Office for Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
Online: hhs.gov/ocr/complaints

We will not retaliate against you for filing a complaint.

We reserve the right to change this notice at any time and make the revised notice effective for all PHI we maintain. The current notice will be posted at our facility and on our website.

For questions, to exercise your rights, or to file a complaint, contact our Privacy Officer:

The Men's Clinic — Privacy Officer
8800 Katy Freeway, Suite 105
Houston, TX 77024
Phone: (713) 828-1476
Email: info@themensclinic.com