17 ©2024 United Benefit Advisors, LLC. All rights reserved. Request confidential communications x You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. x We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not. Ask us to limit what we use or share x You can ask us not to use or share certain health information for treatment, payment, or our operations. x 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 x 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. x We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll 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 privacy notice You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly. Choose someone to act for you x 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. x 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 x You can complain if you feel we have violated your rights by contacting us using the information on page 1. x 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 https://www.hhs.gov/hipaa/filing-a-complaint/what-to- expect/index.html. x 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.