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Privacy Policy

COMMUNITY HEALTH DEVELOPMENT, INC.

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES :

• HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED

• YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION

• HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR

HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION

PLEASE REVIEW THIS NOTICE CAREFULLY. YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR

ELECTRONIC FORM) AND TO DISCUSS IT WITH Community Health Development, Inc. (CHDI) Privacy Officer or CEO AT

830-278-5604 or mcastanon@chdi4health IF YOU HAVE ANY QUESTIONS.

WHO WILL FOLLOW THE PRIVACY PRACTICES DESCRIBED IN THIS NOTICE

This Notice of Privacy Practices (“Notice”) describes the privacy practices of Community Health Development, Inc. (“CHDI”) and its workforce members (including employees, contractors, physicians, nurses, other licensed or certified personnel, volunteers, and front desk, billing and administrative personnel) who have a need to use your health information to perform their jobs. It also applies to any individuals authorized to enter information into your health record. Your other health care providers may have different policies regarding their use and disclosure of your health information created at their location.

LAWS THAT PROTECT YOUR HEALTH INFORMATION

Federal and state laws protect the health information that we create and maintain about you. For example:

• Health Record: Your CHDI Health Record includes a comprehensive, chronological, and documented account of an individual’s health history, including illnesses, tests, treatments, and medications. Your Health Record is protected by HIPAA.

• Part 2 Record: If you receive services from our Part 2 Program(s) Behavioral Health Department or Medical Department,

substance use disorder records that we create and maintain related to the Part 2 Program(s) are provided extra privacy protections under 42 CFR Part 2 (Part 2).

State Laws: State laws allow minors to consent to certain health care services without the consent of a parent or legal guardian when:

• The minor is on active duty with armed services

• 16 years old or older and residing apart from parents, managing conservator or guardian and managing his or her own financial affairs

• Unmarried and pregnant and consenting to treatment related to pregnancy other than abortion,

• Unmarried and the parent of a child and has actual custody of that child and consents for treatment of the child.

These services include consenting to diagnosis or treatment of an infectious, contagious, or communicable disease that is reportable to the Texas Department of State Health Services, consenting to examination or treatment for chemical addiction, dependency, or any other condition directly related to chemical use, and consenting for counseling for suicide prevention, chemical addiction or dependency, or for sexual, physical, or emotional abuse. (Texas Family Code §§32.003—.004). CHDI Records related to these services are confidential and may only be disclosed with the minor’s written authorization or as otherwise permitted or required by law.

COMPLY WITH THE LAW

We will share information from your Health Record if state or federal laws require it. We will share information from your Health Record, including your Part 2 Record, with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

ABOUT YOUR HEALTH INFORMATION

We understand that health information about you and your health is personal and protecting your health information is important to us. We create a record of the care and services you receive at CHDI. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by CHDI, whether made by CHDI personnel or other health care providers, stored and transmitted electronically or by other measures. We are required by law to:

• Maintain the privacy of health information that identifies you (with certain exceptions);

• Give you this Notice of our legal duties and privacy practices with respect to health information we collect and maintain about you; and

• Follow the terms of this Notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that we may use and disclose health information. Following each category is an explanation. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

• DISCLOSURE AT YOUR REQUEST. We may disclose health information when requested by you. This disclosure at your request may require a written Authorization by you.

• FOR TREATMENT. We may use health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, students, or other CHDI personnel who are involved in taking care of you at CHDI. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Additionally, the doctor may need to tell the social worker if you have diabetes so we can arrange for appropriate follow up. Different areas of CHDI also may share health information about you in order to coordinate the different care you need, such as medications, lab work and x-rays. We also may disclose health information about you to people outside of CHDI who may be involved in your healthcare after you leave CHDI, such as nurses, social workers, family members, or clergy. We may also use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

For any Part 2 records:

• You must sign a consent form allowing us to share Part 2 Records, unless an exception applies. For example, if your prescription history includes medication prescribed or dispensed by our Part 2 Programs, you must sign a consent form for us to share your prescription history with the hospital where you are having surgery or with a prescription drug monitoring program, if required by state law.

• You may sign a single consent form for all future uses and disclosures of your Part 2 Records for treatment, payment and health care operations purpose.

• In a bona fide medical emergency, we may share Part 2 Records if: (1) we cannot obtain your consent or (2) if a state or federal authority declares a temporary state of emergency because of a natural or major disaster and our Part 2 Programs are closed and unable to provide services or obtain your consent.

• FOR PAYMENT. We may use and disclose health information about you so that the treatment and services you receive at CHDI may be billed to and payment may be collected from you, an insurance company or a third party such as Workers Compensation. For example, we may need to give your health plan information about a procedure you received at CHDI so your health plan will pay us or reimburse you for the procedure or encounter. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your health plan will cover the treatment.

For any Part 2 Records, you must sign a consent form allowing us to share your Part 2 Records for payment purposes, unless an exception applies. You may sign a single consent form for all future uses and disclosures of your Part 2 Records for payment purposes.

• FOR HEALTH CARE OPERATIONS. We may use and disclose health information about you for our health care operations activities. These uses and disclosures are necessary to operate CHDI efficiently and make sure that all of our patients receive quality care. For example, we may use health information to review the safety and the quality of our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine and analyze health information about many CHDI patients to decide what additional services CHDI should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, students, volunteers and other CHDI personnel for review and learning purposes. Additionally, we may combine the health information we have with health information from other Agencies to compare how we are doing and to see where we can make improvements in the care and services we offer. We will remove information that identifies you from this set of health information so others may use it to study health care and health care delivery without learning who the specific patients are. For any Part 2 Records, you must sign a consent form allowing us to share your Part 2 Records for operations purposes, unless an exception applies. You may sign a single consent form for all future uses and disclosures of your Part 2 Records for health care operations purposes.

ADDITIONAL USES AND DISCLOSURES OF HEALTH INFORMATION:

• SINGLE CONSENT TO USE AND DISCLOSE PART 2 RECORDS

If you sign a single consent form allowing us to use and share your Part 2 Records for all future treatment, payment and health care operations purposes, the recipient may further disclose your Part 2 Records consistent with the consent. If you sign a consent form allowing us to disclose your Part 2 Records for treatment, payment, and health care operations to a covered entity (such as another health care provider) or their business associate (such as a vendor), the recipient may share your Part 2 Records as permitted by HIPAA, except for uses or sharing for civil, criminal, administrative, and legislative proceedings against you.

• SUBSTANCE USE DISORDER RECORDS WE RECEIVE FROM OTHER ORGANIZATIONS

If we receive substance use disorder treatment records from a program subject to 42 CFR Part 2 and are notified the records are protected by Part 2, we shall not use or disclose such records in civil, criminal, administrative, or legislative proceedings against the individual unless based on written consent, or a court order after notice and an opportunity to be heard is provided to the individual or the holder of the record, as provided in 42 CFR part 2. A court order authorizing use or disclosure must be accompanied by a subpoena or other legal requirement compelling disclosure before we will use or disclose the requested record.

• AS REQUIRED BY LAW.

We will disclose health information about you when required to do so by federal, state or local laws or regulations.

• DIRECTORY.

We include certain limited information about you in the CHDI directory i.e., directions to locate you while you are here at CHDI. This information includes your name, address and general condition. and provider. Unless there is a specific written request from you to the privacy officer listed herein to the contrary, this directory information may be released to people who are at CHDI asking for you by name. For example, your transportation driver arrives and wants to know if you are ready to leave, a babysitter picks up your children at school and brings them to CHDI to meet you, s/he asks if they can join you in your room. Your spouse calls and wants to know if s/he can speak to you on the phone.

• SIGN-IN SHEET.

We may use and disclose health information about you by having you sign in when you arrive at CHDI. We may also call out your name when you are ready to be seen.

• APPOINTMENT AND PATIENT RECALL REMINDERS.

We may use and disclose your health information to contact you to remind you regarding appointments or for health care that you are to receive.

• BUSINESS ASSOCIATES.

Some of our functions are accomplished through contracted services provided by “Business Associates.” A “Business Associate” may include any individual or entity that receives your health information from us in the course of performing services for CHDI. Such services may include, without limitation, legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation or financial services. When these services are contracted, we may disclose your health information to our Business Associates so that they can perform the job we have asked them to do. To protect your health information, however, we require the Business Associate to appropriately safeguard your information.

• DISASTER RELIEF.

We may disclose information about you to an entity assisting in disaster relief so that your family can be notified about your condition, status and location.

• FUNDRAISING

CHDI does fundraising; however, we would not use patient information without the patient’s written permission.

• HEALTH-RELATED PRODUCTS AND SERVICES.

We may use and disclose health information to tell you about our health-related products or services that may be of interest to you.

• FAMILY, FRIENDS, OR OTHER INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE.

We may disclose your health information to notify or assist in notifying a family member, your personal representative, or another individual involved in or responsible for your health care about your location at CHDI, your general condition, or in the event of your death. We may also disclose information to someone who helps arrange for payment for your care. If you are able and available to agree or to object, we will give you the opportunity to agree or object prior to making these disclosures, although we may disclose this information in the case of a disaster even over your objection if we believe it is necessary to respond to the disaster or emergency situation. If you are unable or unavailable to agree or object, we will use our best judgment in any communication with your family, personal representative, and other involved individuals.

• 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 Record, including your Part 2 Record. We will make sure the person has this authority and can act for you before we take any action.

• RESEARCH

Community Health Development Inc. does no human research.

• TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY.

We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. For example, we may notify emergency response personnel about a possible exposure to the Human Immunodeficiency Virus (“HIV”). Any such disclosure, however, would only be to the extent required or permitted by federal, state or local laws and regulations.

• CHANGE OF OWNERSHIP.

In the event that CHDI is sold or merged with another organization, your health information/health record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another CHDI, medical group, physician or other healthcare provider.

SPECIAL SITUATIONS

• FUNERAL DIRECTORS, CORONERS AND MEDICAL EXAMINERS.

We may disclose your health information to funeral directors as necessary to carry out their duties. We may also disclose health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. For any Part 2 Records, we can share information from Part 2 Records relating to cause of death if the law requires reporting on cause of death or vital statistics or permits inquiry into cause of death. Other uses or disclosures of any Part 2 Records require written consent.

• HEALTH OVERSIGHT ACTIVITIES.

We may disclose your health information to a health oversight CHDI for activities authorized by federal, state or local laws and regulations. These oversight activities include, for example, audits, investigations, inspections, licensure, illegal conduct, or compliance with other laws and regulations. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

• INMATES.

If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose health information about you to the institution or law enforcement official, if the disclosure is necessary (a) for the institution to provide you with health care; (b) to protect your health and safety or the health and safety of others; or (c) for the safety and security of the correctional institution.

• LAW ENFORCEMENT.

We may release your health information if asked to do so by a law enforcement official in the following circumstances: (a) in response to a court order, subpoena, warrant, summons or similar process; (b) to identify or locate a suspect fugitive, material witness, or missing person; (c) about the victim of a crime, if, under certain limited circumstances, we are unable to obtain the person’s agreement; (d) about a death we believe may be the result of criminal conduct; (e) about criminal conduct at CHDI; or (f) in emergency situations to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

For any Part 2 Records: Using or sharing Part 2 Records for the above purposes requires written consent, except:

• We can share certain information from your Part 2 Records with law enforcement if a crime is committed or threatened on the premise of our Part 2 Programs or against Part 2 Program staff members.

• We can share Part 2 Records for audits or evaluations on behalf of certain government agencies, third-party payors or health plans, or quality improvement organizations. We may also share Part 2 Records with such auditors if you sign a consent allowing us to share Part 2 Records for health care operations.

• LAWSUITS AND DISPUTES.

If you are involved in a lawsuit or a dispute, we may disclose your health information to the extent expressly authorized by a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if reasonable efforts have been made to notify you of the request (which may include written notice to you) and you have not objected, or to obtain an order protecting the information requested.

For any Part 2 Records:

• Part 2 Records, or testimony relaying the content of such records, shall not be used or disclosed in any civil, administrative, criminal, or legislative proceedings against you unless based on specific written consent or a court order;

• Part 2 Records shall only be used or disclosed based on a court order after notice and an opportunity to be heard is provided to you or to the holder of the record, where required by 42 U.S.C. 290dd-2 and 42 CFR Part 2; and

• A court order authorizing use or disclosure must be accompanied by a subpoena or other similar legal mandate compelling disclosure before the Part 2 Record is used or disclosed.

• MILITARY AND VETERANS.

If you are a member of the armed forces, we may release health information about you as required by military authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.

For any Part 2 Records: Using or sharing Part 2 Records for the above purposes requires written consent, except:

• We can share certain information from your Part 2 Records with law enforcement if a crime is committed or threatened on the premise of our Part 2 Programs or against Part 2 Program staff members.

• We can share Part 2 Records for audits or evaluations on behalf of certain government agencies, third-party payors or health plans, or quality improvement organizations. We may also share Part 2 Records with such auditors if you sign a consent allowing us to share Part 2 Records for health care operations.

• NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES.

We may release health information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.

For any Part 2 Records: Using or sharing Part 2 Records for the above purposes requires written consent, except:

• We can share certain information from your Part 2 Records with law enforcement if a crime is committed or threatened on the premise of our Part 2 Programs or against Part 2 Program staff members.

• We can share Part 2 Records for audits or evaluations on behalf of certain government agencies, third-party payors or health plans, or quality improvement organizations. We may also share Part 2 Records with such auditors if you sign a consent allowing us to share Part 2 Records for health care operations.

• ORGAN AND TISSUE PROCUREMENT ORGANIZATIONS.

If you are an organ donor, we may disclose health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transplantation. For any Part 2 Records, written consent is required.

• PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS.

We may disclose health information about you to authorize federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or to conduct special investigations.

• PUBLIC HEALTH REPORTING.

We may disclose health information about you for public health activities. We will only make this disclosure if you agree or when required or authorized by law. These activities generally include the following: (a) to prevent or control disease, injury or disability; (b) to report births and deaths; (c) to report the abuse or neglect of children, elders and dependent adults; (d) to report reactions to medications or problems with products; (e) to notify people of recalls of products they may be using; and (f) to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition. (g) preventing or reducing a serious threat to anyone’s health or safety.

For any Part 2 Records: Using or Sharing for the purposes listen above requires written consent, except:

• For public health purposes, we can disclose Part 2 Records without your consent if: (1) the disclosure is made to a public health authority and (2) information from the Part 2 Record has been de-identified.

• If medical personnel of the Food and Drug Administration (FDA) assert a reason to believe that the health of an individual maybe be threatened by an error in the manufacture, labeling, or sale of a product under FDA jurisdiction, we may disclose Part 2 Records for the exclusive purpose of notifying patients or their physicians.

• We can report suspected child abuse and neglect to appropriate state or local authorities, as required by law.

• We can share certain information from your Part 2 Records with law enforcement if a crime is committed or threatened on the premise of our Part 2 Program(s) or against Part 2 Program staff members.

• VICTIMS OF ABUSE, NEGLECT OR DOMESTIC VIOLENCE.

We may disclose your health information to notify the appropriate government authority if we believe that a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure when required or authorized by law.

• WORKERS’ COMPENSATION.

We may disclose health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

For any Part 2 Records: Using or sharing Part 2 Records for the above purposes requires written consent, except:

• We can share certain information from your Part 2 Records with law enforcement if a crime is committed or

threatened on the premise of our Part 2 Programs or against Part 2 Program staff members.

• We can share Part 2 Records for audits or evaluations on behalf of certain government agencies, third-party payors or health plans, or quality improvement organizations. We may also share Part 2 Records with such auditors if you sign a consent allowing us to share Part 2 Records for health care operations.

• SECURITY CLEARANCES.

We may use medical information about you to make decisions regarding your medical suitability for a security clearance or service abroad. We may also release your medical suitability determination to the officials in the Department of State who need access to that information for these purposes.

• MULTIDISCIPLINARY PERSONNEL TEAMS.

We may disclose health information to a state or local government CHDI or a multidisciplinary personnel team relevant to the prevention, identification, management or treatment of an abused child and the child’s parents, or elder abuse and neglect.

• SPECIAL CATEGORIES OF HEALTH INFORMATION.

In some circumstances, your health information may be subject to additional restrictions that may limit or preclude some uses or disclosures described in this Notice or Privacy Practices. For example, there are special restrictions on the use and/or disclosure of certain categories of health information. For example, (a) AIDS treatment information and HIV tests results; (b) treatment for mental health conditions and psychotherapy notes; (c) alcohol, drug abuse and chemical dependency treatment information; and/or (d) genetic information, are all subject to special restrictions. In addition, Government health benefit programs, such as Medicare or Medicaid, may also limit the disclosure of patient information for purposes unrelated to the program.

YOUR PRIVACY RIGHTS

You have the following rights regarding health information we maintain about you:

• RIGHT TO INSPECT AND COPY.

You have the right to inspect and copy health information that may be used to make decisions about your care. Usually this includes medical and billing records, but may not include some mental health information. If you request a copy of your health information that may be used to make decisions about your care, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to:

Community Health Development, Inc.

908 South Evans, Building A

Uvalde, Texas 78801

Attention: Privacy Officer or Chief Executive Officer

We may deny your request to inspect and copy in specific circumstances. If you are denied access to your health information, you may request that the denial be reviewed. Another licensed health care professional chosen by CHDI will review your request and the denial. The person conducting the review will not be the person who denied your request. CHDI will comply with the outcome of the review.

• RIGHT TO REQUEST RESTRICTIONS.

You have the right to request a restriction or limitation on the health information CHDI uses or discloses about you for treatment, payment or health care operations. You can also request a restriction or limitation on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.

For example, you could ask that we not use or disclose information about a surgery you had. We will never share your information unless you give us written permission for marketing purposes, sale of your information, and most psychotherapy notes.

• WE RESERVE THE RIGHT TO ACCEPT OR REJECT YOUR REQUEST.

If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. We will notify you if we do not agree to a requested restriction. To request restrictions, you must submit a written request to CHDI at the above address. In your request, you must state: (a) what information you want to limit; (b) whether you want to limit its use, disclosure or both; and (c) to whom you want the limits to apply; for example, no disclosures to your spouse.

• Right to restrict Disclosure for Services Paid by You in Full.

You have the right to restrict the disclosure of your health information to a health plan if the health information pertains to health care services for which you paid in full directly to CHDI and the disclosure is not otherwise required by law.

• RIGHT TO AMEND.

If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment to your health information for as long as the information is kept by or for CHDI. You must make your request to amend your health information, in writing, and submit it to CHDI at the above address. You must include a reason that supports your request. In addition, we may deny your request if you ask us to amend information that:

1. Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

2. Is not part of the health information kept by or for CHDI;

3. Is not part or the information which you would be permitted to inspect and copy; or

4. Is accurate and complete.

The law permits us to deny your request for an amendment if it is not in writing or does not include a reason to support the request. Even if CHDI denies your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that you want the addendum to be made part of your health record we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.

• REQUEST AN ACCOUNTING OF DISCLOSURES.

You can ask for a list (accounting) of the times we’ve shared your health information, who we shared it with and why. For CHDI Records, you may request 7 years of disclosures. For Part 2 Records, you may request 3 years of disclosures.

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.

If you consented to the disclosure of your Part 2 Records to an intermediary, you can ask the intermediary for 3 years of disclosures.

RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS.

You have the right to request that we communicate with you about health matters in a certain way or at a certain location.

For example, you can ask that we only contact you at work or by mail. You must make your request for confidential communications in writing to CHDI at the address noted above. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

• 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, including Part 2 Records shared with your written consent for purposes of treatment, payment and health care operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information, including health information in Part 2 Records, for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

• RIGHT TO OBTAIN A PAPER COPY OF THIS NOTICE.

You have the right to receive a paper copy of this Notice. You may request a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.

• Right To Notice of Breach.

You have the right to be notified if we or one of our Business Associates becomes aware of an improper disclosure of your health information.

• 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 compromises 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 information from your CHDI Record, including any Part 2 Records, other than as described

in this notice, unless you consent in writing. You may change your mind at any time. To revoke (take back) your consent, submit a request in writing to CHDI’S Privacy Officer or the CEO at 830-278-5604 or mcastanon@chdi4health.org. If you revoke your consent, it will not affect any information we shared based on your earlier permission.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice at any time. We reserve the right to make the revised or changed Notice effective for all health information we have about you as well as any information we receive in the future. We will post a copy of the current Notice

in CHDI. The Notice will contain the effective date on the first page, in the top right-hand corner. If we amend this Notice, we will offer you a copy of the current Notice in effect. You may request a copy of the current Notice each time that you visit CHDI for services or by calling CHDI and requesting that the current Notice be sent to you in the mail.

FOR MORE INFORMATION, TO FILE A COMPLAINT OR TO REPORT A PROBLEM

If you believe that your privacy rights have been violated, please let us know promptly so we can address the situation. You may file a complaint with CHDI and/or with the Secretary of the federal Department of Health and Human Services. All complaints must be submitted in writing.

To file a complaint with CHDI, send a written complaint to CHDI’s Privacy Officer Chief Executive Officer at:

Community Health Development, Inc. Attention: Privacy Officer or Chief Executive Officer

908 South Evans, Building A

Uvalde, Texas 78801

To file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights, send a letter to:

200 Independence Avenue S.W

Washington, D.C. 20201

Or call 1-877-696-6775, or visit www.hhs.gov/ocr/privacy/hipaa/complaints

If you would like to discuss a problem without submitting a formal complaint, you may contact the Privacy Officer by telephone at (830)278-5604 or by facsimile at (830)278-1836 or via e-mail at www.chdi4health.org. In addition, you may contact the Chief

Executive Officer by telephone at (830)278-5604 or by facsimile at (830)278-1836 or via e-mail at: www.chdi4health.org

You will not be penalized for filing a complaint, and we will not retaliate against you for filing a complaint.

OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will stop the uses and disclosures allowed by that permission, except to the extent that we have already acted in reliance on your permission. For example, we are unable to take back any disclosures we have already made with your permission.

ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

We will ask you to sign an acknowledgment that you received this notice.

EFFECTIVE DATE

2/16/2026