Your Information. Your Rights. Our Responsibilities.

This notice describes how your medical information may be used and disclosed and how you can access it. Please review it carefully.

YOUR RIGHTS

• Get a copy of your medical record (paper or electronic)

• Request corrections to your record

• Request confidential communication

• Ask us to limit what we use or share

• Get a list of disclosures (accounting)

• Get a copy of this notice

• Choose someone to act for you

• File a complaint if you believe your rights were violated

Access Your Records: You may request a copy of your records. We will provide it within 30 days and may charge a reasonable fee.

Request Corrections: You may ask us to correct inaccurate or incomplete information. We may deny your request but will explain why within 60 days.

Confidential Communication: You can request we contact you in a specific way. We will honor reasonable requests.

Limit Information Sharing: You may request limits on sharing. We may decline if it affects your care. If paid in full out-of-pocket, you may request we not share with your insurer.

Accounting of Disclosures: You may request a list of disclosures from the past 6 years. One free request per year.

Choose a Representative: Authorized individuals may act on your behalf.

File a Complaint: You may contact us or the U.S. Department of Health and Human Services without retaliation.

YOUR CHOICES

You can tell us how to share information:

• With family, friends, or caregivers

• Disaster relief situations

• Facility directories

We never share your information without written permission for marketing, sale of your information, or most psychotherapy notes. You may opt out of fundraising communications.

USES AND DISCLOSURES

We may use/share your information to treat you, run our practice, and bill for services. We may also share information for public health, research, legal compliance, law enforcement, workers’ compensation, lawsuits, and with coroners or funeral directors.

SUBSTANCE USE DISORDER (42 CFR PART 2)

We will not share substance use disorder records for legal or investigative purposes without your written consent or a court order and subpoena.

OUR RESPONSIBILITIES

We are required to maintain the privacy and security of your information, notify you of breaches, and follow this notice.

CHANGES TO THIS NOTICE

We may update this notice at any time. Updates apply to all records and will be available upon request.

CONTACT INFORMATION

Newmyer Peak Performance Chiropractic PLLC

Privacy Officer 469-631-0900

Effective Date: 2/16/2026

Additional Commitments: • We do not market or sell personal information • Mental health records require written consent unless required by law or for treatment

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html