This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
We understand the importance of privacy and are committed to protecting the confidentiality of your Protected
Health Information (PHI). This includes medical records requests as well as invoices for the healthcare services we provide.
Should you have any questions about this notice, please contact our Privacy Officer at
(844) 888-8LIM or privacyofficer@liminnovations.com
Your Rights
Inspect and copy your PHI:
You have the right to receive a copy of your PHI that we have created. A reasonable fee may be charged, as allowed by California law.
Request restriction of your PHI:
You may request that we agree to restrictions on certain uses and disclosures of your health information, but we are not required to agree to your request with the following exception. You have the right to ask us to restrict the disclosure of health information to your health plan for a service we provide to you where you have directly paid us (out of pocket, in full) for that service, in which case we must honor your request.
Receive Confidential Communications:
You have the right to request that we send your health information by alternative means or to an alternative address. We will accommodate such reasonable requests.
Receive an Accounting of Disclosures:
You have the right to receive a list of certain disclosures of your health information made by LIM in the past six years from the date of your written request. Under the law, this does not include disclosures made for purposes of treatment, payment or healthcare operations.
Obtain a paper copy of this notice.
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 information.
File a complaint if you feel your rights are violated:
You can complain if you feel we have violated your rights by contacting our Privacy Officer at privacyofficer@liminnovations.com
. 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 www.hhs.gov/ocr/privacy/hippa/complaints/ We will not retaliate against you for filing a complaint.
324 Divisadero Street, San Francisco, CA 94117 | 844.888.8LIM | LIMinnovations.com Page 1

How to Exercise Your Rights:
You may send an email to privacyoffer@liminnovations.com
or write to us at
324 Divisadero Street, San Francisco, CA 94117 .
We will consider your request and provide you a response within a reasonable timeframe.
LIM Innovations, Inc. (LIM) is required by law to maintain the privacy of your PHI.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. LIM is also required to follow the duties and privacy practices described in this notice and provide you with a copy of it.We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
Treat you: We use your health information and share it with other professionals who are treating you.
Run our organization: We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Bill for your services: LIM will use your PHI as part of our billing process and may send it to your insurance company or other appropriate parties, including to you, to obtain payment for our services. If you are insured under another person’s health insurance policy (for example, parent spouse, domestic partner or former spouse), we may also send invoices to the subscriber whose policy covers your health services.
Business Associates: We may provide your PHI to an outside collection agency to obtain payment when necessary.
As required by Law: In certain circumstances, federal or state laws may require that we provide your health information to organization such as:
• Public Health Authorities
• The Food and Drug Administration
• Health Oversight Agencies
• National Security and Intelligence Organizations
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/ consumers/noticepp.html
Changes to the Terms of This Notice
We can change the terms of this notice and the changes will apply to all information we have about you. The new notice will be available upon request, in our office and on our website
324 Divisadero Street, San Francisco, CA 94117 | 844.888.8LIM | LIMinnovations.com Page 2