Privacy Notice

As a client of Path Medical, you have the right to the privacy and confidentiality of your medical
record and treatment information, with a few limited exceptions described in this notice. This right
to privacy and confidentiality is protected by federal and state law, as well as by Path Medical
policy. This notice describes in detail how Path Medical protects and safeguards your right to
privacy and confidentiality. Please review your rights carefully, and if you have any questions or
concerns, call us using the information listed under “Questions and Concerns” of this notice. We
will be happy to answer any questions you may have.

I. IN GENERAL

It is the duty of Path Medical to protect and safeguard your private and confidential treatment and
medical record information. This means that no person other than you is entitled to your treatment
or medical record information, with the few exceptions described below.

II. EXCEPTIONS; WHO YOUR INFORMATION MAY BE DISCLOSED TO

(a) You

Path Medical must disclose your treatment and medical record information to you. You can either
review your treatment and/or medical record information in person or request in writing to obtain
access to your information, by calling for an appointment or writing to the Privacy Officer at Path
Medical (address and phone listed in Question and Concern section of this notice). Path Medical
will provide you with copies of your medical record and/or schedule an appointment for you to see
your medical record within 14 days of receipt of the request.

(b) Your Legal Guardian

If you are (1) under 18 years of age and are not emancipated or (2) have been declared mentally
incompetent by a Florida court, then it is your legal guardian who is entitled to your Privacy and
Confidentiality rights and who has the ability to enforce these rights. Your legal guardian also has
the right to access all treatment disclosures made by you.

(c) For Treatment Purposes, With Your Consent

From time to time, we may need to use, disclose, or obtain documented information about you for
the purposes of better treatment. Some, but not all of the information that may be obtained or
shared with another provider includes medical records, x-ray reports and laboratory results.
Additionally, at times we will need to communicate verbally with others about your treatment.
Such communication regularly occurs between the treatment team, which includes the doctor,
licensed massage therapists, X-Ray Technicians and others. Other times, you may want us to
communicate with your family members as to your treatment.
Prior to any documented information being obtained or disclosed, or any verbal communications
being made, Path Medical will obtain your written consent to release or obtain that specific
information to each party to whom we release information. Without such written consent, no
documents will be obtained or disclosed and no verbal communications will occur.

(d) For Health Care Operations, With Your Consent

Path Medical may at times be required to use and disclose your Protected Health Information (PHI)
to another agency for purposes such as billing, payment, contracting, authorizing, accrediting,
auditing, reviewing, quality improvement, or other related health care operation purposes.
Protected Health Information includes data such as your name, social security number, date of
birth, address and other identifying information.
At the start of treatment, we will ask that you give us your consent to release your PHI for the
purposes discussed in the previous paragraph. This one consent will cover all such release of PHI
for health care operations purposes until your discharge, but you can limit and/or revoke your
consent in writing at any time (see the Questions and Concern section of this notice below).
Additionally, when releasing your PHI for health care operations purposes, Path Medical will only
release information to the minimum extent necessary to accomplish the purpose of the release.
Further, prior to Path Medical releasing any of your PHI for health care operation purposes, Path
Medical will ensure that an agreement between Path Medical and the other entity is in place, where
the other entity agrees to provide you with the privacy and confidentiality protections required by
law and by our agency.

(e) For Health and Safety

At times, Path Medical may need to use and disclose your treatment and medical record
information to avert a serious and imminent threat to your health or safety or the health or safety
of others. When releasing your information under these circumstances, such information will be
released only to the minimum extent necessary to avert the threat. When reasonably possible, Path
Medical will attempt to obtain your written consent prior to the release of such information, but
does not guarantee that such attempt to obtain consent will be made.
Additionally, Florida law requires Path Medical to report to the Abuse Hotline any suspected child
or elderly abuse, neglect, or abandonment. Florida law also requires that we report suspected
domestic violence.

(f) When Required to Disclose by Law

Path Medical may disclose your treatment and medical record information to the minimum extent
necessary when we are required to do so by law, for the purposes of the federal or state regulating
body ensuring Path Medical is complying with all applicable laws and satisfying all of its legal
obligations. When reasonably possible, Path Medical will attempt to obtain your written consent
prior to the release of such information, but does not guarantee that such attempt to obtain consent
will be made.
Path Medical may also disclose your treatment and/or medical record information to the minimum
extent necessary to a law enforcement official if you are a suspect, fugitive, material witness, crime
victim, missing person, etc. Path Medical may additionally disclose the treatment and/or medical
record information to the minimum extent necessary if you are an inmate or other person in lawful
custody to a law enforcement official or correctional institution under certain circumstances or if
it is necessary to assist law enforcement officials to capture an individual who has admitted to
participation in a crime or has escaped from lawful custody.

(g) For Court Proceedings

Path Medical may be required to use or disclose your treatment and/or medical record information
in response to a court or administrative order, subpoena, discovery request, or other lawful process,
under certain circumstances. Under other limited circumstances, such as a court order, warrant, or
grand jury subpoena, we may disclose your PHI to law enforcement officials. When reasonably
possible, Path Medical will attempt to obtain your written consent prior to the release of such
information, but does not guarantee that such attempt to obtain consent will be made. Also, such
information will only be released to the minimum extent necessary to satisfy the request.

(h) For Military and National Security

Path Medical may disclose to military authorities your treatment and/or medical record information
if you are an Armed Forces personnel under certain circumstances or to authorized federal officials
for lawful intelligence, counterintelligence, and other national security activities. When reasonably
possible, Path Medical will attempt to obtain your written consent prior to the release of such
information, but does not guarantee that such attempt to obtain consent will be made prior to the
disclosure. Also, such information will only be released to the minimum extent necessary to satisfy
the request.

(i) For Research, Training or Quality Assurance

Path Medical will not use or disclose any identifying information about you for: research, data,
training or quality assurance unless we first (a) disclose to you in writing the purpose of such use,
(b) limit the use of your information only to the extent necessary to fulfill such purpose, and (c)
receive your written consent to such disclosure.

(j) For Media Purposes

Path Medical will not disclose your protected health information to the media without your
voluntary and written consent. In the event that you voluntarily or inadvertently disclose, on your
own, such confidential information about yourself or another Path Medical client, it is with the
understanding that Path Medical will not be held responsible for claims arising from your
communications.

(k) For Other Purposes, With Your Consent

From time to time, situations may arise where we may need to disclose your confidential
information under special circumstances. Such information will not be released unless we first (a)
disclose to you in writing the purpose of such use, (b) limit the use of your information only to the
extent necessary to fulfill such purpose, and (c) receive your written consent to such disclosure.

III. YOUR RIGHTS

(a) Duration of Consent; Right to Revoke or Limit Consent to Disclose Information

At any time, if you give your written consent to Path Medical to release your information for any
purpose, your written consent to release your information for treatment will remain valid through
the length of treatment, unless otherwise noted, or you revoke or limit your consent. You have the
right to revoke or limit the consent in writing at any time (see Questions and Concerns section for
details).

(b) Right to Request Amendments to Your Medical Record

You have the right to request that we amend your medical record by writing to the Medical Records
department at Path Medical. The writing must contain a detailed description of the amendments
requested and the reasons for such request.
Under certain circumstances, we may deny your request to amend your medical record. If Path
Medical does so, we will provide you with a written reason for such denial within 14 days of
receipt of the request for amendment. If you are unsatisfied with such response, you may use the
procedures set out in the Questions and Concerns section of this Notice, to file an appeal.

(c) Right to Request Restrictions on the Use and Disclosure of your PHI

You have the right to request that we place certain additional restrictions on our use or disclosure
of your health information. We are not required to agree to these additional restrictions, but if we
do, we will abide by our agreement. However, if you are in need of emergency treatment and the
restricted health information is needed to provide the emergency treatment, we may use or disclose
that information to a health care provider in order to facilitate the provision of emergency treatment
to you. Any agreement we may make to a request for additional restrictions must be in writing and
signed by the person authorized to make such an agreement on our behalf. We will not be bound
unless the agreement is so memorialized in writing.

(d) Right to Request Your PHI Log

You have the right to request a copy of your PHI log, which will show you all uses and disclosures
of your PHI made by Path Medical to other parties. Such request can be made in writing to the
Privacy Officer at the address listed in the Questions and Grievance section of this notice.

(e) Right to Request Confidential Communications

You have the right to request that we communicate with you in confidence about your health
information at an alternative address or location. To make such request, please make such request
in writing Path Medical (see Questions and Grievances section).

IV. OTHERS’ RIGHTS

During the course of treatment with Path Medical, you may be privileged to the protected health
information of other Path Medical clients. When receiving such information, you agree to maintain
the privacy of such other client’s protected health information to the same extent as Path Medical
maintains your privacy.

V. EFFECTIVE DATE

This Privacy Notice takes effect on October 1st, 2014 and will remain in effect until a revised
notice is issued. A revised notice may be issued if (a) Path Medical chooses to revise this Privacy
Notice or its Policies or (b) federal or state regulations requires Path Medical to make such
revisions. Path Medical reserves the right to make changes in its privacy practices. Before we make
a significant change in our privacy practices which will affect your rights, we will change this
notice and send the new one to you and, if you are under 18 years of age, to your legal guardian.

V. QUESTIONS AND CONCERNS

If at any time you want more information about Path Medical’s privacy practices, or, have
questions or concerns about this Notice or Path Medical’s Privacy Practices, please contact our
Privacy Officer who will answer any questions or concerns you may have. You may also file a
grievance with our Privacy Officer at: Path Medical, 2304 W. Oakland Park Blvd, Fort Lauderdale,
FL 33311.
Any grievance filed will be investigated by the Path Medical Management Team and the results
of such investigation will be forwarded to you within 30 days of the receipt of your grievance.
Furthermore, you have the right to submit any of your privacy grievance to the U.S. Department
of Health and Human Services at: Secretary of Health and Human Services, 200 Independence
Avenue, SW, Washington, D.C. 20201.
Path Medical supports your right to protect the privacy of your treatment information and medical
record and will not retaliate in any way if you choose to file a grievance with us or with the U.S.
Department of Health and Human Services.