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.

Who we are

This Notice applies to the privacy practices of TMD Health, including all employees and providers who are part of our care team.

Our pledge regarding medical information

We understand that medical information about you is personal. We are committed to protecting your health information. This Notice applies to all the records of your care generated by TMD Health, whether made by our staff or your provider.

How we may use and disclose your health information

We may use and disclose your health information without your written authorization for the following purposes:

• Treatment: To provide, coordinate, or manage your care.
• Payment: To bill and collect payment from health plans or you.
• Health Care Operations: For quality assessment, training, internal auditing, and other administrative and operational purposes.

We may also use and disclose your information for:

• Appointment reminders and communications: Via phone, text, email, or patient portal through Elation Health.
• Health-related services: To inform you of treatment alternatives or health-related benefits and services.
• Public health and safety: As required by law for disease control, abuse or neglect reporting, FDA oversight, and workplace safety.
• Health oversight activities: To comply with audits, investigations, inspections, and licensure.
• Legal proceedings and law enforcement: In response to a subpoena, court order, or other legal process.
• Coroners, funeral directors, and organ donation: To facilitate these processes when necessary.
• Serious threats to health or safety: To prevent a serious threat to your or others' health and safety.

Uses and disclosures that require your written authorization

We will obtain your written permission before using or disclosing your health information for other purposes not described in this notice. If you provide written authorization, you may revoke it at any time in writing.

Your rights regarding health information about you

You have the following rights:

• Right to inspect and copy your medical record
• Right to request amendments to your health record
• Right to an accounting of disclosures
• Right to request restrictions on certain uses or disclosures
• Right to request confidential communications
• Right to receive a paper copy of this notice, even if you have agreed to receive it electronically
• Right to be notified of a breach of your unsecured health information

To exercise these rights, please contact our Privacy Officer.

Changes to this notice

We reserve the right to change this Notice and make the revised notice effective for all health information we maintain. The current Notice will be posted in our office and on our website at www.tmdhealth.com.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with:

Privacy Officer, TMD Health, 75 West Front Street, Red Bank, NJ 07701

Phone: (732) 889-8447 · Email: admin@tmdhealth.com

You may also contact the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.