Barbara Graves Intimate Fashions
Notice of Privacy Practices

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 {HIPAA}

Following breast surgery, your physician referred you to Barbara Graves Intimate Fashions to provide services and supplies appropriate for your condition. Barbara Graves Intimate Fashions will create a medical record containing your name, address, phone number, insurance information, and supplies provided.

Our practice is dedicated to maintaining the privacy of your personal information. We are required by law to maintain confidentiality of your health information and to inform you of our privacy practices. By federal and state law we must follow the terms of the Privacy Practices we have in place at this time.

We may use or disclose your personal information for the following reasons:

Treatment: Barbara Graves Intimate Fashions may use your health information to provide you with services and supplies suitable for your condition. All information obtained by Barbara Graves Intimate Fashions will be recorded in your medical record and used to decide the breast form and supplies that are best for you.

Payment: Barbara Graves Intimate Fashions may use and disclose your health information to your insurance provider to obtain payment. The information accompanying the bill may include information that identifies you and your condition.

Health Care Operations: Barbara Graves Intimate Fashions may use and disclose health information for operational purposes. Your information may be disclosed with staff for training and consultation purposes. Barbara Graves Intimate Fashions may use your information to discretely inform you of a new product.

Specialized Government Functions: Your health information may be used or disclosed to support specialized government functions such as:

• Activities relating to military and veterans
• National security and intelligence activities
• Protective services for the president and other government officials

Barbara Graves Intimate Fashions reserves the right to make new provisions for all protected health information it maintains. Revised notices will be made available to you by mail.

Although your health record is the property of Barbara Graves Intimate Fashions, the information belongs to you.

You have the right to:

• Request a limit on certain uses and disclosures of your information
• Get a copy of the notice of information practices upon request
• Inspect and copy your health record
• Make changes to your health record
• Obtain a detailed list of anyone that has requested your health information
• Authorize any use of your health information by other means or at other locations
• Cancel any such authorization to use or disclose health information except to the extent it has already been taken

Barbara Graves Intimate Fashions is required to:

• Provide you with information regarding our privacy practices
• Abide by the terms of this notice
• Accommodate reasonable requests you may have to communicate your health information
• Never to disclose your health information without your permission, except as described in this notice
• Establish safeguards to physically protect your written and computerized health information
• Require all Barbara Graves Intimate Fashions' employees to adhere to the Privacy Practices

If you have questions and would like additional information, you may call the Company Privacy Officer at 501-227-5537.

If you believe your privacy rights have been violated, you can file a complaint with the Company Privacy Officer or with Health and Human Services.