At The Leaves, the confidentiality of all information concerning patients is of the utmost importance. The ethical standards upheld by Christian Science nurses and other staff come from the teachings of Christian Science with its emphasis on the confidential relationship between Christian Science nurse and patient, and Christian Science practitioner and patient. Maintaining that confidentiality for your protection is a Federal law known as the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

This law requires that all organizations such as ours protect the privacy of patients in a variety of ways. The Leaves adheres to the letter and spirit of this law. This notice describes how information regarding the services you receive here may be used and disclosed to others. Please review it carefully before signing it.

1. I understand that the use or disclosure of my protected health information (PHI) by The Leaves will only be for the purpose of providing Christian Science nursing care to me, obtaining payment for my care bills, and conducting the normal business of running the facility. PHI refers to any information about me and my care needs, collected at The Leaves or from others, deemed necessary to care for me properly. This information about me includes: my name, address, telephone number, and the same information for my spouse or close family member I designate; my date of birth, Social Security and Medicare numbers; my church affiliation, my Christian Science practitioner's name and phone number; any copy of my Health Care Power of Attorney, including the name(s) of my agent(s) and my preferences regarding care; and records regarding my care and billing records.

2. I understand that my health care information will be given to my Responsible Party, the Christian Science practitioner, my insurance company, and Medicare (by law). In addition, I authorize The Leaves to share my health care information with the following individuals:

If there are more than three individuals who are authorized to receive my health care information, I will ask them to call my Responsible Party.

3. I understand that, if I do not object in writing, The Leaves will share the fact that I am in the facility with telephone callers who directly ask for me by name, and with visitors who arrive and ask for me by name. The Leaves does not, however, disclose information regarding my care or condition in response to these inquiries.

4. I understand that, for my protection, The Leaves will sign agreements with any business associates (for example, its auditor) that would have a valid reason to disclose my PHI. These agreements will include a promise that the business will not disclose any PHI in any way not essential to the normal activities of their business.

5. For my further protection, I understand that I will be asked to sign specific authorization any time The Leaves decides to disclose any of my PHI to other care providers if I am being transferred to an alternate care facility, or to anyone else for purposes other than the routine needs described above. The only exceptions to this would be for contact with legal authorities.

6. I understand The Leaves expects me to bring any concerns about this policy, or The Leaves' compliance with it, to the attention of The Leaves HIPAA Compliance Officers, Jennifer Johnson or Leanne DeVey. I also have the right to file a formal complaint with The Leaves HIPAA Compliance Officer(s) and/or with the Federal agency, the Department of Health and Human Services, if I feel that there has been a violation of these privacy rights. The Leaves will not retaliate against me if I feel the need to file a complaint.

7. I understand that I have the right to review the complete HIPAA Privacy Policy of The Leaves which is always available at the Business Office. This policy describes the types of uses and disclosures of my PHI that may occur in the course of my stay at The Leaves. I may inspect, copy, or amend my PHI.

The Leaves, Inc.
1230 West Spring Valley Rd, Richardson, TX
972-231-4864

Effective as of February 15,2026

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.

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services.

Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician's practice, and any other use required by law.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of your physician's practice. These activities include, but are not limited to, quality assessment, employee review, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment, and inform you about treatment alternatives or other health-related benefits and services that may be of interest to you.

We may use or disclose your protected health information in the following situations, except SUD records as explained in Feb 15, 2026 addendum, without your authorization. These situations include: as required by law, public health issues as required by law, communicable diseases, health oversight, abuse or neglect, food and drug administration requirements, legal proceedings, law enforcement, coroners, funeral directors, organ donation, research, criminal activity, military activity and national security, workers' compensation, inmates, and other required uses and disclosures. Under the law, we must make disclosures to you upon your request. Under the law, we must also disclose your protected health information when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements under Section 164.500.

Provided By HCSI

Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization or opportunity to object unless required by law. You may revoke the authorization, at any time, in writing, except to the extent that your physician or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.

The following are statements of your rights with respect to your protected health information.

You have the right to inspect and copy your protected health information (fees may apply) - Under federal law, however, you may not inspect or copy the following records: Psychotherapy notes, information compiled in reasonable anticipation of, or used in, a civil, criminal, or administrative action or proceeding, protected health information restricted by law, information that is related to medical research in which you have agreed to participate, information whose disclosure may result in harm or injury to you or to another person, or information that was obtained under a promise of confidentiality.

You have the right to request a restriction of your protected health information - This means you may ask us not to use or disclose any part of your protected health information and by law we must comply when the protected health information pertains solely to a health care item or service for which the health care provider involved has been paid out of pocket in full. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. By law, you may not request that we restrict the disclosure of your PHI for treatment purposes.

You have the right to request to receive confidential communications You have the right to request confidential communication from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively i.e. electronically.

You have the right to request an amendment to your protected health information If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures - You have the right to receive an accounting of all disclosures except for disclosures: pursuant to an authorization, for purposes of treatment, payment, healthcare operations; required by law, that occurred prior to April 14, 2003, or six years prior to the date of this request.

You have the right to obtain a paper copy of this notice from us even if you have agreed to receive the notice electronically. We reserve the right to change the terms of this notice and we will notify you of such changes on the following appointment. We will also make available copies of our new notice if you wish to obtain one.

You have the right to 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.

• We will make sure the person has this authority and can act for you before we take any action.

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Compliance Officer of your complaint. We will not retaliate against you for filing a complaint.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. We are also required to abide by the terms of the notice currently in effect. If you have any questions in reference to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our main phone number.

Provided By HCSI