Align for Life, LLC

7199 W 98th Terr, STE 130 Overland
Park, KS 66212

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW THIS CAREFULLY.

Summary

In the course of receiving care from an affiliate of Align for Life, LLC (“Align for
Life,” “we,” or In the course of receiving care from a Align for Life (“we,” or
“us”), you provide us with “protected health information,” which is individually
identifiable health information deserving special treatment under the Health
Insurance Portability and Accountability Act (“HIPAA”), as amended. We may
obtain your protected health information from conversations with you,
questionnaires, examinations, tests, and from others who have provided or
will provide care to you. This Notice of Privacy Practices informs you how we
may use and disclose your protected health information, as well as your legal
rights with respect to such information.

Our Legal Duties

We are required by law to:
maintain the privacy of protected health information, as provided by
HIPAA;
provide this Notice to you of our privacy practices and legal duties
regarding your protected health information;
notify you following any breach of unsecured protected health
information which affects you; and
abide by the terms of this Notice until we adopt any new Notice.

How We May Use or
Disclose Your Protected
Health Information

We may use your protected health information, or disclose it to others, for the
following purposes allowed by HIPAA; all other uses or disclosures require
your written authorization (the examples do not include every possible use or
disclosure and are representative only):

1. Treatment.

We will use your protected health information to
provide medical care and services. Our doctors, employees, and
others who work under our direct control, may read protected
health information to learn about your medical history and, in turn,
use it to make decisions about your care. We may also disclose
protected health information to another doctor who is providing
care to you.

2. Payment.

We will use your protected health information, and
disclose it to others, as necessary to obtain payment for the
services we provide. Our Billing Department employees may use
protected health information to prepare a bill. We may send that
bill, and any protected health information it contains to you or
third-party payer. We may also disclose protected health
information to companies who we utilize for payment-related
services. We will not use or disclose more information for
payment purposes than is necessary.

3. Health Care Operations.

We may use protected health
information for activities that are necessary to operate our
organization. This includes reading protected health information
to review the performance of our staff or to plan services we need
to provide, expand, or reduce. We may disclose protected health
information to others with whom we contract to provide
administrative services, including our attorneys, auditors,
accreditation services, and consultants. We may use protected
health information to ensure quality control of office procedures
and protocols, including audio and visual recording our offices to
enhance our operations.

4. Legal Requirement and Restrictions on Government Access
to Health Information.

We will disclose protected health
information when required to do so by law. This includes
reporting information to government agencies which have the
legal responsibility to monitor the healthcare system, such as
Medicare, and to ensure compliance, such as the Department of
Health and Human Services and Office for Civil Rights. We will
also disclose protected health information when we are required
to do so by a court order, subpoena, or other judicial or
administrative process.

5. Public Health Activities.

We will disclose protected health
information when required to do so for public health purposes.
This includes reporting certain diseases, births, deaths, and
reactions to certain treatments.

6. Reporting of Abuse.

We may disclose protected health
information when the information relates to a victim of abuse,
neglect, or domestic violence. We will make this report only in
accordance with laws that require or allow such reporting, or with
your permission as follows:

Mandatory Reporting:

If one of our physicians has
reasonable cause to believe that a minor child patient
may be an abused or neglected child, our physicians, as
mandatory reporters, are required to immediately report
such suspected abuse or neglect to one of the following
state-specific entities:
Missouri Department of Family Services
Kansas Department for Children and Families

Reporting of Abuse With Your Permission:

If one of our physicians has reasonable cause to believe that an
adult patient may be a victim of abuse, our physicians
will offer to a suspected adult victim of abuse immediate
and adequate information regarding services available
to him or her.

7. Law Enforcement.

We may disclose protected health
information for law enforcement purposes. This includes providing
information to help locate a suspect, fugitive, material witness, or
missing person, or in connection with suspected criminal activity.
We must also disclose protected health information to a federal
agency investigating our compliance with federal privacy
regulations.

8. Specialized Purposes.

We may disclose protected health
information for a number of other specialized purposes, but we
will only disclose as much information as is necessary for the
purpose. For example, we may disclose your protected health
information:
to the armed forces as authorized by military command
authorities;
to coroners, medical examiners, funeral directors, and
organ procurement organizations (for organ, eye, or
tissue donation)
for national security, intelligence, and protection of the
President;
to a correctional institution or to law enforcement
officials to provide an inmate with health care, to protect
the health and safety of the inmate and others, or for the
safety, administration, and maintenance of the
correctional institution; or
to an employer for purposes of workers’ compensation
and work site safety laws.

9. Averting a Serious Threat.

We may disclose protected health
information if we decide that the disclosure is necessary to
prevent serious harm to the public or to an individual. The
disclosure will only be made to someone who is able to prevent or
reduce the threat.

10. Family and Friends.

We may disclose protected health
information to those involved in your care when you approve, or,
when you are not present or not able to approve, when such
disclosure is deemed appropriate in our professional judgment.
When you are not present, we determine whether the disclosure
of your protected health information is authorized by law (e.g.
legal guardian or representative), and, if so, disclose the
information directly relevant to the person’s involvement with your
healthcare. We do not disclose protected health information to a
suspected abuser, if, in our professional judgment, we have
reason to believe that such a disclosure could cause serious
harm.

11.Information to Patients.

We may use protected health
information to provide you with additional information. This may
include sending you appointment reminders or information
regarding treatment options or other health-related services that
we provide.

Your Legal Rights

1. Authorization.

We will not use or disclose protected health
information for any purpose that is not listed in this Notice without
your written authorization. If, at our request, you authorize us in
writing to use or disclose protected health information for
purposes not listed above, such as for our marketing purposes,
you have the right to revoke the authorization at any time in
writing (but not to the extent we have already relied upon your
original authorization). If the authorization is to permit disclosure
of protected health information to an insurance company as a
condition of obtaining coverage, other laws may allow the insurer
to continue to use such information to contest claims or coverage,
even after you revoke the authorization.

2. Restrictions.

You have the right to request us to restrict certain
uses or disclosures of your protected health information. After
consideration, we may comply with your request, but we may
always use or disclose your health information to provide
emergency treatment to you. Pursuant to 45 CFR 164.522(a), we
have the right not to honor your request, except if you request us
to not provide protected health information to your health insurer
when you have paid for our services in full.

3. Confidential

Communication. You have the right to request us
to communicate with you by alternate means or at alternate
locations, such as sending your mail to an address other than
your home or speaking with you on the telephone instead of
sending mail.

4. Copy of Health

Information. You have the right to inspect your
protected health information and to receive a copy of it. This right
is limited to certain information, as provided in 45 CFR 164.524. If
you want to review or receive a copy of your records, you must
make a written request to our Clinical Operations Manager
identified below. We may charge a fee for the cost of copying and
mailing the records. We will respond to your request within 15
business days. We may, however, deny access to certain
information. If we do, we will give the reason in writing. We will
also explain how patients may appeal the decision.

5. Amendment of Health Information.

You have the right to
request us to amend protected health information if you believe it
is not correct or not complete. This right is limited to certain
information, as provided in 45 CFR 164.526. Any such request
must be in writing and specify the reason the information is not
correct or complete. We will respond to the request in writing
within 60 days. We may deny the request if we did not create the
information, if it is not part of the records we use to make
decisions about you, if the information would not be permitted for
you to inspect or copy, or if it is complete and accurate.

6. Accounting of Disclosure.

You have the right to receive an
accounting of certain disclosures of your protected health
information to others. The list will include dates of the
disclosures, the names of the people or organizations to whom
the information was disclosed, a description of the information,
and the reason. Any such request must be in writing and must
specify the time period the list will cover, but such time period may
not be more than six (6) years prior to your request. Disclosures
for the following reasons will not be included on the list:
disclosures for treatment, payment, or health care operations;
disclosures for national security purposes; disclosures to
correctional or law enforcement personnel; disclosures that
patients have authorized; and disclosures made directly to the
patient.

7. Paper Copy of this Privacy Notice.

You have a right to receive a
paper copy of this Notice. If you receive this Notice electronically,
you may receive a paper copy by contacting our Privacy Officer
identified below.

8. Complaints.

You have the right to complain about our privacy
practices if you believe your privacy has been violated. You may
file a complaint with our Privacy Officer identified below or with the
Secretary of the U. S. Department of Health and Human Services.
Any such complaint must be in writing. We will not retaliate
against anyone filing a complaint.

Our Right to Change This Notice

We reserve the right to change the terms of the privacy practices, as
described in this Notice, at any time. We reserve the right to apply these
changes to any protected health information which we already have, as well
as to protected health information we receive in the future. Before we make
any change in the privacy practices described in this Notice, we will adopt a
new Notice that includes the change and its effective date.

Whom To Contact

To assert your legal rights as provided above, contact our Privacy Officer, Dr.
Jeremy Bullimore, at (913)356-9088 or drjbullimore@alignforlife.com:
For more information about this Notice;
For more information about our privacy policies;
To exercise any of the patient rights, as listed on this Notice; or
To request a copy of our current Notice of Privacy Practices.
Contact our Medical Records Department at (913) 356-9088: To request a
copy of your protected health information