Notice of Privacy Practices

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.

Your Rights

When it comes to your health information, you have the right to:

Get a copy of your medical record — You may request an electronic or paper copy of your health information.

Ask us to correct your record — You may ask us to correct information you believe is inaccurate or incomplete.

Request confidential communications — You may ask us to contact you in a particular way or at a particular location.

Ask us to limit what we use or share — You may request restrictions on certain uses or disclosures of your health information.

Ask for a list of certain disclosures — You may request an accounting of certain disclosures of your health information.

Get a copy of this Notice — You may request a paper or electronic copy at any time.

Choose someone to act for you — If you have legally authorized a person to act on your behalf, that person may exercise certain rights concerning your health information.

File a complaint — You may complain to us or to the U.S. Department of Health and Human Services if you believe your privacy rights have been violated.

We will not retaliate against you for filing a privacy complaint.

How We May Use and Share Your Health Information

We may use and share your health information without your separate written authorization when permitted by law for purposes including:

Treatment

We may use and share your information to provide and coordinate your healthcare.

For example, we may use your Sleep Performance Assessment, medical history, sleep testing results, and other health information to evaluate your sleep and determine appropriate care.

Payment

We may use and share information to obtain payment for services.

Sleep Performance currently operates primarily on a cash-pay basis but may accept insurance in the future.

Healthcare Operations

We may use and share information to operate our practice, improve care, maintain records, conduct quality activities, and manage our healthcare services.

Healthcare Services and Technology

We may use secure healthcare technology platforms, including our electronic health record and assessment systems, to provide healthcare services.

Our Sleep Performance Assessment may be completed through PlatoForms and relevant information may be transferred to Tebra, our primary clinical system.

Other Uses Required or Permitted by Law

We may also use or disclose health information when permitted or required by law, including for certain:

• public health activities
• health and safety purposes
• law enforcement requests
• judicial or administrative proceedings
• workers' compensation matters
• medical examiner or coroner activities
• organ and tissue donation
• research
• government oversight
• other purposes permitted by HIPAA

Your Choices

For certain information, you may tell us how you would like us to share your information.

For example, you may ask us to share information with:

• a family member
• a close friend
• another person involved in your care or payment for your care

We will follow your instructions when required by law.

Marketing

We may contact you about Sleep Performance services and educational information.

Where HIPAA requires your written authorization for marketing, we will obtain it.

Marketing communications are separate from clinical communications.

You may opt out of marketing emails or text messages at any time.

Opting out of marketing does not prevent us from contacting you about:

• appointments
• healthcare
• prescriptions
• home sleep testing
• equipment
• billing
• other communications necessary to provide or administer your care

Sale of Your Health Information

We will not sell your health information without your written authorization except as otherwise permitted by law.

Sleep Performance Assessment

Sleep Performance may use an online Sleep Performance Assessment to collect information about your:

• sleep
• sleep goals
• sleep patterns
• daily rhythm
• schedule
• performance
• recovery
• other factors relevant to your healthcare

The assessment may calculate preliminary scores or results.

Assessment scores are not a medical diagnosis or treatment plan.

A Sleep Performance clinician reviews relevant information and makes clinical decisions based on professional medical judgment.

Home Sleep Testing

Sleep Performance may provide home sleep testing when clinically appropriate.

For certain standard home sleep tests, equipment may be provided and shipped by a third-party testing company.

For certain lab-grade home sleep tests, Sleep Performance may provide equipment directly.

Information necessary to arrange, administer, return, and manage home sleep testing may be used and disclosed as permitted by law.

Our Responsibilities

We are required by law to:

• maintain the privacy and security of your protected health information
• provide you with this Notice describing our privacy practices
• notify you when a breach of unsecured PHI requires notification under applicable law
• follow the terms of the Notice currently in effect

We will not use or disclose your health information other than as described in this Notice unless permitted or required by law or you provide written authorization.

If you provide an authorization, you may generally revoke it in writing as permitted by law.

Substance Use Disorder Records

If we maintain substance use disorder records protected by 42 CFR Part 2, additional federal privacy protections may apply.

Where applicable, we will comply with HIPAA and Part 2 requirements.

California and Other Applicable Privacy Laws

We will comply with applicable federal and California privacy laws governing your health information.

Where California law provides greater privacy protection than federal law, we will comply with applicable requirements.

Questions or Complaints

If you have questions or believe your privacy rights have been violated, contact:

• Sleep Performance Medical Corporation d/b/a Sleep Performance Company
• 12487 Canal Dr Unit 4 Rancho Cucamonga, CA 91739
• Email: info@sleepperformancecompany.com Privacy Officer: [NAME/TITLE] Phone: (909) 666-9627

You may also file a complaint with the:

• U.S. Department of Health and Human Services Office for Civil Rights
• HHS Office for Civil Rights HIPAA Complaint Information

You do not have to contact us first, and you will not be retaliated against for filing a complaint.

Changes to This Notice

We may change this Notice from time to time.

The current Notice will be available on our website and upon request.

Effective Date: [MONTH DAY, 2026]

Acknowledgment of Receipt

I acknowledge that I have received or been provided access to Sleep Performance Medical Corporation's Notice of Privacy Practices.

Patient Name: ______________________________

Signature: _________________________________

Date: _____________________________________

If signed by a personal representative:

• Name: _____________________________________
• Relationship/Authority: _____________________
• Signature: _________________________________
• Date: _____________________________________

If the patient declines to sign:

Patient declined to acknowledge receipt.

Staff/Provider: _________________________________

Date: _________________________________________