NOTICE OF PRIVACY PRACTICES

Jennifer Banks, ARNP, PLLC dba Familiar Primary Care

Effective November 1, 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 applies to Jennifer Banks, ARNP, PLLC, doing business as Familiar Primary Care, and to members of its workforce who are authorized to use or disclose protected health information. In this notice, "we," "us," and "our" refer to Familiar Primary Care.

Privacy Contact: Jennifer Banks, ARNP

Phone: 509-433-7827

Email: jenn@familiarprimarycare.com

Address: 1111 E Westview Ct, Ste C, Spokane, WA 99218-1376

IMPORTANT NOTE ABOUT SUBSTANCE USE DISORDER RECORDS

To the extent we have substance use disorder patient records protected by 42 CFR part 2, we will not use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a court order and subpoena as required by law.

YOUR RIGHTS

When it comes to your health information, you have certain rights. This section explains those rights and some of our responsibilities to help you.

GET AN ELECTRONIC OR PAPER COPY OF YOUR MEDICAL RECORD

You may ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. Ask us how to do this. We will provide a copy or summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee as allowed by law.

ASK US TO CORRECT YOUR MEDICAL RECORD

You may ask us to correct information you believe is incorrect or incomplete. We may deny the request, but if we do, we will explain why in writing, usually within 60 days.

REQUEST CONFIDENTIAL COMMUNICATIONS

You may ask us to contact you in a specific way, such as only by cell phone, or to send mail to a different address. We will agree to reasonable requests.

ASK US TO LIMIT WHAT WE USE OR SHARE

You may ask us not to use or share certain information for treatment, payment, or our operations. We are not required to agree, and we may decline if the restriction could affect your care. If we agree, we may still use or share the information when needed for emergency treatment. If you pay in full out of pocket for a service or item, you may ask us not to share information about it with your health insurer for payment or health care operations. We will agree unless a law requires disclosure.

GET A LIST OF CERTAIN DISCLOSURES

You may ask for an accounting of certain disclosures made during the six years before your request, including who received your information and why. The accounting excludes disclosures for treatment, payment, and health care operations and certain other disclosures. One accounting in any 12-month period is free; we may charge a reasonable, cost-based fee for an additional accounting during that period.

GET A COPY OF THIS NOTICE

You may ask for a paper copy at any time, even if you agreed to receive it electronically. We will provide it promptly.

CHOOSE SOMEONE TO ACT FOR YOU

A legally authorized personal representative may exercise your rights and make choices about your information. We will verify that person's authority before taking action.

FILE A COMPLAINT

You may complain to us or to the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

YOUR CHOICES

For certain health information, you may tell us your preferences about what we share. You may tell us to share information with family, close friends, or others involved in your care or payment, and to share information in a disaster relief situation. If you cannot tell us your preference, such as when you are unconscious, we may share information if we believe it is in your best interest. We may also share information when needed to lessen a serious and imminent threat to health or safety.

We generally need your written permission to use or disclose your information for marketing, to sell your information, or to share most psychotherapy notes if we maintain them. Familiar Primary Care does not maintain a hospital directory and does not currently use patient information for fundraising. If our practices change, we will follow applicable notice, authorization, and opt-out requirements.

OUR TYPICAL USES AND DISCLOSURES

TREAT YOU

We may use your information and share it with other professionals who are treating you. Example: another clinician asks about your conditions or medications so your care can be coordinated safely.

RUN OUR PRACTICE

We may use and share your information to operate the practice, improve care, manage services, and contact you when necessary. Example: we use health information to review quality, coordinate appointments, or manage patient services.

BILL FOR YOUR SERVICES

We may use and share your information to bill and obtain payment from health plans or other entities. Example: we provide information to your health plan so it can process a claim for your care.

Part 2 reminder: if we have substance use disorder patient records protected by 42 CFR part 2, additional federal restrictions may apply even when another use or disclosure is otherwise permitted.

OTHER USES AND DISCLOSURES

The law allows or requires us to use or share information in other ways, usually for public health, oversight, or legal purposes. We must meet the applicable legal conditions before doing so.

HELP WITH PUBLIC HEALTH AND SAFETY

We may share information for activities such as preventing disease, assisting with product recalls, reporting adverse medication reactions, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to health or safety.

CONDUCT HEALTH OVERSIGHT

We may share information with health oversight agencies for authorized audits, investigations, inspections, and licensure activities.

DO RESEARCH

We may use or share information for health research when applicable legal requirements are met.

COMPLY WITH THE LAW

We will share information when state or federal law requires it, including with the U.S. Department of Health and Human Services if it requests information to determine whether we are complying with federal privacy law.

OTHER PERMITTED OR REQUIRED PURPOSES

We may share information with organ procurement organizations; with a coroner, medical examiner, or funeral director when a person dies; for workers' compensation; for permitted law enforcement, health oversight, or special government functions; and in response to a court or administrative order or, when legal requirements are met, a subpoena or other lawful process.

SPECIAL PROTECTION FOR PART 2 RECORDS

In all of the situations above, if we have substance use disorder patient records protected by 42 CFR part 2, we will not use or disclose those records in civil, criminal, administrative, or legislative investigations or proceedings against you without your written consent or a court order and subpoena, as required by law.

OUR RESPONSIBILITIES

We are required by law to maintain the privacy and security of your protected health information. We will notify you as required by law if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in the notice currently in effect and make a copy available to you. We will not use or share your information other than as described in this notice unless you authorize us in writing. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

MORE PROTECTIVE LAWS

Some federal and Washington laws provide additional privacy protections for certain information, including some mental health, substance use disorder, sexually transmitted infection, and minor-consented care records. When a more protective law applies, we will follow that law. Nothing in this notice permits a use or disclosure that another applicable law prohibits.

CHANGES TO THIS NOTICE

We may change the terms of this notice. Changes may apply to all information we maintain about you, including information created or received before the change. The current notice will be available upon request, at our office, and on any website we maintain that provides information about our services or benefits.

QUESTIONS, COPIES, OR COMPLAINTS

Contact Jennifer Banks, ARNP at 509-433-7827 or jenn@familiarprimarycare.com, or write to 1111 E Westview Ct, Ste C, Spokane, WA 99218-1376.

You may also complain to the U.S. Department of Health and Human Services Office for Civil Rights online at hhs.gov/hipaa/filing-a-complaint, by calling 1-877-696-6775, or by mailing 200 Independence Avenue, S.W., Washington, D.C. 20201. Familiar Primary Care will not retaliate against you for exercising a privacy right or filing a complaint.