The following is a description (“Notice”) of the privacy
practices (“Privacy Policy”) of the Toronto Ketamine Clinic as those practices
relate to “protected health information.” This Notice also describes the rights
of individuals whose protected health information is maintained by the Toronto
Ketamine Clinic pursuant to the Privacy Policy.

PLEASE REVIEW THIS NOTICE AND THE PRIVACY POLICY
CAREFULLY.

The Privacy Policy is designed to comply, where applicable,
with Canadian and other international laws and regulations concerning
protection and security of confidential information, including protected health
information. Specifically, the Privacy Policy requires the Toronto Ketamine
Clinic’s compliance with the Health Insurance Portability and Accountability
Act of 1996 (HIPAA), as amended. Any U.S.-based patient that receives treatment
in a non-U.S. facility should receive a copy of this Notice. The Privacy Policy
and this Notice are subject to change without notice to the patient; however,
the current Notice is available on the Toronto Ketamine Clinic’s website (TorontoKetamineClinic.com)
or a patient may request a paper copy by contacting the Privacy Department, as
described below.

Protected Health Information

“Protected health information” is information related to a patient’s physical or mental health or health care services that may identify the patient specifically. Protected health information may include, but is not limited to, health histories, examinations, results of tests, complications, physician progress reports and other private medical information.

Authorization

The Toronto Ketamine Clinic will generally request authorization by a written consent before utilizing or disclosing a patient’s protected health information outside of the Toronto Ketamine Clinic. A patient may revoke, by written notice to the Toronto Ketamine Clinic, any authorization to use or disclose protected health information; however, this revocation shall not apply to any use or disclosure made prior to receipt of the revocation. All revocations should be addressed to the Privacy Department, as described below.

Toronto Ketamine Clinic’s Use or Disclosure for Treatment

The Toronto Ketamine Clinic may, in order to facilitate your treatment, disclose protected health information to (1) treating or proctoring physicians, (2) treatment facilities and their staff, or (3) Toronto Ketamine Clinic consultants bound by confidentiality agreements that review patient treatment information. In the event that a patient’s health is at risk and a patient’s consent cannot be obtained, The Toronto Ketamine Clinic reserves the right to disclose a patient’s protected health information to the patient’s relative, guardian or known acquaintance to the extent necessary to protect the health of the patient.

Toronto Ketamine Clinic’s Use or Disclosure for Reimbursement

The Toronto Ketamine Clinic may, in order to facilitate your treatment, disclose protected health information to third-party payors. However, as the Toronto Ketamine Clinic does not deal directly with third-party payors to seek reimbursement, such disclosures will only be made upon a request for such information by (1) the patient or (2) the third-party payor.

Required Disclosures

In addition to voluntary disclosures, the Toronto Ketamine Clinic may be required by law to disclose protected health information (1) to public health officials (Canadian or foreign governments) (2) in response to valid court order or legal request or (3) to prevent serious health risk to the patient or the general public.

Research

Generally, the Toronto Ketamine Clinic will not disclose protect health information for use in medical research without written consent of the patient. However, the Toronto Ketamine Clinic may release certain protected health information without written consent if the released protected health information poses a minimal risk to identifying the patient individually (e.g. as part of a data set with no Social Security Number, Social Insurance Number, Name, Initials, Phone Number or Address).

Internal Use

The Toronto Ketamine Clinic may use protected health information in order to contact patients concerning treatment received.

Patient Access Protected Health Information

A patient may request a copy of their protected health information. The Toronto Ketamine Clinic may choose to deny certain requests that are not required by law; however, the Toronto Ketamine Clinic will provide all protected health information requested as required by law. Any such requests should be made to the Privacy Department as listed below and should include the information requested.

Amend Records

A patient may ask the Toronto Ketamine Clinic to amend their protected health information, if it is incomplete or incorrect. Any such requests should be made to the Privacy Department as described below and should include the proposed amendment and reason for the amendment.

Disclosure Logs

A patient may request a log of disclosures of their protected health information made in the previous six (6) years to persons or organizations other than (1) the Toronto Ketamine Clinic or its employees or consultants or (2) the patient. Patient will be notified in advance of any costs associated with complying with their request. Any such requests should be made to the Privacy Department as described below and should include the specific time period of the disclosures requested.

Questions or Reporting Improper Disclosures

Questions concerning the privacy of protected health information or potential improper disclosure should be directed to the Privacy Department as described below. The Toronto Ketamine Clinic will keep all communications concerning protected health information strictly confidential.

Toronto Ketamine Clinic, Privacy Department

123 Edward Street, Suite 1401

Toronto, Ontario

M5G 1E2

Info@torontoketamineclinic.com

416-546-0675