Interpreting My Results

health screening resultsFirst of all, we would like to thank everyone who decided to own their health this year by attending one of our 9Health Fairs. Now that you have your results, the next thing you should do is take them to your health practitioner so they can help you understand exactly what your results mean for your health.

By keeping your results from year to year, your health care provider can compare your results to previous year results and notice any trends that may need attention. If you don’t have results from previous years, that’s okay too. We still suggest taking them to your doctor so they can keep copies in your medical records.

You can also go to any King Soopers or City Market pharmacy or call 9Health Fair for help understanding your results.

Zeroing in on Your Results

Now that you have your results back, take a look at them. Do you see any areas in bold? Those are areas you will want to look at and most likely discuss with your health care provider. Here are a few areas you may want to focus on:

  1. Areas that have already been identified as concerns. Maybe you already know that you have high cholesterol, thyroid issues, etc. If you know that you have certain health concerns, take a look at those first. If anything has changed since your previous test, you’ll want to discuss those changes with a medical professional. Hopefully, when you look at your results, you’ll see improvement and know that whatever changes you’ve made have been working.
  2. Cholesterol. Take a look this area, particularly your numbers for HDL (the good cholesterol) and LDL (bad cholesterol). If you have any results in bold, you’ll want to get with your doctor to discuss strategies to correct it. High cholesterol is a major risk factor for heart disease.
  3. Glucose and A1c. These tests will let you know if you may be at risk for developing diabetes. Diabetes is a preventable disease. If you detect it early enough you can reverse your risk of developing the disease. (Diabetes Screenings: Which One is Right for You)

If anything extremely serious or urgent is found in your results, you will receive a phone call from a 9Health Fair nurse within 24-72 hours. If you haven’t received a phone call, but still have results that are noted in bold, you should schedule an appointment with a medical professional to discuss those results in more detail. Your test results are a great way to get a snapshot of your health and work to reverse anything concerning before it becomes a serious and costly issue.

Do You Still Have Questions About Your Results?

You’ve attended a 9Health Fair, but you have some questions. Here are the answers to frequently‐ asked questions from participants.

Q: It’s been more than 4 weeks since I attended the 9Health Fair and I still have not received my blood screening results. What should I do?

A: Call our office (303‐698‐4455 or 800‐332‐3078) and ask to speak to someone in the Client Services Department. They will be able to help you. If you have the yellow copy of your participant form from the fair, please have that available when you call.

Q: Can I get another copy of my report?

A: Yes. Call our office (303‐698‐4455 or 800‐332‐3078) and ask to speak to someone in the Client Services Department. They will be able to help you. If you have the yellow copy of your participant form from the fair, please have that available when you call.

Q: I lost my receipt. Can you mail me a copy?

A: Yes. Call our office (303‐698‐4455 or 800‐332‐3078) and ask to speak to someone in the Client Services Department. They will be able to help you. If you have your results, please have them available when you call.

Q: Does Medicare or my insurance cover the costs of screening?

A: Medicare does not cover the cost of screenings provided by a 9Health Fair. Since insurance companies have different requirements for coverage, you should consult your insurance provider regarding reimbursement of screening costs.

Q: Does 9Health Fair have procedure/diagnostic/CPT codes so I can get reimbursed by my insurance?

A: No. 9Health Fair does not perform any procedures or provide any diagnoses.

Q: I’m concerned about the security of my results. Do you provide my screening results to insurance providers or the medical information bureau?

A: No. 9Health Fair does not provide results to anyone other than the participant unless the participant signs an “Authorization to Release Confidential Information” authorizing us to do so.

ALAMININE AMINOTRANSFERENCE , ALT (SGPT) The ALT enzyme* is found mainly in the liver. damage from alcohol, strenuous exercise and a number of diseases can cause high values for both AST (SGOT) and ALT (SGPT) and should be evaluated by your health care provider. Low values are not generally considered significant.

ALBUMIN is the most plentiful protein in the blood. Approximately two-thirds of the total protein circulating in your blood is albumin. It is produced primarily in the liver and helps keep the fluid portion of the blood within the blood vessels. When your albumin level is too low, water can leak into other parts of your body and cause swelling. This can be caused by malnutrition, too much water in the body, liver or kidney disease, severe injury or major bone fractures and slow bleeding over a long period of time.

ALKALINE PHOSPHATASE is an enzyme that is found in many body tissues, but the most important sites are bone, liver, bile ducts and gut. A high level of alkaline phosphatase in your blood may indicate bone, liver, or bile duct disease. Certain drugs may also cause increased levels. Growing children, because of bone growth, normally have higher levels than adults. Low values are not generally considered significant.

ASPARTATE AMINOTRANSFERENCE, AST (SGOT) The AST enzyme* is found mainly in the heart, liver and muscles. It is released into the blood stream when any of these organs are damaged. Increased levels are usually associated with liver disease or heart attacks.

BILIRUBIN, DIRECT is a specific form of bilirubin that is formed in the liver and excreted in the bile. Normally very little of this form of bilirubin is found in the blood. However, in liver disease, this form of bilirubin leaks into the blood so a high level of direct bilirubin may indicate a problem with the liver cells.

BILIRUBIN, TOTAL is the pigment in the blood that makes the plasma or serum part of your blood yellow. When the bilirubin level in the blood is very high for a period of time, the whites of your eyes and your skin may become yellow- this is known as jaundice. Bilirubin comes from the breakdown of old red cells in the blood. A high bilirubin level in the blood can be caused by too many red blood cells being destroyed (hemolyzed), by liver disease, or by a blockage of bile ducts.

BUN (blood urea nitrogen) is a waste product from protein breakdown in the liver. It is excreted by the kidneys. If kidney function is impaired, or if a person is dehydrated, the BUN level will increase. Internal blood loss, high protein diets, and/or strenuous exercise can also cause a high BUN level. A low BUN level may be the result of liver disease, poor diet, pregnancy, or drinking too much water.

CALCIUM is one of the most important elements in the body, essential for maintenance and repair of bone and teeth, heart function and blood clotting. Ninety-nine percent of the calcium in your body is contained in your bones – only one percent is in the blood. Low levels of calcium in the blood are associated with malnutrition. High levels can be caused by bone disease, excessive use of antacids and milk, cancer, overdosing on Vitamin d and some hormone disorders. Any elevated calcium level should be evaluated by your health care provider.

CHLORIDE is also one of the body’s minerals. Involved with water balance, most body chloride comes from salt in the diet. A high chloride level may mean severe dehydration, certain kidney disorders or hyperventilation. A low chloride level may result from excessive vomiting, diarrhea, severe burns, excessive sweating or kidney failure. Borderline low or high levels of chloride have very little significance.

CHOLESTEROL is an essential blood fat found in nearly every body tissue. Elevated levels have been shown to be associated with a higher risk of heart disease and clogged blood vessels. If elevated, the result should be discussed with your health care provider.

CHOLESTEROL/HDL RATIO is obtained by comparing the total cholesterol level to the HdL cholesterol level.

CREATININE The main job of the kidney is to filter the blood, excreting waste products into the urine while preserving essential elements. One way to measure kidney function is to determine how well the kidney can filter and excrete creatinine, an easily measured waste product of muscle metabolism. In certain types of kidney disease, the ability of the kidneys to clear the blood of creatinine decreases and blood levels of creatinine increase. High values require medical evaluation by your health care provider, especially when associated with high BUN results.

ESTIMATED GLOMERULAR FILTRATION RATE (eGFR) TEST is the best overall measure of how your kidneys are functioning. It is a calculation incorporating risk factors such as age, gender and ethnicity, and can screen for early kidney disease or associated cardiovascular disease. For a significant percentage of participants with mildly abnormal eGFR results, no underlying disease is present. Minimally abnormal eGFR should be repeated in 4-6 weeks.

GAMMA-GLUTAMYLTRANSFERASE (GGT) is an enzyme* that is primarily found in the liver. drinking too much alcohol, certain drugs, liver disease, stress, physical exertion, some common medications and bile duct disease can cause high levels of GGT in the blood. High values should be evaluated by your health care provider. GLOBULINS are proteins that can be formed in the liver or the immune system. Globulins have many functions, transporting a variety of things such as fats and hormones and acting as infection fighters to help the body defend itself. If your globulin level is abnormal your health care provider may want to measure some of the individual proteins that make up this group.

GLUCOSE is the primary energy source for all body tissues. The sugars and carbohydrates you eat are ordinarily converted into glucose, which can be used to either produce immediate energy or be stored in the liver or as fat throughout the body. High blood glucose levels (hyperglycemia) after fasting for 12 hours might indicate you have diabetes. Your doctor may want to do further testing. A low glucose level (hypoglycemia) accompanied with symptoms such as weakness, nausea, sweating and difficulty thinking clearly, is suggestive of hypoglycemia. Even if you know you have diabetes, it is important to report any abnormal levels to your health care provider.

HDL CHOLESTEROL High density lipoprotein (HdL) cholesterol is one of several types of fats. It is referred to as “good cholesterol” because it acts as a scavenger, removing excess cholesterol from artery walls. It has been shown that the HIGHER the level of HdL cholesterol the LOWER the risk of developing heart disease.

IRON The body must have iron to make hemoglobin and to help transfer oxygen to the cells. If the body is low in iron, all body cells, particularly muscles in adults and brain cells in children, do not function up to par. On the other hand too much iron in the body can cause injury to the heart, pancreas, joints, testicles, ovaries, etc. Iron excess is found in the hereditary disease called hemochromatosis which occurs in about 3 out of every 1000 people. Any value outside the specified reference range should be evaluated by your health care provider.

LACTATE DEHYDROGENASE (LDH or LD) is an enzyme* found in all tissues in the body. Thus, a high level in the blood can result from a number of different diseases. Also, slightly elevated levels in the blood are common and usually do not indicate disease. The most common sources of Ld are the heart, liver, muscles, and red blood cells. Any damage to cells will raise the Ld level in the blood.** (See Hemolysis comment.)

LDL CHOLESTEROL Low density lipoprotein (LdL) cholesterol is a part of the “total cholesterol.” This is the cholesterol that forms deposits on artery walls. The LOWER the amount of LdL cholesterol, the LOWER the risk of developing heart disease.

MAGNESIUM helps regulate energy production in the cell. It is one of the most abundant metals in the body. A low magnesium level in the blood may indicate alcoholism, severe malnutrition, vomiting or diarrhea. High values indicate kidney disease. As with all other abnormal results, any value outside the reference range should be reported to your health care provider.

PHOSPHATE is closely related to calcium in bone development, with most phosphate in the body found in bones. Very low levels of phosphate can be associated with starvation or malnutrition, leading to muscle weakness. High levels of phosphate are associated with kidney disease. Values outside the Specified Reference Range should be reported to your health care provider.

PROSTATIC SPECIFIC ANTIGEN (PSA) is a blood test that measures a protein that is only produced by the male prostate gland. Elevations of PSA may occur in people with prostate cancer or non-cancerous prostatic diseases. Although high PSA values do not always indicate prostate cancer, all elevated values should be reported to your health care provider for further evaluation. A normal PSA level does not entirely exclude the possibility of prostate cancer.

Understanding Your Laboratory Results
Vitamin D Screen

How can I make sure I have enough Vitamin D?

1. Sunshine: Exposure without sunscreen of arms and legs to sun for 10-15 minutes a few days a week permits the body to make the vitamin D it needs. Darker skinned people require more sun exposure to make adequate vitamin D.
2. Diet:The following foods contain vitamin D: EggYolk, Liver, Oily fish such as tuna, mackerel, salmon, and foods with added vitamin D
3. Supplements

What is the recommended daily amount of Vitamin D?
Recommendations vary, but experts recently have suggested that people need to get moreVitamin D than listed in the dietary reference intakes (DRIs) guideline. The amount ofVitamin D you need changes as you get older.
• Infants starting by age 2 months, children, and teens need 200 to 400 IU a day.
• Adults up to age 50 need 400 to 800 IU a day.
• Adults age 50 or older need 800 to 1,000 IU a day.

Who May Not Get Enough Vitamin D?
Most people don’t get enoughVitamin D. Your body uses sunshine to make vitamin D. But in the winter, people often spend more time indoors and don’t get enough sun. And using sunscreen, which helps prevent skin cancer, reduces the amount of sun your body gets. Other things that reduce how much Vitamin D your body makes include:
• Dark skin, such as many African Americans have.
• Age, especially if you are older than 65.
• Digestive problems, such as Crohn’s or celiac disease.
• Liver and kidney disease.

Understanding Your Laboratory Results
Diabetes Screen

How is hemoglobin AIC testing used?
Your sugar metabolism plays a major role in regulating your body’s use of energy. Diabetes is a common disorder of sugar metabolism, caused by defects in the action or production of insulin. Early diagnosis and treatment of diabetes can help prevent complications ranging from heart disease, high blood pressure, stroke, kidney disease, nervous system damage and blindness. The Diabetes Screen consists of a glucose level, which provides a snapshot view of your body’s sugar management and hemoglobin A1C, which provides a record of your average blood glucose levels over the last two to three months. The fasting glucose level is the established screening test for diabetes. Hemoglobin A1C, which does not require fasting, is a test that is used to monitor glucose control among people treated for diabetes. The American Diabetes Association recommends the use of screening tests to identify those who might benefit from additional testing. Repeated measurements of your glucose and the results of other tests are needed to support a diagnosis of diabetes.

What do the results mean?
The lab report provides a blood glucose level and a hemoglobin A1C level, both with reference ranges. A high level suggests that you should be evaluated by your physician for diabetes. Symptoms of diabetes include excessive thirst, increased urination, tiredness, blurry vision, and dry itchy skin. Other conditions that can elevate your glucose levels include pancreatitis, kidney failure or stress from surgery or trauma. Medications including steroids can also contribute to high blood glucose. If either your glucose or hemoglobin A1C levels are above the reference range, this suggests that you should discuss the status of your sugar metabolism with your physician.

Understanding Your Laboratory Results
InSure® FIT™

This information is provided by Quest Diagnostics – the nation’s leading provider of diagnostic testing, information and services – to help you understand your results. Insure-Fit-Bro_InSure-FIT-Bro2-10 1/19/11 1:37 PM Page 1 The InSure® FIT™ test is a fecal immunochemical test (FIT), that detects blood in or on stool. Colorectal conditions such as polyps, colitis, diverticulitis, hemorrhoids, fissures or colorectal cancer may cause bleeding in the lower intestine. The hidden (occult) blood is then passed in the stool into the toilet bowl water. A yearly fecal occult blood test (FOBT) or fecal immunochemical test (FIT) is one of the colorectal cancer screening options recommended by the American Cancer Society for healthy adults 50 years of age and older. The InSure® FIT™ test should be used only to detect the presence of blood in your stool, and is not intended to take the place of other diagnostic procedures, such as colonoscopy or sigmoidoscopy in combination with double contrast barium x-ray. Your health care provider will make a diagnosis based on further testing and evaluation. If the test is negative (not detected), it means that no blood was found in the sample that was tested. Many colorectal conditions do not bleed all the time. Additionally, blood may not be uniformly distributed in or on the stool, and the test result may be negative even when blood or lower gastrointestinal disease is present. If the test is positive (detected), you will need to undergo additional testing and evaluation by a health care provider. This additional testing and evaluation may include tests to determine the cause of the bleeding. We strongly encourage you to share the results of your test with your health care provider. This test result should be used by your health care provider along with other signs and symptoms and medical history to determine next steps Warning Signs of Colorectal Cancer include: n blood in the stool or in the toilet after having a bowel movement n a change in bowel habits that lasts more than a few days n weight loss n cramping in the lower stomach n a feeling of discomfort or urge to have a bowel movement when there is no need for one If you are experiencing any of these symptoms, please discuss them with your health care provider immediately. Always seek the advice of your health care provider when you have any questions or concerns about your InSure® FIT™ test results or any medical condition. The results of a physical exam and a review of any signs and symptoms you may be experiencing will help your health care provider determine whether you have a colorectal condition.

Take Home Colon Cancer Screening Kit Instructions (English)
Take Home Colon Cancer Screening Kit Instructions (Spanish)

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.

The ordering physicians and Quest Diagnostics who are associated with 9Health Fairs (collectively “Health Fair Providers” in this Notice) are committed to protecting the privacy of your personal and health information. This protected health information (PHI) includes test results and other patient identifiable information that we collect or create as part of offering testing at the 9Health Fairs.

We urge you to read this Joint Notice of Privacy Practices carefully so that you will understand both our commitment to the privacy of your PHI, and how you can participate in that commitment. Should you have any questions about this Notice or our privacy practices, please call us at: (800) 849-7321 x6703 or write to us at the following address:
Quest Diagnostics Incorporated
Attn: Health Fair Program – Privacy Officer
695 South Broadway Denver, CO 80209

Health Fair Providers Privacy Policy
Health Fair Providers and our employees are committed to obtaining, maintaining, using and disclosing PHI in a manner that protects patient privacy. We will only use or disclose the minimum amount of your PHI we consider necessary to perform a job or complete an activity. This Notice applies to all PHI that we use, maintain or share between us associated with health fairs offered by 9Health Fair.

If the ordering physicians or Quest Diagnostics are providing services to you separate and apart from such health fairs, these persons or companies may have different Notices regarding their use and disclosure of your PHI created in their offices. Health Fair Providers are sharing PHI in jointly providing health fair services to you, however, they are separate legal entities and are not responsible for the medical or professional judgments of the other.

Health Fair Providers are required by law to provide you with this Joint Notice of Privacy Practices with respect to PHI, to maintain the privacy of PHI, to state the uses and disclosures of PHI that Health Fair Providers may make, and to list your rights and our legal duties with respect to your PHI.

  • Your PHI at Health Fair Providers includes personal and medical information (such as your name, address, date of birth, test ordered, etc.) that we obtain from you or other sources.
  • Your PHI also includes the laboratory testing results that we create. An example of PHI is as follows: Jane Smith, Date of Birth: 2/15/68, resides at 123 Main Street, Anytown, NJ, cholesterol result of 215 mg/dL.

Health Fair Providers are required to abide by the terms of the Joint Notice of Privacy Practices currently in effect.

How We May Use and Disclose Your Protected Health Information

Your PHI will be used or disclosed for treatment, payment, or healthcare operations purposes and for other purposes permitted or required by law. Not every use or disclosure is listed; however, all of the ways we use or disclose your PHI will fall into one of the categories listed below.

If we wanted to use or disclose your PHI for other purposes, we would have to obtain your written authorization. You have the right to revoke your authorization at any time, except if we have already made a disclosure based on that authorization. We do not need your authorization or permission to use or disclose your PHI for the following purposes:
For Treatment – As a health care provider that provides laboratory testing for ordering physicians, Quest Diagnostics uses your PHI as part of our testing process and discloses your PHI to ordering physicians and other authorized health care professionals who need access to your laboratory results to treat you. In addition to your ordering physician, we may provide a specialist consulting physician with information about your results to further validate the results before release to your physician. Occasionally, we may contact you to arrange for a redraw of your specimens.
For Payment – We will use your PHI in our billing departments and disclose your PHI to 9Health Fair for payment purposes, or to third parties to assist us in creating bills, claim forms, or getting paid for our services. In some cases, we may have to contact you to obtain billing information or for other billing purposes.
For Healthcare Operations – We may use or disclose your PHI in the course of activities necessary to support our health care operations, such as performing quality checks on our testing, for teaching purposes, or for developing normal reference ranges for tests that we perform.
Disclosures to Business Associates – Health Fair Providers may disclose your PHI to other companies or individuals, including 9Health Fair, who need your PHI in order to provide specific services to us. These other entities, known as “business associates,” must maintain the privacy and security of PHI. Our business associates must only use your PHI for designated treatment, payment, or health care operations purposes that they perform on our behalf. If 9Health Fair instructs us to further disclose your PHI to its business associates, then 9Health Fair shall enter into a contract with those entities to require that they also maintain the privacy and security of your PHI. As Permitted or Required by Law – We may use or disclose your PHI for various public policy purposes that are authorized or required by federal or state law. For example, we are required to disclose your PHI to the Secretary of the U.S. Department of Health and Human Services (“HHS”) upon request. We must provide you with copies of your PHI at your request, except where restricted or prohibited by state law.
Public Safety – When the appropriate conditions apply, we may use or disclose PHI to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
To Avert a Serious Threat to Health or Safety – We may use or disclose your PHI when necessary to prevent a serious threat to your health and safety or that of another person or the general public. Any use or disclosure for this purpose would only be made to someone able to help prevent the threat. For example, we may disclose your PHI in an investigation regarding the licensing of healthcare providers.
Health Oversight – We may disclose your PHI in connection with governmental oversight, licensure, auditing, and other purposes. For example, governmental agencies periodically review our records to ensure that Health Fair Providers are complying with the rules of various regulatory and licensing agencies. HHS and State Health Departments are examples of agencies that oversee aspects of Health Fair Providers’ operations. Other agencies may audit our billing and laboratory records to verify that the services were provided as claimed.
Judicial and Administrative Proceedings – We may disclose your PHI as required to comply with court orders, discovery requests or other legal process in the course of a judicial or administrative proceeding.
Law Enforcement – We may also disclose PHI for law enforcement purposes. For example, we may be required to release PHI as required by law or in compliance with a court order, warrant, investigative demand or similar legal process. We may provide your PHI in response to a subpoena, discovery request or other legal process in the course of an administrative or judicial proceeding, but only if efforts have been made to tell you about the request or to obtain an order of protection for the requested information. We may release PHI for other law enforcement purposes, such as to identify or locate a suspect, fugitive, material witness, or missing person. Specialized Government Functions – We may disclose your PHI for military and veterans activities, national security or intelligence purposes, or to correctional institutions, or to law enforcement officials having custody of an inmate.
Research – We may disclose health information for research purposes when an Institutional Review Board or privacy board has reviewed the research proposal and established protocols to ensure the privacy of your PHI and determined that the researcher does not need to obtain your authorization prior to using your PHI for research purposes. We may also disclose information about decedents to researchers under certain circumstances.
Note Regarding State Law – For all of the above purposes, in cases where state law is more restrictive than federal law, we are required to follow the more restrictive state law. 2 3 4
Fundraising – 9Health Fair may use your PHI to communicate with you to raise funds to support health fair services and educational programs it provides to the community. You may opt out of receiving such communications by contacting 9Health Fair at (303) 698-4455 or 1139 Delaware, Denver, CO 80204.

Your Rights Concerning Privacy and Confidentiality
Access – You or your authorized or designated personal representative has the right to inspect and copy your PHI. Health Fair Providers will deny access to certain information for specific reasons, for example, where state law prohibits such patient access. If your request is denied, you may request that the denial be reviewed.
Amendments – You have the right to request amendments to your PHI (but we are not required to make the requested amendments). If we deny your written request to change your PHI we will provide you with a written explanation of the reason for the denial and additional information regarding further actions that you may take.
Accounting – You have the right to receive an accounting of disclosures of your PHI that were made by Health Fair Providers for a period of up to six years prior to the date of your written request. Under the law, this accounting does not include disclosures made for purposes of treatment, payment, health care operations, or certain other excluded purposes, but includes other types of disclosures, including disclosures for public health reporting or in response to a court order.
Restrictions – You have the right to ask us if we will agree to restrictions on certain uses and disclosures of your PHI, but we are not required to agree to your request.
Confidential Communications – We may contact you by phone or by mail based on information you provide to us. You have the right to request that we send your PHI by alternate means or to an alternate address and we will accommodate reasonable requests.
Joint Notice of Privacy Practices – A copy of our current Joint Notice will be posted in the participant registration area at the health fair. You have the right to request a paper copy of this Joint Notice.
Complaints – If you believe your privacy rights have been violated, you have the right to register a complaint with Health Fair Providers or the Secretary of the U.S. Department of Health and Human Services. Health Fair Providers will not retaliate against any individual for filing a complaint. You may file a complaint by calling us or by writing to us at the address indicated in this Joint Notice.
How to Exercise Your Rights – Write to us with your specific written request and be sure to include sufficient information for us to identify all of your records. You may also contact us at the toll-free telephone number below to request an access form. Health Fair Providers will consider your request and provide you a response within a reasonable timeframe. For additional details, or for instructions regarding how to exercise these rights, call us at the number indicated below.

You may request a copy of this Joint Notice by calling (800) 849-7321, extension 6703

How To Contact Us – If you have questions or concerns regarding the privacy or confidentiality of your PHI, or you wish to register a complaint, please write us at the address located at the beginning of this notice or contact:
Quest Diagnostics, Health Fair Program – Privacy Officer: (800) 849-7321, x6703

Note: Health Fair Providers reserves the right to amend this Joint Notice of Privacy Practices, at any time, to reflect changes in our privacy practices, and to make these changes applicable to and effective for all PHI that we maintain, including PHI that we created or received prior to the effective date of the Joint Notice revision. Revised February, 2013