VISITOR CONFIDENTIALITY AGREEMENT

In compliance with Title 42 of the Code of Federal Regulations (CFR 42 Part 2) and the Health Insurance Portability and Accountability Act of 1996 “HIPAA” (CFR 45),

I agree to the following:

As a visitor in any capacity, I will not copy, remove, or in any way duplicate or export patient identifying information from Sundown M Ranch; furthermore, I will not disclose—in any form—any patient identifying information with any person, agency, or entity, during, after, or at any time in the future relating to any protected healthcare information that I may have come into contact with during my visit at Sundown M Ranch.

Wellness Attestation: Please do not come to Sundown M Ranch if you are currently not feeling well, have Flu or Covid symptoms.

I am attesting that I do not have any Covid symptoms and I have not been exposed to anyone with Covid recently (within last 10 days).

Symptoms include but are not limited to:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

Sundown M Ranch believes, in principle and practice, that visitation by family and other meaningful persons is a benefit to the treatment program. However, patients need to be afforded protection of their privacy and confidentiality, as well as from individuals under the influence of alcohol or other drugs and inappropriate behavior.

With the Covid Pandemic still creating some risk management issues, visiting procedures are altered to ensure the safety of the patients and personnel.

Procedure:

□ Patients are not allowed to have visitors or place or receive phone calls until the 6th day of treatment.

□ Visitation is on Sundays from 2:00 p.m. to 4:00 p.m. On-duty staff will ask visitors arriving at any other time to leave the premises.

□ Visitors must sign up to visit via the Sundown M Ranch website.
○ They will review SMR visitation policies and procedures. They will not bring contraband onto SMR property.
○ They will attest that they are not currently experiencing any Covid or Flu like symptoms.
○ They will review and sign the confidentiality agreement.
○ Visitors must sign up via the SMR website or they will not be allowed to enter.

□ The front gate will have cones to force visitors to the administration building portico. Staff will monitor and manage all incoming visitors. Staff will ensure visitors have signed up on the SMR website and will provide visitors a badge. Staff will direct visitors where to park and what areas they may utilize for visiting.
○ Visitors who do not sign up via the SMR website will be asked to leave. No exceptions.

□ All visitors are to follow Sundown M Ranch rules and regulations.

□ Pets are not allowed on the SMR campus.

□ Visitors visiting adult patient may utilize the SMR grounds and the adult coffee shop for patient visitation. The restroom in the main hallway of the adult facility (directly up the hall from the coffee shop) is the only other indoor areas visitors may enter. Adult visitors should remain around the adult facility and will not go past the Gymnasium area towards the Youth Facility. Visitors are prohibited from any other areas and especially the sleeping wings.

□ Adult visitors may smoke in the designated smoking area located behind the adult facility and in front of the gymnasium.

□ Patients are not allowed to sit or ride in automobiles. Patients are not allowed to use visitors electronic devices (tablets, laptops, cell phones).

□ Visitors under the influence of alcohol or other drugs will be asked to leave the facility.

□ Visitors are not allowed to bring weapons or contraband onto Sundown M Ranch property.

□ Visitors displaying inappropriate, threatening, or compromising behavior will be asked to leave the facility.

Contraband includes but is not limited to: Licit or illicit drugs, paraphernalia, tobacco products, e cigs, vapes of any kind, food, medications (both prescription or over the counter), and weapons or any kind. Please do not bring any contraband onto SMR property.

Sundown M Ranch believes in principle and practice, that visitation by family and other meaningful persons is a benefit to the treatment process. Sundown M Ranch also believes that the Persons Served should be afforded protection of their privacy and confidentiality. Sundown M Ranch will take reasonable precautions to protect the persons served.

With the Covid Pandemic still creating some risk management issues, visiting procedures are altered to ensure the safety of the patients and personnel.

Procedure:

• Visitation is on Sundays from 2:00 p.m. to 4:00 p.m. On-duty staff will ask visitors arriving at any other time to leave the premises.

• Visitors must sign up to visit via the Sundown M Ranch website.
○ They will review SMR visitation policies and procedures. They will not bring contraband onto SMR property.
○ They will attest that they are not currently experiencing any Covid or Flu like symptoms.
○ They will review and sign the confidentiality agreement.
○ Visitors must sign up via the SMR website or they will not be allowed to enter.

• The front gate will have cones to force visitors to the administration building portico. Staff will monitor and manage all incoming visitors. Staff will ensure visitors have signed up on the SMR website and will provide visitors a badge. Staff will direct visitors where to park and what areas they may utilize for visiting.
○ Visitors who do not sign up via the SMR website will be asked to leave. No exceptions.

• All visitors are to follow Sundown M Ranch rules and regulations.

• Pets are not allowed on the SMR campus.

• Youth patient visitors may utilize the SMR grounds and specific visiting areas for patient visitation. Visitors are not allowed in the sleeping wings.

• Patients are not allowed to sit or ride in automobiles. Patients are not allowed to use visitors' electronic devices (tablets, laptops, cell phones).

• Visitors under the influence of alcohol or other drugs will be asked to leave the facility.

• Visitors are not allowed to bring weapons or contraband onto Sundown M Ranch property.

• Visitors displaying inappropriate, threatening, or compromising behavior will be asked to leave the facility.

• Youth facility is a tobacco free area. Visitors are prohibited from bringing tobacco products including but not limited to: cigarettes, chewing tobacco, e cigarettes, vapes of any kind, snuff or any related product into the facility or grounds.

• Contraband includes but is not limited to: Licit or illicit drugs, paraphernalia, tobacco products, e cigs, vapes of any kind, food, medications (both prescription or over the counter), and weapons or any kind. Please do not bring any contraband onto SMR property.

• Prior to visitation, privileges regarding visiting must be approved by the Clinical Team.

•Youth visitors are family only. No non-family members are allowed.