93 You may then submit a written statement disagreeing with the denial and have th at statement included with any future disclosures of that PHI. You may contact the Privacy Official at the address and phone number listed above. You or your personal representative will be required to complete a form to request amendment of the PHI. You H ave the Right to Receive an Accounting of the Fund’s PHI Disclosures At your request, the Fund will also provide you with an accounting of certain disclosures by the Fund of your PHI. We do not have to provide you with an accounting of disclosures related to treatment, payment, or health care operations, or disclosures made to you or authorized by you in writing. See the Fund’s Accounting for Disclosure Policy for the complete list of disclosures for which an accounting is not required. The Fund has 60 days to provide the accounting. The Fund is allowed a single 30 - day extension if the Fund gives you a written statement of the reasons for the delay and the date by which the accounting will be pro vided. If you request more than one accounting within a 12 - mont h period, the Fund may charge a reasonable, cost - based fee for each subsequent ac counting. Your Personal Representative You may exercise your rights through a personal representative. Your personal representative will be required to produce evidence of aut hority to act on your behalf before the personal representative will be given access to your PHI or be allowed to take any action for you. Proof of such authority will be a completed, signed and approved Appointment of Personal Representative form. You may obtain this form by calling the Fund Office. The Fund retains discretion to deny access to your PHI to a personal representative to provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who may b e subject to abuse or neglect. The Fund will recognize certain individuals as personal representatives without you having to complete an Appointment of Personal Representative form. For example, absent notice of restrictions under the Fund’s Right to Reque st Restrictions on the Use and Disclosure Policy and Procedures, the Fund will automatically consider a Spouse to be the personal representative of an i ndividual covered by the plan. In addition, the Fund will consider a parent, guardian or other person acting in loco parentis as the personal representative of an unemancipated minor unless applicable law requires otherwise. A Spouse or a parent may act on an individual’s behalf, including requesting access to their PHI. Spouses and uneman cipated minors may, however, request that the Fund restrict access of PHI to family members as described above at the beginni ng of Section 3 of this Notice. You should also review the Fund’s Policy and Procedure for the Recognition of Personal Representati ves for a more complete description of the circumstances where the Fund will automatically consider an individual t o be a personal representative. Section 4: The Fund’s Duties Maintaining y our Privacy The Fund is required by law to maintain the privacy of your PHI and to provide you and your eligible dependents with notice of its lega l duties and privacy practices. This notice is effective beginning on April 14, 2003 and the Fund is required to comply with the terms of this notice. However, the Fund reserve s the right to change its privacy practices and to apply the changes to any PHI received or maintained by the Fund prior to that date. If a privacy practice is