Patient Privacy

NOTICE OF PRIVACY PRACTICES

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 to Protect your Rights.

Your health information is personal, and we are committed to protecting it. Your accurate health information is also very important to our ability to provide you with quality care and to comply with certain laws.

I. We are Legally Required to Safeguard Your Protected Health Information by:

A.Maintaining the privacy of your health information, also known as "protected health information" or "PHI;"

B.Providing you with this Notice, and Complying with this Notice.

II. How We May Use and Disclose Your Protected Health Information.

The law requires us to have your written authorization for some uses and disclosures. In other circumstances, the law allows us to use or disclose PHI without your written authorization. Some types of PHI, such as drug and alcohol abuse, patient treatment information, HIV test results, mental health information, and genetic testing results, may be subject to greater protection of your privacy with more restrictions on our use or disclosure of PHI. In general, we disclose a minor patient's PHI to a parent or guardian, but in some situations, we may deny the parents access to the minor patient's PHI.

This section explains and shows examples of each of these disclosure situations:

A.Uses and Disclosures for Treatment, Payment and Health Care Operations .

-To provide treatment to you, we may use or disclose your PHI to physicians, nurses, and other health care personnel who are involved in your care.

-To contact you as a reminder that you have an appointment for treatment, to tell you about or recommend possible treatment options or alternatives, or about health-related benefits or services that may interest you, we may use and disclose your PHI.

- To get paid for treatment provided to you, we may use or disclose your PHI to your insurance carrier. We may use or disclose your PHI to our business associates who perform billing and claims processing services, to create the bills that we submit to the insurance company.

B.Uses and Disclosures that Require Us to Give You the Opportunity to Object.

-We may provide relevant portions of your PHI to a family member, friend or other person you indicate is involved in your health care. In an emergency or when you are not capable of agreeing or objecting to these disclosures, we will disclose PHI as we determine is in your best interest, but will tell you about it after the emergency, and give you the opportunity to object to future disclosures to family and friends.

C.Certain Uses and Disclosures Do Not Require Your Written Authorization Other than Treatment, Payment, and Health Care Operations. The law allows us to disclose PHI without your written authorization in the following situations:

-When Required by Law. We disclose PHI, for example, when we are required to do so by federal, state, or local law.

- For Public Health Activities. We disclose PHI, for example, when we report suspected child abuse, occurrence of certain diseases, or adverse reactions to a drug or medical device.

-For Reports About Victims of Abuse, Neglect, or Domestic Violence. We disclose your PHI in these reports if we are required or authorized by law to do so, or if you otherwise agree.

-To Health Oversight Agencies. We provide PHI as requested to government agencies who have authority to audit or investigate our operations.

- For Lawsuits and Disputes. If you are involved in a lawsuit or dispute, we disclose your PHI in response to a subpoena or other lawful request, but only if efforts have been made to tell you about the request or to obtain a court order that will protect the PHI requested.

-To Law Enforcement. We release PHI if asked to do so by a law enforcement official, in the following circumstances: (a) in response to a court order, subpoena, warrant, summons, or similar process. (b) In emergency circumstances, to report a crime, its location or victims, or the identity, description or location of the person who committed the crime.

-To Coroners, Medical Examiners, and Funeral Directors. We disclose PHI to facilitate the duties of these individuals.

-To Organ Procurement Organizations. We disclose PHI to facilitate organ donation and transplantation.

-For Medical Research. We may disclose your PHI without your written authorization, to medical researchers who request it for approved medical research projects. However, with very limited exceptions, such disclosures must be cleared through a special approval process before any PHI is disclosed to the researchers, who are required to safeguard any PHI they receive.

-To Avert a Serious Threat To Health or Safety. We disclose your PHI to someone who can help prevent a serious threat to your health and safety or the health and safety of another person or the public.

-For Special government Functions. We disclose your PHI, for example, to federal officials for intelligence and national security activities that are authorized by law, or so that they may provide protective services to the President or foreign heads of state or conduct special investigations authorized by law.

-To Workers' Compensation or Similar Programs. We provide your PHI to these programs in order for you to obtain benefits for work-related injuries or illness.

III.Other Uses and Disclosures of Your Protected Health Information.

Other uses and disclosures of your PHI that are not covered by this Notice or the laws that apply to us will be made only with your written permission. You may revoke that permission, in writing, at any time. If you do, we will no longer use or disclose your PHI for the purposes specified in the written authorization, but we cannot take back any disclosures we have already made with your permission, and we are required to keep certain records of the uses and disclosures made when the authorization was in effect.

IV. Your Rights Related to Your Protected Health Information:

A.The Right to Request Limits on Uses and Disclosures of Your PHI.

You may ask us to limit how we use and disclose your PHI, as long as you are not asking us to limit uses and disclosures that we are required to make. Requests must be submitted in writing. We are not required to agree to your request, but if we do, we will put it in writing and will abide by the agreement except when you require emergency treatment.

B.The Right to Choose How We Communicate With You. You may ask that we send information to you at a specific address (for example, at work rather than at home) or in a specific manner (for example, by telephone rather than by regular mail). We must agree to your request as long as we believe it is reasonable and we determine that it would not be disruptive to our procedures.

C.The Right to See and Copy Your PHI. Except for limited circumstances, you may look at and copy your PHI if you ask in writing to do so.

If you ask us to copy your PHI, we will charge you $15 for up to 30 pages, $0.35 per page thereafter (paper or digital).

D.The Right to Correct or Update Your PHI. If you believe that the PHI we have about you is incomplete or incorrect, you may ask us to amend it. Requests must be made in writing, and tell us why you think the amendment is appropriate.

We will act on your request within 60 days (or 90 days if extra time is needed), and will inform you in writing whether we agree to the amendment or not. If we make the amendment, we will ask whom else you would like us to notify of the amendment.

We may deny your request if you ask us to amend information that:

- was not created by us, unless the person who created the information is no longer available to make the amendment;

- is not part of the PHI we keep about you;

- is not part of the PHI that you would be allowed to see or copy; or

- is determined by us to be accurate and complete.

If we deny your request, we will tell you in writing how to submit a statement of disagreement or complaint, or to request inclusion of your original amendment request in your PHI.

E.The Right to Get a List of Your PHI Disclosures We Have Made. The list will not include disclosures made for our treatment, payment and health care operations purposes, those made directly to you or your family or friends. The list will not include disclosures made with your written authorization, for national security purposes or to law enforcement personnel, disclosure of limited data set, or disclosures made before April 4, 2003.

Your request for a list of disclosures must be made in writing. We will respond to your request within 60 days (or 90 days if the extra time is needed). The list we provide will include disclosures made within the last six years unless you specify a shorter period. There is a $15 fee for providing you this list.