Notice of Privacy Practices

Our Legal Duty

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect April 14, 2003 and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law, and to make those changes effective for all health information we maintain, including information we created or received before the changes. Before a significant change, we will update this Notice and make the new one available upon request.

You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies, contact us using the information listed at the end of this Notice.

Uses and Disclosures of Health Information

We use and disclose health information about you for treatment, payment, and healthcare operations. For example:

• Treatment: We may use or disclose your health information to a physician or other healthcare provider providing treatment to you.
• Payment: We may use and disclose your health information to obtain payment for services we provide to you.
• Healthcare Operations: We may use and disclose your health information in connection with our healthcare operations, including quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.

Your Authorization

In addition to our use of your health information for treatment, payment or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time; your revocation will not affect any use or disclosures permitted while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.

To Your Family and Friends

We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.

Persons Involved in Care

We may use or disclose health information to notify, or assist in the notification of, a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, we will provide you with an opportunity to object to such uses or disclosures prior to making them. In the event of your incapacity or emergency circumstances, we will disclose only health information that is directly relevant to the person's involvement in your healthcare, based on our professional judgment. We will also use our professional judgment and common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays, or other similar forms of health information.

Marketing

We will not use your health information for marketing communications without your written authorization.

Other Uses and Disclosures

• Required by Law: We may use or disclose your health information when required to do so by law.
• Abuse or Neglect: We may disclose your health information to appropriate authorities if we reasonably believe you are a possible victim of abuse, neglect, domestic violence, or other crimes, and to avert a serious threat to your health or safety or the health or safety of others.
• National Security: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances, and to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities.
• Appointment Reminders: We may use or disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards, or letters).

Patient Rights

Access

You have the right to look at or get copies of your health information, with limited exceptions. You may request copies in a format other than photocopies; we will use the format you request unless we cannot practicably do so. You must make your request in writing. A form is available from us, or you may send us a letter to the address at the end of this Notice. We will charge a reasonable, cost-based fee for copies and staff time ($0.25 per page, $15 per hour to locate and copy, and postage if mailed), plus a cost-based fee for an alternative format. If you prefer, we will prepare a summary or explanation of your health information for a fee.

Disclosure Accounting

You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than treatment, payment, healthcare operations and certain other activities, for the last 6 years (but not before April 14, 2003). If you request this accounting more than once in a 12-month period, we may charge a reasonable, cost-based fee.

Restriction

You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in an emergency).

Alternative Communication

You have the right to request that we communicate with you about your health information by alternative means or to alternative locations. Your request must be made in writing, specify the alternative means or location, and provide a satisfactory explanation of how payments will be handled.

Amendment

You have the right to request that we amend your health information. Your request must be in writing and explain why the information should be amended. We may deny your request under certain circumstances.

Electronic Notice

If you receive this Notice on our website or by e-mail, you are entitled to receive this Notice in written form.

Questions and Complaints

If you want more information about our privacy practices or have questions or concerns, please contact us.

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information, you may complain to us using the contact information below. You also may submit a written complaint to the U.S. Department of Health and Human Services; we will provide you with the address upon request.

We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.