NOTICE OF PRIVACY PRACTICES

Effective Date: 02/01/03

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.

HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION

FOR TREATMENT. This includes the provision, coordination, or management of your health care and related services by us or with other health care providers, including the coordination or management of health care with a third party; consultation between health care providers relating to you; or a referral to another provider. For example, we may discuss you health information with your physician, home health nurse or others providing you with care.

FOR PAYMENT. This includes activities to obtain or provide reimbursement for the provision of health care. This includes: (1) determinations of eligibility or coverage (including coordination of benefits or the determination of cost sharing amounts), and adjudication of subrogation of health benefit claims; (2) billing, claims management, collection activities, obtaining payment under a contract for reinsurance (including stop-loss insurance and excess of loss insurance), and related health care data processing; (3) review of health care services with respect to medical necessity, coverage under a health plan, appropriateness of care, or justification of charges; and (4) utilization review activities, including precertification and preauthorization of services, concurrent and retrospective review of services. For example, we may contact your insurance company to justify your need for services and receive payment.

FOR HEALTH CARE OPERATIONS. This includes (1) conducting quality assessment and improvement activities; (2) reviewing the competence or qualifications of health care professionals; (3) underwriting, premium rating, and other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits, conducting or arranging for medical review; (4) legal services, and auditing functions, including fraud and abuse detection and compliance programs; (5) business planning and development; (6) business management and general administrative activities including management activities, customer service, and resolution of internal grievances. For example, your records may be reviewed by an accreditation agency for the purpose of evaluating the quality of the services you have received.

FOR APPOINTMENT REMINDERS. To advise you of upcoming appointments.

FOR TREATMENT ALTERNATIVES. To advise you of possible treatment options or alternatives that may be of interest to you.

FOR HEALTH RELATED BENEFITS AND SERVICES. To advise you of health related benefits or services you may have interest in.

FOR COORDINATION OF CARE OR PAYMENT. Information may be released to a family member, other relative, or a close personal friend, or any other person identified by you as being involved with your care or payment for your care unless you have requested that such disclosure not occur and our firm has agreed to such a request.

FOR AVOIDING A SERIOUS THREAT TO HEALTH OR SAFETY. To prevent a serious threat to your health and safety or the health and safety of the public or another person.

FOR COMPLIANCE WITH THE LAW. Information may be released when required by federal, state or local law.

FOR PREVENTING PUBLIC HEALTH RISKS. This would involve such things as preventing or controlling disease, injury or disability; reporting births and deaths; reporting child abuse or neglect; reporting reactions to medications or problems with product; notification of product recalls; notifying persons who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; notifying appropriate authorities if we believe a patient has been the victim of abuse, neglect or domestic violence as required by law.

FOR SPECIAL SITUATIONS.

Disclosures for health oversight activities by regulatory bodies.
Disclosures for judicial and administrative proceedings
Disclosures for law enforcement purposes
Uses and disclosures about decedents
Uses and disclosures for cadaveric organ, eye or tissue donations
Uses and disclosures for specialized government functions
When you are not present or not capable of providing consent due to incapacity or emergency circumstances and the we determine it is in your best interest to disclose information pertinent to your healthcare.
Disclosures to correctional institutions

OTHER USES AND DISCLOSURES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. A written request, on the form we supply, is required. If you provide us with such authorization, you may revoke the same at any time. If you revoke such authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. Understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care we provided you.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION

RIGHT TO INSPECT AND COPY. You may inspect and request copies of medical information that may be used to make decisions about your care. Usually this includes medical and billing records. A written request, on the form we supply, is required. We may charge a fee for the costs of copying, mailing, preparation or other supplies associated with your request.

We may deny your request to inspect and copy in certain limited circumstances, e.g., when the information is compiled in reasonable anticipation of legal action or proceeding; when disclosure could endanger the life or safety of you or another person; when the information references another person and disclosure is likely to cause substantial harm to such person; when the request is made by your personal representative and disclosure is likely to cause substantial harm to you or another person. If denial should occur, you may request that the denial be reviewed by a health care professional other than the person who denied your original request.

RIGHT TO AMEND. You may, for as long as the information is kept by us, ask us to amend medical information we have about you that you believe is incorrect or incomplete. A written request, with supporting reasons on the form we supply, is required. We may deny your request in certain circumstances, e.g., when your request is incomplete; when the information was not created by us (unless the creator is no longer available to make the amendment); when the information is not part of the information available for your inspection and copying; when the information is accurate and complete.

RIGHT TO REQUEST RESTRICTIONS. You may request restrictions of uses and disclosures of information we use for treatment, payment or health care operations and to family members. A written request, on the form we supply, is required. We are not required to agree with your request.

RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS. You may request that we communicate with you about medical matters in a certain way or at a certain location. A written request, on the form we supply, is required but a reason for the request does not have to be supplied. We will make reasonable accommodation of such requests when appropriate and if information regarding how any payments will be handled and an alternate address or method of contact is provided.

RIGHT TO AN ACCOUNTING OF DISCLOSURES. You may request an accounting of disclosures made for non-TPO purposes and disclosures made without authorization as required or limited by law. A written request, on the form we supply, is required. The request must be limited to the most recent 6-year period that does not extend beyond the implementation of this policy. The first accounting you request will be at no charge but we may charge a fee for additional lists.

RIGHT TO A PAPER COPY OF THIS NOTICE. You have the right to a paper copy of this notice. You may ask for a copy of this notice at any time even if you have received this notice electronically.

RIGHT TO PRIVACY. You will not be required to waive your rights under this policy as a condition of the provision of health care.

CHANGES TO THIS NOTICE

We are required by law to maintain the privacy of confidential information and provide you with notice of our legal duties and privacy practices and to abide by the terms of our current ?Notice of Privacy Practices?. We reserve the right to change this notice and our policies. We reserve the right to make the revised or changed notice and policies effective for medical information we already have about you as well as any information we receive in the future. A copy of this notice is posted in our facility.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our firm and with the Secretary of the Dept. of Health and Human Services. All complaints to our firm must be submitted in writing to the Director of Services. You will not be penalized or retaliated against for filing a complaint.

CONTACT PERSON

For further information regarding this notice, contact our Director of Services at (864)-850-6293.