This Notice of Privacy Practices is NOT an authorization.  It describes how we, our Business Associates, and their subcontractors may use and disclose your Protected Health Information to carry out treatment, payment, or health care operations, and for other purposes that are permitted or required by law.  It also describes your rights to access and controls your Protected Health Information. “Protected Health Information” is information that identifies you individually, including demographic information that relates to your past, present, or future physical or mental health condition and related health care services.

THE COMPANY’S PLEDGE REGARDING MEDICAL INFORMATION

Our Company understands that medical information about you and your health is personal. Our Company is committed to protecting medical information about you. In order to provide you with quality care and to comply with certain state and federal legal requirements, our Company creates a record of the services you receive at our Company. This Notice applies to all of the records of your care generated by our Company. This Notice will tell you about the ways in which our Company may use and disclose medical information about you. It also describes your rights and certain obligations our Company has regarding the use and disclosure of medical information. Our Company is required by law to: (1) Make sure that medical information that identifies you is kept private; (2) Give you this Notice of its legal duties and privacy practices concerning medical information about you; (3) Follow the terms of the Notice that are currently in effect, and (4) Notify you in case there is an unauthorized use or disclosure of your unsecured medical information.

1. USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

We may use and disclose your Protected Health Information in the following situations:

• Treatment:

  We may use or disclose your Protected Health Information to provide medical treatment and/or services in order to manage and coordinate your medical care. For example, we may share your medical information with other physicians and health care providers, rehabilitation therapists, laboratories,  worker’s compensation adjusters, etc. to ensure that the medical provider has the necessary medical information to diagnose and provide treatment to you.

• Payment:

  Your Protected Health Information will be used to obtain payment for your health care services.

• Health Care Operations:

  We may use and disclose your Protected Health Information to manage, operate, and support the business activities of our practice. These activities include, but are not limited to, quality assessment, employee review, licensing, fundraising, and conducting or arranging for other business activities. We may use or disclose your Protected Health Information, as necessary, to contact you to remind you of your appointment, and inform you about treatment alternatives or other health-related benefits and services that may be of interest to you.

• Required by Law:

  We will use or disclose your Protected Health Information when required to do so by local, state, federal, and international law.

• Law Enforcement:

  We will disclose your Protected Health Information for law enforcement purposes when all applicable legal requirements have been met. This includes, but is not limited to, law enforcement due to identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or warrant, and grand jury subpoena.

• Coroners and Medical Examiners:

  We disclose Protected Health Information to coroners and medical examiners to assist in the fulfillment of their work responsibilities and investigations.

• Public Health:

  Your Protected Health Information may be disclosed and may be required by law to be disclosed for public health risks. This includes: reports to the Food and Drug Administration (FDA) for the purpose of quality and safety of an FDA-regulated product or activity; to prevent or control disease; report births and deaths; report child abuse and/or neglect; reporting of reactions to medications or problems with health products; notification of recalls of products; reporting a person who may have been exposed to a disease or may be at risk of contracting and/or spreading a disease or condition.

• Health Oversight Activities:

  We may disclose your Protected Health Information to a health oversight agency for audits, investigations, inspections, licensures, and other activities as authorized by law.

• Military, National Security, and other Specialized Government Functions:

  If you are in the military or involved in national security or intelligence, we may disclose your Protected Health Information to authorized officials.

• Worker’s Compensation:

  We will disclose only the Protected Health Information necessary for Worker’s Compensation in compliance with Worker’s Compensation laws.  This information may be reported to your employer and/or your employer’s representative regarding an occupational injury or illness.

2. PROTECTED HEALTH INFORMATION AND YOUR RIGHTS

The following are statements of your rights, subject to certain limitations, with respect to your Protected Health Information:

• Inspect and copy your Protected Health Information:

  Pursuant to your written request, you have the right to inspect and copy your Protected Health Information in paper or electronic format.

• Receive an electronic copy of medical records:

  You have the right to request an electronic copy of your medical record for yourself or to be sent to another individual or organization when your Protected Health Information is maintained in an electronic format. We will make every attempt to provide the records in the format you request; however, in the case that the information is not readily accessible or producible in the format you request, we will provide the record in a standard electronic format or a legible hard copy form.

• Request Amendments:

  At any time if you believe the Protected Health Information we have on file for you is inaccurate or incomplete, you may request that we amend the information. Your request for an amendment must be submitted in writing and detail what information is inaccurate and why. Please note that a request for an amendment does not necessarily indicate the information will be amended.

• Receive an accounting of certain disclosures:

  You have the right to receive an accounting of disclosures of your Protected Health Information. An “accounting” being a list of the disclosures that we have made of your information. The request can be made for paper and/or electronic disclosures and will not include disclosures made for the purposes of: treatment; payment; health care operations; notification and communication with family and/or friends; and those required by law.

• Request restrictions of your Protected Health Information:

  You have a right to restrict and/or limit the information we disclose to others, such as family members, friends, and individuals involved in your care or payment for your care. You also have the right to limit or restrict the information we use or disclose for treatment, payment, and/or health care operations. Your request must be submitted in writing and include the specific restriction requested, whom you want the restriction to apply, and why you would like to impose the restriction.

• Request to receive confidential communications:

  You have a right to request confidential communications from us by alternative means or at an alternative location. You do not have to disclose the reason for your request; however, you must submit a request with specific instructions in writing.

• Receive a paper copy of this notice:

  Even if you have agreed to receive an electronic copy of this Privacy Notice, you have the right to request we provide it in paper form. You may make such a request at any time.

3. CHANGES TO THIS NOTICE

We reserve the right to change the terms of this notice and will notify you of such changes. We will also make copies available of our new notice if you wish to obtain one. We will not retaliate against you for filing a complaint.

4. COMPLAINTS

If at any time you believe your privacy rights have been violated and you would like to register a complaint, you may do so with us or with the Secretary of the United States Department of Health and Human Services.

If you wish to file a complaint with the Secretary of the United States Department of Health and Human Services, please go to the website of the Office for Civil Rights (www.hhs.gov/ocr/hipaa/), call 202-619-0257 (toll free 877-696-6775), or mail to:

Secretary of the US – Department of Health and Human Services

200 Independence Ave S.W.

Washington, D.C. 20201

We are required by law to provide individuals with this notice of our legal responsibilities and privacy practices with respect to Protected Health Information. We are also required to maintain the privacy of, and abide by the terms of the notice currently in effect.

5. OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this Notice or the laws that apply to use will be made only with your written permission. If you provide the Company permission to use or disclose medical information about you, you may revoke that permission in writing at any time. If you revoke your permission the Company will stop any further use or disclosure of your medical information for the purposes covered by your written authorization, except if the Company has already acted in reliance on your permission. You understand that the Company is unable to take back any disclosure the Company has already made with your permission and that the Company is required to retain its records of the care that the Company provided to you.