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.

According to Federal Law, all of our patients have a right to know how we use your health information, when we can disclose this information, and what rights you have as a patient. This Notice of Privacy Practices describes how we may use your Protected Health Information to carry out treatment, payment and health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your health information. Protected Health Information (PHI) is information about you including demographic information that may identify you and that relates to your past, present or future physical or mental health and related health care services.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Your Protected Health Information may be used and disclosed by your physician, our office staff and others outside our office that are involved in your care and treatment for the purpose of providing services to you, to pay health care bills, to support the operation of the physician's office and any other use required by law.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your health information, as necessary to a home health agency that provides care to you. We may also disclose your health information to a physician that you have been referred to so that the physician has the necessary information to diagnose and treat you.

Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant health information be disclosed to your health insurance plan to obtain approval for the hospital admission.

Health Care Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of our office. These activities include, but are not limited to: quality improvement activities, including making sure you receive quality health care and correct medical procedures, and that all the rules and laws have been followed; evaluate the competence of our health care providers; resolve any complaining or grievances you may have; employee review activities, training of medical students, licensing, certification or credentialing activities, marketing or fund raising activities, and conducting or arranging for other business activities. For example, we may disclose your health information to medical students that see patients at our office. We may use a sign in sheet at our registration desk and call you by name when you are seen. We may use or disclose your health information, as necessary, to contact you to remind you of your appointment.

************************************************************************************** We may use or disclose your protected health information (PHI) in the following situations without your authorization.

Business Associates: Certain areas of our services may be performed through contracts with outside persons or organizations. Examples of these include insurance agents, and vendors that help us process your claims. At times it may be necessary for us to provide certain parts of your PHI to one or more of these business associates.

Other permitted and required uses and disclosures will be made only with your consent and signed authorization or your opportunity to object, unless required by law. You may revoke this authorization at any time in writing unless your physician has already acted on this authorization.

YOUR PATIENT RIGHTS

You have the right to inspect and request a copy of your Protected Health Information. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in a civil, criminal or administrative action or proceeding; and protected health information that is subject to law that prohibits access to this information.

You have the right to request a restriction of your Protected Health Information. This means you may ask us to restrict certain uses and disclosures of your health information. You may also request that any part of your health information not be disclosed to family members or friends who may be involved in your care. However, this office is not required to agree to a requested restriction if it is believed that it is in your best interest to disclose the information. You then have the right to use another health care professional.

You have the right to receive confidential communications from us. You may request any communication from us remain confidential. You may request an alternative means or location for this disclosure.

You have the right to request that your physician amend your protected health information. If your request for amendment is denied, you then have the right to file a statement of disagreement with us and we may prepare and provide you with a copy of a rebuttal to your statement.

You have the right to receive an accounting of disclosures of your protected health information that is not related to treatment, payment or healthcare operations. These instances would require your authorization and may include: marketing or selling of mailing lists, information released to employers or life insurance companies.

You have the right to receive a paper copy of this notice if you have agreed to receive it electronically.

FAMILY HEALTH MEDICAL SERVICES OBLIGATIONS TO YOU: Family Health Medical Services is required by law to maintain the privacy of your protected health information and to provide you with this notice of its legal duties and privacy practices with respect to that health information. We are required to abide by the terms of the notice currently in effect. Family Health Medical Services reserves the right to change the terms of this notice and to make new terms effective for all protected health information it maintains. We will provide you with a copy of any changes made.

COMPLAINTS: You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our privacy official of your complaint. Family Health Medical Services will not retaliate in any way against anyone filing a complaint. If you want to make a complaint, or would like further information regarding your Protected Health Information or Patient Rights under the HIPAA legislation, please contact our privacy official at Family Health Medical Services.

Revised 3/1/05