This notice of Privacy Practices describes how we 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 control your protected health information. “Protected health information” is information about you, including demographic that may identify you, and that relates to your past, present, or future physical or mental health or condition and related healthcare services.

Uses and Disclosure 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 healthcare services to you, to pay any healthcare bills, to support the operation of the physician’s practice, and any other use required by law.

Treatment

We will use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care for you. Your protected health information may be provided to a physician to whom you’ve been referred to, to ensure that the physician has the necessary information to diagnose or treat you in regards to the community of your care.

Payment

Your protected health information will be used, as needed, to obtain payment for your healthcare services. For example, obtained approval for the hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.

Health Operations

We may use or disclose, as needed, your protected health information in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conduction or arranging for other business activities. In addition, we may use a sign-in sheet at the front desk where you will be asked to sign you name and indicate the

physician you are to be seeing. We may also call you by name in the waiting room when you are ready to be seen by the physician. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We may use or disclose you protected health information in the following situations without your authorization.

These situations include, as required by law: public health issues, communicable diseases, health oversight, abuse or neglect, FDA requirements, legal proceedings, law enforcement, coroners, funeral directors, organ donation, research, criminal activity, military activity, national security, Worker’s Compensation, and inmates. Required uses and disclosures: under the law, we must make disclosures to you and when requirements of Section 164-500.

Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object unless required by law.

You may revoke this authorization at any time, in writing, except to the extent that your physician or the physician’s practice has taken an action in reliance on the use or disclosure indicated in the authorization.