Our Obligations

We are required by law to:

• Maintain the privacy of protected health information

• Give you notice of your legal duties and privacy practices regarding health information about you

• Follow the terms of our notice that is currently in effect

How We May Use and Disclose Health Information

Described as follows are the ways we may use and disclose health information that identifies you (“Health

Information”). Except for the following purposes, we will use and disclose health information only with your written

permission. You may revoke such permissions at any time by writing to our practiceʼs

privacy officer.

Treatment. We may use and disclose Health Information for your treatment and to provide you with treatment-related

health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or other

personnel, including people outside our office, who are involved in your medical care and need the information to

provide you with medical care.

Payment. We may use and disclose Health Information so that we or others may bill and receive payment from you,

an insurance company, or a third party for treatment and services you receive. For example, we may give your health

plan information so that they will pay for your treatment.

Health Care Operations. We may use and disclose Health Information for health care operation purposes. These

uses and disclosures are necessary to make sure that all of our patients receive quality care to operate and manage

our office. For example, we may use and disclose information to make sure the obstetric or gynecologic care you

receive is of the highest quality. We may also share information with our entities that have a relationship with you (for

example, your health plan) for their healthcare operation activities.

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services. We may use and

disclose Health Information to contact you and remind you that you have an appointment with us. We also may use

and disclose Health Information to tell you about treatment alternatives or health

related benefits and services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care. When appropriate, we may share Health Information

with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We

may also notify your family about your location or general condition, or disclose such information to an entity assisting

in a disaster relief effort.

Research. Under certain circumstances, we may use and disclose Health Information for research. For example, a

research project may involve comparing the health of patients who receive one treatment to those who receive

another for the same condition. Before we use or disclose Health Information for research, the project will go through

a special approval process. Even without special approval, we may permit researchers to look at records to help them

identify patients who may be included in their research project or for other similar purposes.

Special Situations

As required by law. We will disclose Health Information when required to do so by international, federal, state, or

local law.

To Avert a Serious Threat to health or safety. We will disclose Health Information when necessary to prevent

a serious threat to your health and safety or the public, or another person. Disclosure, however, will be made

only to someone who may be able to help provide treatment.

Business Associates. We may disclose Health Information to our business associates that perform functions on our

behalf or to provide us with services if the information is necessary for such functions or services. For example, we

may use another company to perform billing services on our behalf. All of our business associates are obligated to

protect the privacy of your information and are not allowed to use or disclose any information other than that as

specific in our contract.

Organ and Tissue Donation. If you are an organ donor, we may use or release Health Information to organizations

that handle organ procurement or other entities engaged in procurement; banking or transportation of organs, eyes,

or tissues to facilitate organ, eye, or tissue donation, and transplantation.

Military and Veterans. If you are a member of the army forces, we may use or release Health Information as

required by military command authorities. We also may release Health Information to the appropriate foreign military

authority if you are a member of a foreign military.

Workerʼs Compensation. We may release Health Information for workerʼs compensation or similar programs. These

programs provide benefits for work-related injuries or illness.

Public Health Risks. We may disclose Health Information for public health activities. These activities generally

include disclosure to prevent or control disease, injury, or disability; report child abuse or neglect; report reactions to

medications or problems with products; notify people of recalls of products they may be using; inform a person who

may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and report

to the appropriate government authority if we believe a patient has been a victim of abuse, neglect, or domestic

violence. We will only make this disclosure if you agree or when required by law.

Health Oversight Activities. We may disclose Health Information to a health oversight agency for activities

authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.

These activities are necessary for the government to monitor the health care system, government programs, and

compliance with civil rights laws.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health Information in response

to a court or a court administrator's order. We also may disclose Health Information in response to a subpoena,

discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been

made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement. We may release Health Information if asked by a law enforcement official if the information is: 1)

in response to a court order, subpoena, warrant, summons, or similar process; 2) limited information to identify or

locate a suspect, fugitive, material witness, or missing person; 3) about the victim of a crime, even if, under certain

circumstances, we are unable to obtain the personʼs agreement; 4) about a death we believe may be the result of

criminal conduct; 5) about criminal conduct on our premises, and 6)in an emergency to report a crime to the location

of the crime, if victims, or the identity, description, or location of the person who committed the crime.

Coroners, Medical Examiners, Funeral Directors. We may release Health Information to a coroner or medical

examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We

may also release Health Information to funeral directors as necessary for their duties.

National Security and Intelligence Activities. We may release Health Information to authorized federal officials so

they may provide protection to the President, other authorized persons, or foreign heads of state, or to conduct

special investigations.

Protective Services and Intelligence Activities. We may release Health Information to authorized federal officials

so they may provide protection to the President, other authorized persons, or foreign heads of state, or to conduct

special investigations. Inmates or Individuals in Custody. If you are an inmate of a correctional institution or in the custody of a law

enforcement official, we may release Health Information to the correctional institution or law enforcement official. This

release would be made if necessary 1) for the institution to provide you with health care; 2) to protect your health and

safety or the health and safety of others, or; 3) for the safety and security of the correctional institution.

Your Rights

You have the following rights regarding the health information we have about you:

Right to Inspect and Copy. You have the right to inspect and copy Health Information that we may use to make

decisions about your care or payment for your care. This includes medical and billing records, other than

psychotherapy notes. To inspect and copy this information, you must make your request in writing to our Privacy

Officer.

Right to Amend. If you feel that the health information we have is incorrect or incomplete, you may ask us to amend the

information. You have the right to request an amendment for as long as the information is kept by or for our office. To

request an amendment, you must make your request, in writing, to our Privacy Officer.

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of

Health Information for purposes other than treatment, payment, and health care operations or for which you provided

written authorization. To request an accounting of disclosures, you must make your request, in writing, to our Privacy

Officer.

Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we

use or disclose for treatment, payment, or health care operation. You also have a right to request a limit on the Health

Information we disclose to someone involved in your care or the payment for your care, like a family member or

friend. For example, you can ask that we not share information about your particular diagnosis or treatment with your

spouse. To request a restriction, you must make your request, in writing, to our Privacy Officer. We are not required

to agree with your request. If we agree, we will comply with your request unless the information is needed to

provide you with emergency treatment.

Right to Request Confidential Communication. You have the right to request that we communicate with you about

your medical matters in a certain way or at a certain location. For example, you can ask that we contact you only by

mail or at work. To request confidential communications, you must make your request, in writing, to our Privacy

Officer. Your request must specify how or where you wish to be contacted. We will accommodate reasonable

requests.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You must ask us to give you

a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a

paper copy of this notice. You may obtain a copy of this notice by contacting our

office.

Changes to This Notice

We reserve the right to change this notice and make the new notice apply to Health Information we already have, as

well as any information we receive in the future. We will post a current copy of our notice at our office. The notice will

contain the effective date on the first page, in the top right-hand corner.

Complaints

If you believe your privacy has been violated, you may file a complaint with our office or with the Secretary of the

Department of Health and Human Services. To file a complaint with our office, contact our Privacy Officer. All

complaints must be made in writing. You will not be penalized for filing a complaint.