NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully.

INTRODUCTION: We (the practice) are required by law to maintain the privacy of “protected health information” (PH). “Protected health information” (PH) includes any identifiable information that we obtain from you or others that release to your physical or mental health, the health care you have received or payment for your health. As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of PHI. We must comply with the provisions of this notice, although we reserve the right to change the terms of this notice from time to time to make the revised notice effective for all protected health information we maintain. You can always request a copy of your most current privacy notice by calling our office, COMMUNITY FAMILY MEDICINE at 919-776-6000.

PERMITTED USES AND DISCLOSURES: Following are examples of the types of uses and disclosures of your PHI that may be made by the Practice. TREATMENT: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services, including consultations between health care providers regarding your care and referrals for health care from one health care provider to another. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Therefore, the doctor may review your medical records to assess whether you have potentially complicating conditions like diabetes.

PAYMENT: Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility of coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, prior to providing health care services, we may need to provide your health plan information about your medical condition to determine whether the proposed course of treatment will be covered. When we subsequently bill the health plan for the services rendered to you, we can provide the health plan with information regarding your care if necessary to obtain payment.

HEALTH CARE OPERATIONS: We may use or disclose, as needed, your PHI in order to support the business activities of our practice. This includes activities to treatment and payment, such as quality assurance activities, case management receiving and responding to patient complains, physician reviews, compliance programs, audits, business planning, development management and administrative activities. We will share your PHI with third party “business associates” that perform various activities (e.g., billing, transcription services) for the Practice. Whenever an arrangement between the Practice and a business associate involves the use or disclosure of your PHI, we will provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your PHI for other marketing activities. For example, your name and address may be used to send you a newsletter about our practice and the services we offer. We may also send you information about products or services that we believe may be beneficial to you. You many contact our Privacy Officer to request that these materials not be sent to you. We may use or disclose your demographic information and the dates that you received treatment from your physician, as necessary, in order to contact you for fundraising activities supported by our practice. If you do not want to receive these materials, please contact our Privacy Official and request that these fundraising materials not be sent to you.

OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT  MAY BE WITH AN OPPORTUNITY TO OBJECT:We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, then the Practice may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is to your health care will be disclosed.

FACILITIES DIRECTORIES: Unless you object, we will use and disclose in our facility directory your name, the location at which you are receiving care, your condition in general terms, and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name. Members of the clergy will be told your religious affiliation.

OTHERS INVOLVED IN YOUR HEALTHCARE: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person that you identify, your PHI directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION OR OPPORTUNITY TO OBJECT:We may use or disclose your PHI in the following situations without your authorization. These situations include: REQUIRED BY LAW: We may use or disclose your PHI to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures. PUBLIC HEALTH: We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority. COMMUNICABLE DISEASE: We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition. HEALTH OVERSIGHT: We may disclose your PHI to health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Over sight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws. ABUSE OR NEGLECT: We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition we may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws. FOOD AND DRUG ADMINISTRATION: We may disclose your PHI to a person or company required by the FDA to report adverse events, product defects or problems, biological deviations, tract products; to enable product recalls; to make repairs or replacements, or to conduct prost marketing surveillance, as required. LEGAL PROCEDURES: We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court of administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process. LAW ENFORCEMENT: We may also disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law (2) limited information requests for identification and location purposes (3) pertaining to victims of a crime (4) suspicion that death has occurred as a result of criminal conduct (5) in the event that a crime occurs on the premises of the Practice, and (6) medical emergency and it is likely that a crime has occurred. CORONERS, FUNERAL DIRECTORS, AND ORGAN DONATION: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death of for the coroner or medical examiner to perform other duties authorized by law. We may also disclosure PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. PHI may also be sued and disclosed for cadaveric organ, eye or tissue donation purposes. RESEARCH: We may disclose your PHI to researchers. Your PHI may be used for research purposes only if the privacy aspects of the research have been reviewed and approved by a special Privacy Board or Institutional Review Board, if the researcher is collecting information in preparing a research proposal, if the research occurs after your death, or if you authorize the use or disclosure. CRIMINAL ACTIVITY: Consistent with applicable federal and state laws, we may disclose your PHI, if we believe that the use or disclosure is necessary to prevent or lessen a serous and imminent threat to the health or safety of a person or the public. We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual. MILITARY ACTIVITY AND NATIONAL SECURITY: When the appropriate conditions apply, we may use or disclose PHI of individuals we are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veteran Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President of other legally authorized. WORER’S COMPENSATION: Your PHI may be disclosed by us as authorized to comply with workers’ compensation laws and other legally-established programs. INMATES: We may use or disclose your PHI if you are an inmate or a correctional facility and your physician created or received your PHI in the course of providing care to you. REQUIRED USES AND DISCLOSURES: Under the law, we must make disclosures to you and when required by the Secretary of Department Health & Human Services to investigate or determine our compliance with the requirements of Sections 164.500 et.seq.

USES AND DISCLOSURES BASED UPON YOUR WRITTEN AUTHORIZATION: Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by laws as described below. You may revoke this authorization, at any time, in writing, except to the extent that the Practice has taken an action in reliance on the use or disclosure indicated in the authorization.

YOUR RIGHTS: (1) You have the right to request restrictions on our uses and disclosures of PHI for treatment, payment and healthcare operations. However, we are not required to agree to your request. (2) You have the right to reasonably request to receive communications of PHI by alternative means or at alternative locations. (3) Subject to payment of a reasonable copying charge, you have the right to inspect and copy the PHI contained in your medical and billing records used by us to make decisions about you, except for: (i) psychotherapy notes, which are notes recorded by a mental health professional documenting or analyzing the contents of conservation during a private counseling session or a group, joint for family counseling session and that have been separated from the rest of your medical record, (ii) information compiled in a reasonable anticipation of, or for use in, a civil, or administrative action or proceeding, (iii) PHI involving laboratory tests when your access is required by law; (iv) if you are a prison inmate and obtaining such information would jeopardize your health, safety, security, custody, or rehabilitation or that of other inmates, or the safety of any officer, employee or other person at the correctional institution or person responsible for transporting you; (v) if we obtained or created PHI as part of a research study for as long as the research is in progress, provided that you agreed to the temporary denial of access when consenting to participate in the research; (vi) your PHI is contained in records kept by a federal agency or contractor when your access is required by law; and if you cannot afford to pay for copies, you will not be denied access or (vii) if the PHI was obtained from someone other than us under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information. (4) We may deny a request for access to Phi if: (i) a licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to endanger your life of physical safety of that of another person, (ii) the PHI makes reference to another person (unless such other person is a health care provider) and a licensed health care professional has determined, in the exercise of professional judgment, that the access requested is reasonably likely to cause substantial harm to such other person. If we deny a request for any of the three reasons described above, then you have the right to have our denial reviewed in accordance with the requirements of applicable law. (5) You have the right to request a correction to your Phi but we may deny your request for correction, if we determine that the PHI or record that is the subject of the requested amendment; (i) is not part of your medical or billing record; (ii) is not available for inspection as set forth above; or (iii) is accurate and complete. In any event, any agreed upon correction will be included as an addition to, and not a replacement of, already existing record. (6) You have the right to receive an accounting of disclosures of PHI made by us to individuals or entities other than to you, except for expectations pursuant to the law. (7) You have the right to request and receive a paper copy of this notice from us.

COMPLAINTS: If you believe that your privacy rights have been violated, you should immediately contact Lucy Guevara, Administrator at 919-776-6000. We will not take action against you for filing a complaint. You also may file a complaint with the Secretary of Health and Human Services. This notice is effective as of September 14, 2006.