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NOTICE OF PRIVACY PRACTICES

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU AS A PATIENT OF THIS PRACTICE MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI).

PLEASE REVIEW THIS NOTICE CAREFULLY. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the confidentiality of health information that identifies you. In conducting our business, we will create records regarding you and the treatment and services we provide you. We are required by law not only to maintain the confidentiality of your records but also to provide you with this notice of our legal duties and the privacy practices that we follow in our office. We must follow the terms of this notice of privacy practices.

The terms of this notice apply to all records containing your health information that are created and retained by our office. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice and you may request a copy at any time. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS

Treatment: Our practice may use or disclose your health information to a physician or other health care provider for purposes related to your treatment.

Payment: Our practice may use or disclose your health information to bill and collect payment for the services and items you may receive from us.

Health Care Operations: Our practice may use or disclose your health information to operate our business. For example, we may use your health information to evaluate the quality of care you received from us or to conduct business planning activities for our office.

Appointment Reminders: Our practice may use and disclose your health information to contact you and remind you of an appointment.

Treatment Options: Our practice may use and disclose your health information to inform you of potential treatment alternative options or alternatives.

Health-Related Benefits and Services: Our practice may use and disclose your health information to inform you of health-related benefits or services that may be of interest to you.

Release of Information to Family/Friends: Our practice may release your health information to a friend or family member that is involved in your care or who assists in taking care of you, but only if you agree that we may do so.

Disclosures Required by Law: Our practice will use and disclose your health information when we a are required to do so by federal, state or local law. USE AND DISCLOSURE OF YOUR HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

Public Health Risks: Our practice may disclose your health information to public health authorities that are authorized by law to collect information for the purpose of reporting such things as abuse or neglect (including domestic violence), reporting potential exposure to a communicable disease.

Health Oversight Activities: Our practice may disclose your health information to a health oversight agency for activities authorized by law such as investigations, civil, administrative and criminal procedures, other activities necessary for the government to monitor programs, compliance with civil rights laws and the health care system in general.

Lawsuits and Similar Proceedings: Our practice may use and disclose your health information in response to a court or administrative order, in response to a discovery request, subpoena or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

Law Enforcement: We may release your health information if asked to do so by a law enforcement official in circumstances such as, criminal conduct in our offices or in emergency situations to report a crime.

Military: Our practice may disclose your health information if you are a member of U.S. or foreign military forces (including veterans) and if required by appropriate authorities.

National Security: Our practice may disclose your health information to federal officials for intelligence and national security activities authorized by law. YOUR RIGHTS REGARDING YOUR PRIVATE HEALTH INFORMATION

Confidential Communications: You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For example, you may ask that we contact you at home rather than work. You must make a written request. Our practice will accommodate reasonable requests.

Requesting Restrictions: You have the right to request a restriction on our use or disclosure of your health information. We are not required to agree to these additional restrictions but, if we do, we will abide by our agreement, except in emergency. Request for additional restrictions must be made in writing.

Inspection and Copies: You have the right to inspect and obtain a copy of your health information. You must submit your request in writing. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.

Amendment: You may ask us to amend your health information if you believe it is incorrect or incomplete. Your request must be made in writing and you must provide us with a reason that supports your request. We may deny your request if, in our opinion, the information is accurate and complete, if it is not part of the information kept by or for the practice, or not created by our practice.

Accounting of Disclosures: All of our patients have a right to request a list of certain non-routine disclosures our practice has made of your health information. for non-treatment or operations purposes. Use of your health information as part of routine patient care is not required to be documented. Requests must be submitted in writing and must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request is free of charge but our practice may charge you for additional lists within the same 12-month period.

Right to a Paper Copy of this Notice: You are entitled to receive a paper copy of our notice of privacy practices.

Right to Provide an Authorization for Other Uses and Disclosures: Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.

Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services, Office of Civil Rights. You will not be penalized for filing a complaint.

All complaints must be submitted in writing to:

Practice Administrator Columbus Arthritis Center 1211 Dublin Road Columbus Ohio 43215

Office of Civil Rights – Regional Manager Department of Health & Human Services 233 N. Michigan Avenue, Suite 240 Chicago, Illinois 60601

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