PRIMARY CARE HEALTH SERVICES, INC. NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. WHY YOU ARE GETTING THIS NOTICE

A new federal law, called Health Portability and Accountability Act, went into effect on April 14, 2003. The law was created to protect the privacy of patient’s medical and billing records and to allow patients to have more control over those records. To accomplish this, the law created some new rights for patients. Also, The law created a rule that, unless specifically allowed by law, health care providers cannot use a patient’s health information, or give that information out to others, without the patient’s written permission. Primary Care Health Services Inc. has always regarded patient privacy as an important part of patient care and will continue to make every effort to maintain the confidentiality of your health information. We are giving you this Notice so that you will know what your privacy rights are. Also, this Notice explains when Primary Care is allowed to use your health information and when Primary Care may give it out to others.

YOUR PRIVACY RIGHTS

YOU HAVE THE RIGHT TO GET AN EXPLANATION OF PRIMARY CARE’S PRIVACY POLICIES

We are required by law to give you this Notice of our privacy policies. This Notice explains 1. Your right to control your health information; 2. Primary Care’s right to use your health information; and 3. Primary Care’s right to give your health information out to others. If you received this Notice by e-mail or some other electronic form, and you would like a paper copy, you can either ask for a copy at any of Primary Care’s facilities or contact the Privacy Officer listed on the last page of this Notice. All of the facilities that make up Primary Care Health Services Inc. are required to follow this Notice. Also, all of the doctors and other health care practitioners who care for you at our facilities, and the employees and staff of those facilities, will follow this Notice. This Notice can be changed from time to time. All changes that we make will apply to all of the health information that we have, not just information that is created after the changes are made. Whenever the Notice is changed, we will post the new Notice in our medical facilities. Also, you can get a copy of the changed Notice by asking for one at Primary Care’s medical facilities or by contacting the Privacy Officer listed on the last page of this Notice.

YOU HAVE THE RIGHT TO ASK THAT PRIMARY CARE NOT GIVE OUT YOUR HEALTH INFORMATION

You may ask Primary Care not to give your health information out to others. You can ask us not to give your information out for treatment, payment or health care operations purposes. For example, you may ask that your health information not be given to your health insurance company, and may instead make a personal payment for your care. Also, you can ask us not to share your health information with family and friends who are involved in your care or to notify your family and friends that you are at our medical facilities. We do not have to agree to your request, and sometimes we are not allowed to agree.

YOU HAVE THE RIGHT TO BE CONTACTED IN A SPECIFIC MANNER

You can ask Primary Care to contact you at work instead of at home. In fact, you have the right to ask that Primary Care contact you in whatever manner you want. This means that you can choose the location for us to contact you (at home, work, at a friend or relative’s home, etc.). Also, you can choose the method of contact (postal mail, telephone, e-mail, etc.). We will agree to any reasonable request.

YOU HAVE THE RIGHT TO REVIEW YOUR MEDICAL RECORD

You can review and copy your medical record. As a general rule, patients have the right to look at and receive copies of, their medical records, billing records, and any other records that we use to make decisions about their care. You can arrange to see your record or to get a copy of it, by contacting the Privacy Officer listed on the last page of this Notice. There might be a charge for copying your medical record. You may look at your medical record, at Primary Care’s facilities, for free. Also, copies of immunization records are given out for free. But, if you want to have a copy of any other part of your record, you will be charged Primary Care’s regular fee for copying and mailing the record. Sometimes, we can refuse to let you look at, or copy, your record. Primary Care will not let you see your record if your doctor decides that reviewing your record would be harmful to your health.

YOU HAVE THE RIGHT TO CORRECT YOUR MEDICAL RECORD

If you think that your record is incomplete or incorrect, you may ask for it to be changed. Sometimes, we can refuse to change a record. We can refuse to change a record that we did not create (such as a report stored in your medical record that was sent to us by a hospital). If you disagree with our decision not to correct your record, there are some options available to you. 1. Ask that we include your request for change in the record, or 2. Send us a written statement that explains why you think the change should be made

YOU HAVE THE RIGHT TO KNOW WHO HAS BEEN GIVEN HEALTH INFORMATION ABOUT YOU

If you ask, we will give you a list of the people and organizations, outside of our organization, who were given your health information during the six years before you made your request.

PRIMARY CARE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION AS FOLLOWS:  WITH YOUR WRITTEN PERMISSION

Sometimes, Primary Care will get your written permission before it gives out your health information.

FAMILY MEMBERS OR OTHERS INVOLVED IN YOUR HEALTH CARE

Except in emergency situations, we will first tell you that we are going to call your family or friends. If you do not want us to contact them, let us know. We will follow your request.

WITHOUT YOUR PERMISSION

Primary Care may use, and give out, your records so that treatment can be provided to you or anyone else. We may use, and give out, your health information to help us to get paid for the care that we provide to you. We may also give information about you to another health care provider or a health plan to allow them to get paid for services they provide to you. We may use your health information, or give it out to others, for many of our day-to-day business activities. For example, you call to complain about the care that you received we will use your medical record to help us address your complaint. We may give your health information to another organization, in certain situations:

1. We can give your information to another healthcare organization that provides medical services to you.

2. We can give your information to another person or organization that is part of an “organized health care arrangement” with us. We may use or give out health information about you that does not identify you. We will continue to use and give out your health information when state law requires it.

• We will report child abuse.
• We will report cancer to the state’s cancer registry. We will continue to use and give out health information for public health purposes.
• We will report communicable diseases (such as HIV, hepatitis, rabies, etc.).
• We may give information to the FDA to allow it to track whether drugs and devices (such as pacemakers) are effective and safe.
• We may report births and deaths and other vital statistics. Sometimes, if we think you are being abused or neglected, we are allowed to make a report to the authorities: There are other times when we may use, or give out, your health information. Here are some examples:

1. We may give information to the police to help them catch someone who admitted to being part of a violent crime or who is a suspect, missing person, fugitive or material witness.

2. We can report suspicious deaths to the police or report crimes that occur at our facilities.

3. If you make a serious threat to harm yourself, someone else, or the public.

4. If you are a prisoner, or in the custody, we may give your health information in order to protect the safety of you, the other inmates, and staff.

5. We can give your health information to the government to allow it to maintain national security. We may use your health information, and give out your health information to health oversight agencies (government agencies that supervise the health care industry) to allow them to conduct audits or investigations. For example, the government officials who run the Medicare program might look through our medical and billing records to make sure that we are correctly billing for the medical services that we provide. If you are enlisted in the armed services, we might be asked to give your information to the military.

Sometimes, we can use and give out your health information by order of a Court or Administrative Tribunal or when defending Primary Care Health Services, Inc.

The protections that are listed in this Notice continue to apply after your death. We may contact your relatives or friends to notify them that you have died and provide information about you to the coroner, medical examiner or a funeral director, to allow them to identify your body, prepare your body for burial or cremation, etc. We may use, and give out, your health information in order to allow the organ donation process to occur. As a general rule, we will not allow your health information be used for research. We may use, and give out, your health information to allow you to get workers’ compensation benefits.

SPECIAL SITUATIONS

State law provides special protection to HIV-related information, records of mental health treatment and substance abuse records. We will use, or give out, these kinds of health information only when state law says that we are allowed.

As a general rule, parents or guardians of a child control how we use and give out the child’s health information. Parents and guardians are also able to exercise their children’s rights to look at their records, receive a list of who has received the children’s health information, etc.

That is because a parent or guardian of a child younger than 18 is considered to be the child’s “personal representative.”

Please call or write the Privacy Officer listed for exceptions to that general rule:

EFFECTIVE DATE

This Notice is effective on April 14, 2003. Starting on this date, we will follow the rules outlined in this Notice. We will continue to follow this Notice unless we change the Notice.

WHAT YOU CAN DO IF YOUR PRIVACY RIGHTS ARE VIOLATED

You can complain to us and to the Secretary of the federal Department of Health and Human Services if you believe that your privacy rights have been violated. To complain to us, please write to the Privacy Officer listed on the last page of this Notice. No action will be taken against you because you file a complaint.