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Privacy Policy

MD Confidential

NOTICE OF PRIVACY PRACTICES
Effective Date: MARCH 19, 2009

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this Notice, please contact MD Confidential Privacy Officer Kary Veggian by dialing (650) 254-1200.

Each time you visit a facility, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information ("protected health information"). This Notice applies to all of the records of your care generated by the office, whether made by office personnel, agents of the office, or your doctor. Your doctor may have different policies or notices regarding the doctor's use and disclosure of medical information created in the doctor's office or clinic.

OUR RESPONSIBILITIES

We are required by law to maintain the privacy of your protected health information and to provide you with a description of our privacy practices and legal duties with respect to your protected health information.

This Notice covers the privacy practices of all health care professionals, employees, contract staff, students and volunteers for MD Confidential.

Within this Notice, a reference to the office may also include the independent and group physician practices with which the office contracts directly for services.

When we provide joint health care to you, we share your protected health information with one another as necessary to per-form treatment, to obtain payment or to carry out operational activities. Within this Notice, a reference to the office may also include the above listed entities.

Whenever we use or disclose your protected health information, we will abide by the terms of our Notice of Privacy Practices. Please sign and return at your earliest convenience the. "Acknowledgment of Receipt" form which will acknowledge your receipt of this Notice.

USES AND DISCLOSURES

A. How We May Use and Disclose Health Information About You - (No Authorization Required)

For Treatment: We may use your protected health information to provide treatment or services to you. We may disclose your protected health information to doctors, nurses, technicians, medical students, or other office personnel who are involved in taking care of you at the office. 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. Different departments of the office also may share your protected health information to coordinate the different things you may need, such as prescriptions, lab work, meals, and x-rays.

We may also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from the office.

For Payment: We may use and disclose medical information about your treatment and services to bill and collect payment from you, your insurance company, health plan or another third party payer. For example, we may need to give your insurance company information about your surgery so they will pay us or reimburse you for the treatment. We may also inform your insurance company about the treatment you are going to receive to determine whether your plan will cover it.

For Health Care Operations: We will also use your protected health information to assist in running our operations. Members of the medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all patients we serve. For example, we may combine medical information about many patients to evaluate the need for new services or treatment. We may disclose information to doctors, nurses, and healthcare students for educational purposes. And we may combine medical information we have with that of other offices to determine where we can make improvements. We may remove information that identifies you from this set of medical information to protect your privacy.

We may also use and disclose your protected health information:

·To our business associates who we contract with to perform services;

·To remind you that you have an appointment for medical care;

·To assess your satisfaction with our services;

·To inform you about possible treatment alternatives;

·To inform you about health-related benefits or services;

·For population-based activities relating to improving health or reducing health care costs; and

·For conducting training programs or reviewing competence of health care professionals.

Effective Date: MARCH 19, 2009

To Business Associates: Some services are provided to us or on our behalf through contracts with third parties ("Business Associates"). For example, we may disclose your protected health information to a copy service we use when making copies of your health record or to a consultant who performs utilization reviews for the office. When these services are contracted, we may disclose your protected health information to our Business Associates so that they can perform the duties we have asked them to do and bill you or your third-party payer for the services rendered. To protect your protected health information, however, we require our Business Associates to appropriately safeguard your information.

To Individuals Involved in Your Care or Payment for Your Care: We may, in our professional judgment, use or disclose your protected health information to a family member, other relative, a friend or any other person identified by you who is involved in your medical care or who helps pay for your care (including your health insurance company). In an emergency situation or in the event of your incapacity, we may exercise our professional judgment to determine whether a disclosure to a particular person is in your best interest. We will disclose only the information that we believe is directly relevant to the person's involvement with your health care or payment for your care. In addition, we may disclose your protected health information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

For Research: We may disclose information to researchers when an institutional review board ("IRB") that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information has approved their research. Unless the IRB has issued a waiver of authorization, we will almost always ask for your written permission ("Authorization") before a researcher will have access to your name, address or other information that already reveals who you are. We may also use or disclose protected

health information for research purposes if we remove certain infor mation that may directly identify you such as your name, telephone number, Social Security number, medical record number and account number. In certain cases, prior to commencement of a study or prior to your enrollment as a subject in a study, your personal heath information may be disclosed without your Authorization on a limited basis to further the office's research mission. For example, we may disclose medical information about you to people preparing to conduct a research project -- to help them identify patients with specific medical conditions and/or to assess the viability of a research idea (subject recruitment and reviews preparatory to research) - so long as the medical information they review does not leave the office.

For Organized Health Care Arrangement: Hospital Surgery Center and the independent and group practices with which the office has directly contracted for services are presenting you this Notice as a joint Notice. Protected health information will be shared as necessary to carry out treatment, payment and health care operations. Physicians and caregivers may have access to protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time.

To Affiliated Covered Entity: Caregivers at other facilities may have access to protected health information at their locations to assist in reviewing past treatment information as it may affect treatment at this time. Please contact the Privacy Officer, or designee, for further information on the specific sites included in this affiliated covered entity.

Effective Date: MARCH 19, 2009

As Required or Permitted by Law: We will use or disclose your protected health information if we are required or permitted by law to do so, including the following:

·Public Health Activities: We may disclose your protected health information for authorized public health activities: to public health officials to prevent or control disease, injury or disability; to the U.S. Food and Drug Administration (the "FDA") as required or permitted by the FDA; to report to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.

·Victims of Abuse, Neglect or Domestic Violence: If we reasonably believe you are a victim of abuse, neglect or domestic violence, we may disclose your protected health information to a governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect or domestic violence.

·For Health Oversight Activities: We may disclose your protected health information to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid.

·To Law Enforcement Officials: We may disclose your protected health information to the police or other law enforcement officials in certain limited, allowable circumstances or in compliance with a court order or a grand jury or an administrative subpoena.

·For Legal Proceedings: We may disclose your protected health information in the course of a judicial or administrative proceeding in response to: (1) a court order; (2) a legally-valid order issued by a state or federal administrative agency or licensing board; and (3) a subpoena, discovery request, or other lawful process in a third party action but only after efforts have been made to notify you that your protected health information is being sought so that you can obtain an order protecting the information requested.

·Decedents: We may disclose your protected health information to a coroner, a medical examiner or a funeral director.

·Organ & Tissue Procurement: We may disclose your protected health information to entities engaged in procurement, banking or transplantation of cadaveric organs, eyes or tissue for purposes of facilitating donation and transplantation.

·Health or Safety: We may use or disclose your protected health information to prevent or lessen a serious and imminent threat to a person's or the public's health or safety.

·Specialized Government Functions: We may use and disclose your protected health information to units of the government with special functions, such as the U.S. military, the U.S. Department of State, under certain circumstances, and correctional institutions.

Workers' Compensation: We may disclose your protected health information as authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs.

Effective Date: MARCH 19, 2009

B. Uses and_ Disclosures Requiring Your Written Authorization

Marketing Activities (Marketing Authorization): We must also obtain your written authorization prior to using your protected health information to send you any marketing materials ("Marketing Authorization"). However, no Marketing Authorization is required in the following circumstances: We may communicate with you: (1) about health-related products or services we provide; (2) about services or products relating to your treatment; (3) about services or products for purposes of case management, or care coordination, or to recommend alternative treatments, therapies, providers or care settings; (4) and provide you with marketing materials in a face-to-face encounter; (5) and give you a promotional gift of nominal value.

Uses and Disclosures of Your Highly Confidential Information: Federal and state laws require special privacy protections for certain highly sensitive information about you ("Highly Confidential Information"), including the subset of your protected health information that: (1) is maintained in psychotherapy notes; (2) is about mental health and developmental disabilities services; (3) is about alcohol and drug abuse prevention, treatment and referral; (4) is about HIV/AIDS testing, diagnosis or treatment; (5) is about venereal disease; (6) is about genetic testing; (7) is about child abuse and neglect; (8) is about domestic abuse of an adult with a disability; or (9) is about sexual assault. For purposes other than those permitted or required by law, we must obtain your written authorization in order for us to disclose your Highly Confidential Information.

Effective Date: MARCH 19, 2009

HOW YOU CAN ACCESS AND CONTROL YOUR PROTECTED HEALTH INFORMATION

The following describes the actions you may take with respect to your protected health information that we maintain.

Inspect and Copy: You may request to inspect and obtain a copy of your protected health information that may be used to make decisions about you and your treatment so long as we maintain this information in our records. Usually, this includes medical and billing records. Under federal law, however, you may not inspect or copy the following: (1) psychotherapy notes; (2) information compiled in reasonable anticipation of, or use in, legal proceedings; or (3) information subject to a federal law that prohibits access to protected health information. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your protected health information, you may request that the denial be reviewed in some situations. We will comply with the outcome of the review.

If you request a copy of your protected health information, we may charge a fee for the costs of copying, mailing, or other supplies we use to fulfill your request. If you wish to make a request, you may obtain a request form from, or submit your detailed request in writing, including the protected health information you are requesting access to and the relevant dates, to the Health Information Management Services Department.

Amendment: If you feel that your protected health information is incorrect or incomplete, you may ask us to amend the information so long as the information is kept by or for the office. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial. If you wish to make a request, you may obtain a request form from, or submit your detailed request in writing, to the Health Information Management Services Department. You must include your reasons for the request.

Accounting of Disclosures: You may request an accounting of disclosures. This is a list of certain disclosures we made of your protected health information for purposes other than treatment, payment or health care operations during any time period prior to the date of your request provided: (1) such period does not exceed six years; (2) disclosures made for treatment, payment, health care operations and certain other limited purposes will not be included; and (3) disclosures that occurred prior to MARCH 19, 2009 are also excluded. If you wish to make a request, you may obtain a request form from, or submit your detailed request in writing, to the Health Information management Services Department.

The first accounting you request within a 12-month period is free of charge. For additional accounting(s), we may charge you for the costs of providing the accounting(s). We will notify you of the cost involved in advance; you may choose to withdraw your request at that time before any cost is incurred.

Effective Date: MARCH 19, 2009

Request Additional Restrictions: You may request a restriction or limitation on our use or disclose of your protected health information for purposes of treatment, payment or health care operations. You may also request a limit on your protected health information we disclose to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. If you wish to make a request, you may obtain a request form from, or submit your detailed request in writing, to your care provider or to the Privacy Officer, or designee,.

Request Confidential Communications: You may request that we communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that we contact you at work or by U.S. Mail. MD Confidential will accommodate reasonable requests for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing to your care provider or to the Privacy Officer and the written request includes a mailing address where you will receive bills for services rendered by the office and related correspondence regarding payment for services. Please realize, we reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice and the revised Notice will be effective for the information we already have about you as well as any information we receive in the future. The revised Notice will be effective for all protected health information that we maintain as of the effective date of such revised Notice, even if we collected or received the protected health information prior to the revised Notice's effective date. The current Notice in effect will be posted in the office and will include the effective date. In addition, each time you register at or are admitted to the office for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current Notice in effect.

Effective Date: MARCH 19, 2009

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the office's Privacy Officer. To obtain information or be contacted by the Privacy Officer, or designee, you may leave a message on the Corporate Compliance Hotline, or you may call Administration at 650-940-7300. Or you may file a complaint by contacting the Secretary of the U.S. Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

OTHER USES OF PROTECTED HEALTH INFORMATION

Other uses and disclosures of protected health information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you authorized us to use or disclose your protected health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your protected health information for the reasons covered by your written authorization. You understand that we are unable to take back any uses or disclosures we have already made in reliance on the authorization, and that we are required to retain our records of the care that we provided to you.

STATE SPECIFIC REQUIREMENTS

Many states have requirements for reporting including population-based activities relating to improving health or reducing health care costs. Some states have separate privacy laws that may apply additional legal requirements. If the state law is more stringent than the federal law, the state law will preempt the federal law.

PRIVACY OFFICER

The Privacy Officer, or designee, may be reached by dialing Kary Veggian at (650) 254-1200.