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.

We recognize the importance of keeping your health information secure and confidential and we are dedicated to protecting your privacy. This Privacy Notice is being provided to you as a requirement of a federal law, the Health Insurance Portability and Accountability Act (“HIPAA”). This Notice describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information in some cases. Your “protected health information” means any communication of health information about you, including demographic data that can be used to identify you. You may request a copy of this notice at any time.

This Notice covers all health care professionals authorized to enter information into your chart, all volunteers authorized to help you while you are here, all our employees and on-site contractors providing care. Your physician may have different policies or notices about health information that were created in his or her private office or clinic.

Uses and Disclosures of Protected Health Information: We may use your health information for purposes of providing treatment, obtaining payment for treatment, and conducting health care operations. Your health information may be used or disclosed only for these purposes unless the facility has obtained your authorization or the use of disclosure is otherwise permitted by the HIPAA privacy regulations or state law. Disclosures of your health information for the purposes described in this Privacy Notice may be made in writing, orally, or by facsimile.

Treatment : We will use and disclose your health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party for treatment purposes. For example, we may disclose your health information to a pharmacy to fill a prescription or to a laboratory to obtain a pathology report. We may also disclose health information to physicians who may be treating you or consulting with the facility with respect to your care. For example, the anesthesiologist providing your care at the facility. In some cases, we may also disclose your health information to an outside treatment provider for purposes of the treatment activities of the other provider. We may disclose your health information to physicians, nurses and other personnel who are involved in taking care of you.

Payment : Your health information will be used, as needed, to obtain payment for the services that we provided. This may include certain communications to your health insurance company to get approval for your procedure and to process billing information. We may also disclose health information to your health insurance company to determine whether you are eligible for benefits or whether a particular service is covered under your health plan. In order to get payment for the services we provide to you, we may also need to disclose your health information to your health insurance company to demonstrate the medical necessity of the services or, as required by your insurance company, for utilization review. We may disclose information to third parties who may be responsible for payment, such as family members, or to bill you. We may also disclose patient information to another provider involved in your care for the other provider's payment activities. This may include disclosure of demographic information to anesthesia care providers for payment of their services.

Healthcare Operations : We may use or disclose your health information, as necessary, for our own health care operations in order to provide quality care to all patients. Health care operations generally include such activities as: quality assessment and improvement activities; employee review activities; training programs including those in which students, trainees, or practitioners in health care learn under supervision; accreditation, certification, licensing or credentialing activities; accounting and auditing, including compliance reviews; medical reviews; legal services; maintaining compliance programs; business management and general administrative activities.

Telephone Calls : As part of treatment, payment and health care operations, we may also use or disclose your health information for the following purposes: to remind you of your procedure date, to inform you of payment, to inform you of pre-operative preparation, and to contact you regarding your status following your procedure.

Family and Friends Involved in Your Care: If you do not object, we may share your health information with your family member(s), personal representative, or a close personal friend if it is directly relevant to the person's involvement in your procedure or payment related to your procedure. We may disclose your information in connection with trying to locate or notify family members or others involved in your care concerning your location or condition.

You may object to these disclosures. If you do not object to these disclosures or if we can infer from the circumstances that you do not object we may disclose your information as described. If we determine, in the exercise of our professional judgment, that it is in your best interest for us to make disclosure of information that is directly relevant to the person's involvement with your care, we may disclose your health information as described.

Other Uses and Disclosures Which Do Not Require Authorization: Federal policy rules allow us

to use or disclose your health information without your permission or authorization

for a number of reasons:

1. Requirements by Law, Legal Proceedings, Health Oversight Activities and Law Enforcement: We will disclose your health information as required by federal, state and other law. For example, we are required to report victims of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when you agree to the disclosure. We will disclose your health information when ordered in a legal or administrative proceeding, such as a subpoena, discovery request, summons, warrant, or other lawful process. We may disclose your health information to law enforcement officials to identify or locate suspects, witnesses, victims of crime, or missing persons. We may disclose health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.
2. Serious Threat to Health or Safety : We may, consistent with applicable law and ethical standards of conduct, use or disclose your health information if we believe, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety, or to the health and safety of the public.
3. Specified Government Functions: In certain circumstances, federal regulations authorize the facility to use or disclose your health information to facilitate specified government functions relating to military and veterans activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions, and law enforcement custodial situations.
4. Worker's Compensation : We may release your health information to comply with worker's compensation laws or similar programs.

Authorization: Other uses and disclosures of your health information not outlined in this Notice, or other laws not mentioned, will not be made without your written authorization. You may revoke your authorization in writing, and we will discontinue future uses and disclosures of your health information for the reasons covered in your authorization.

YOUR RIGHTS

The Right to Inspect and Copy Your Health Information: You may inspect and/or obtain a copy of your health and/or billing information. To do so, please contact the Business Office Coordinator or the Security Officer at 301-598-5100. If you request a copy of your information, we may charge you a fee for the costs of copying, mailing or other costs incurred by us in complying with your request.

We may deny your request to inspect or copy your health information. If your request is denied we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed.

The Right to Request a Restriction on Uses and Disclosures of Your Health Information: You may ask us not to use or disclose certain parts of your health information for the purposes of treatment, payment or health care operations. You may also request that we not disclose your health information to family members or friends who may be involved in your care or for notification purposes as described in this Notice. Your request must state the specific restriction requested and to whom you want the restriction to apply.

The facility is not required to agree to a restriction that you may request. We will notify you if we deny your request to a restriction. If the facility does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. Under certain circumstances, we may terminate our agreement to a restriction. You may request a restriction by contacting the Privacy Officer at 301-598-5100.

The Right to Request to Receive Confidential Communications From Us By Alternative Means: You have the right to request that we communicate with you in certain ways. We will accommodate reasonable requests. We may condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not require you to provide an explanation for your request. Requests must be made in writing to our Privacy Officer.

The Right to Request Amendments to Your Health Information: You may request an amendment to your health information as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Requests for amendment must be in writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendments.

The Right to Receive an Accounting: You have the right to request an accounting of certain disclosures of your health information made by us. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice. We are also not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures to friends or family members involved in your care, or certain other disclosures we are permitted to make without your authorization. The request for an accounting must be made in writing to our Privacy Officer. The request should specify the time period sought for the accounting. We are not required to provide an accounting for disclosures that take place prior to April 14, 2003. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.

The Right to Obtain a Paper Copy of this Notice: Upon request, we will provide a separate paper copy of this notice even if you have already received a copy or have agreed to accept this Notice electronically.

Our Duties: We are required by law to maintain the privacy of your health information and to provide you with this Privacy Notice of our duties and privacy practices. We are required to abide by terms of this Notice and it may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all future health information that we maintain. If we change this Notice, we will provide a copy of the revised Notice upon subsequent visits or by written or oral request.

Complaints: You have the right to express complaints to the facility and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. You may complain to the facility by contacting the facility's Privacy Officer verbally or in writing, using the contact information below. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint. If you feel that your privacy rights have been violated by this facility you may submit a complaint to our Privacy Officer or the U.S. Department of Health and Human Services by sending it to:

EFFECTIVE DATE

This Notice is effective April 14, 2003.

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