Your Privacy HIPAA Compliance 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. Our Commitment to Your Privacy: We understand that medical information about you is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain. We are required by law to keep medical information about you private, to give you this notice of our legal duties and privacy practices with respect to medical information about you and to follow the terms of the notice that is currently in effect. Changes to this Notice: We may change our policies at any time. Changes will apply to medical information we already hold, as well as new information after the change occurs. Before we make a significant change in our policies, we will change our notice and post the new notice in our waiting room and on our website at www.stelizabethphysicians.com. You will be given a copy of the current notice the first time you visit our office after the effective date. You will be asked to acknowledge in writing your receipt of this notice. How we may use and disclose medical information about you: We may use and disclose medical information about you for treatment (such as sending medical information about you to a specialist as part of a referral or faxing information to your pharmacy for prescription refills); to obtain payment for treatment (such as sending billing information to your insurance company or Medicare); and to support our health care operations (such as comparing patient data to improve treatment methods). We may use or disclose medical information about you for several other reasons. Subject to certain requirements, we may give out medical information about you without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, research studies under certain limited circumstances, funeral arrangements and organ donation, workers' compensation purposes, and emergencies. We also disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances, or in response to valid judicial or administrative orders. We may also contact you for appointment reminders, to tell you about or recommend possible treatment options, alternatives, health-related benefits or services that may be of interest to you. We may disclose medical information about you to a family member, friend or other person you identify who is involved in your medical care unless you object. Other uses of medical information: In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision. Your rights regarding your medical information: In most cases, you have the right to view or obtain a copy of medical information that we use to make decisions about your care, when you submit a written request. After the first request for copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision. If you believe information in your record is incorrect or that important information is missing, you have the right to request that we correct the records, by submitting a request in writing that provides your reason for requesting the amendment. We have a right to deny your request to amend a record if the information was not created by us; if it is not part of the medical information maintained by us; or if in our opinion that amended record is inaccurate. You may appeal, in writing, a decision by us not to amend a record. You have the right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, health care operations or where you specifically authorized a disclosure, when you submit a written request. The request must state the time period desired for the accounting, which must be less than a 6 year period and starting after April 14, 2003. The first disclosure list in a 12 month period is free; other requests may be charged. We will inform you of the charge before you incur any costs. If this notice was sent to you electronically, you have the right to a paper copy of this notice. You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you. You may request, in writing, that we not use or disclose medical information about you for treatment, payment or healthcare operations or to persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will consider your request but we are not legally required to accept it. We will inform you of our decision on your request. All written requests or appeals should be submitted to: Corporate Privacy Officer St. Elizabeth Physicians 334 Thomas More Parkway, Suite 160 Crestview Hills, KY 41017 Complaints: If you are concerned that your privacy rights may have been violated, or if you disagree with a decision we made about access to your records, you may contact our Corporate Privacy Officer in writing. Finally, you may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our Corporate Privacy Officer can provide you the address. You may contact the Corporate Privacy Officer at the above address or by calling (866) 669-5124. Under no circumstance will you be penalized or retaliated against for filing a complaint. We care for patients and serve everyone without regard to race, color, religion, ethnic origin, sex, marital status, public assistance, disability, age or any other category prohibited by law.