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.

OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and the treatment and service we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practice. 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 future. Our practice will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.

WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS
The following categories describe the different ways we may use and disclose your IIHI.
Treatment. Our practice may use your IIHI to treat you. For example, we may ask you to have laboratory tests and we may use the results to help us reach a diagnosis. We may disclose your IIHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice - including but not limited to, our doctors and nurses - may use or disclose your IIHI to others who may assist in your case, such as your spouse, children or parents. Finally, we may disclose your IIHI to other health care providers for purposes related to your treatment.

Payment. Our practice may use and disclose your IIHI in order to bill and collect payment for the services and item you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits and we may provide your insurer with details regarding your treatment to determine if your insurer will pay for your treatment. We also may use and disclose your IIHI to obtain payment from third parties that may be financially responsible, such as family members. We may use your IIHI to bill you directly for services and items. We may disclose your IIHI to other health care providers and entities to assist in their billing and collection efforts.

Health Care Operations. Our practice may use and disclose your IIHI to operate our business. As examples of ways in which we may use and disclose your information for our operations, our practice may use your IIHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice. We may disclose your IIHI to other health care providers and entities to assist in their health care operations.

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

Missed Appointments. Our practice may use or disclose your IIHI to contact you by telephone or mail regarding missed appointments.

Treatment Options. Our practice may use and disclose your IIHI to inform you of potential treatment options or alternatives.

Health-Related Benefits and Services. Our practice may use and disclose your IIHI 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 you IIHI to a family member or friend that is involved in your care, or who assists in taking care of you.

Disclosures Required By Law. Our practice will use and disclose your IIHI when we are required to do so by federal, state or local law.

USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or disclose your IIHI:

Public Health Risks. Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information. For examples please request a copy of our complete Privacy Policy.

Health Oversight Activities. Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

Lawsuits and Similar Proceedings. Our practice may use and disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. For more explanation, please request a copy of our Privacy Policy.

Law Enforcement. We may release IIHI if asked to do so by a law enforcement official, regarding a crime victim in certain situations, if we are unable to obtain the person's agreement. For more explanation, please request a copy of our Privacy Policy.

Research. Our practice may use and disclose your IIHI for research purposes in certain limited circumstance. We will obtain your written authorization to use your IIHI for research purposes except when and Institutional Review Board or Privacy Board has determined that the waiver of your authorization has been satisfied. For a list of examples, please request a copy of our Privacy Policy.

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

Workers' Compensation. Our practice may release your IIHI for workers' compensation and similar program.

YOUR RIGHTS REGARDING YOUR IIHI
You have the following rights regarding the IIHI that we maintain about you:

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. You may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Practice Management, specifying the requested method of contact, or location. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.

Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment or health care operation. Additionally, you have the right to request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. To request restrictions, you must make your request in writing to Practice Management, and you will be further instructed.

Inspection and Copies. You have the right to inspect and obtain a copy of the IIHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Practice Management; in order to inspect/or obtain a copy of your IIHI. Our practice may charge a fee for the cost of copying, mailing, labor and supplies associated with your request. We may deny your request to inspect/copy in certain limited circumstances and you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.

Amendment. You may request an amendment of your IIHI if you believe it is incorrect or incomplete. Submit your request for amendments in writing to Practice Management with supporting information for the amendment.

Accounting of Disclosures. All of our patients have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain non-routine disclosures our practice has made of your IIHI for non-treatment, non-payment or non-operations purposes. Use of your IIHI as part of the routine patient care in our practice is not required to be documented. Request should be made in writing to Practice Management, all requests 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. Fees may be associated with your request and will be discussed when a request is made.

Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time.

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. To file a complaint with our practice, contact Annette Kahleh 713.776.8888. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

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. Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for the reasons described in the authorization. Please note, we are required to retain records of your care.

ANY QUESTION REGARDING THIS NOTICE OR OUR HEALTH INFORMATION PRIVACY POLICIES PLEASE CONTACT: ANNETTE KAHLEH 713.776.8888