Cardiology Associates, P

WE HAVE A LEGAL DUTY TO SAFEGUARD THE PRIVACY OF YOUR PROTECTED HEALTH INFORMATION (“PHI”).

We are required by law to maintain the privacy of your health information. We call this information “protected health information” (or “PHI” for short), and it includes information that identifies you, or can be used to identify you, that we have created or received about your past, present or future health or condition, the provision of health care to you, or payment for your health care. We are also legally required to provide you with this notice of our privacy practices with respect to PHI. This notice generally explains the types of uses and discloses of your PHI that are permitted or required, and your rights with respect to your PHI. We are legally required to follow the privacy practices that are described in this notice. However, we reserve the right to change our privacy policies and the terms of this notice at any time. Any change will apply to all PHI that we maintain, including the PHI we already have. Before we implement an important change to our privacy policies, we will promptly change this notice and post a new notice in the waiting room. You can also request a copy of this notice from the contact person identified at the end of this notice, and can view a copy of this notice on our website at www.cardioassoc.com.

REQUIRED AND PERMITTED USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

We use and disclose health information for many different reasons. Generally, we are required to limit any uses and disclosures to that which is reasonably necessary to achieve the purpose of the use or disclosure. For some of these uses and disclosures, we need your prior written authorization. Below, we describe the different categories of our uses and disclosures that do not require your authorization, and provide some examples.

Permitted uses and disclosures relating to treatment, payment or health care operations:

Treatment. We may disclose your PHI to physicians, nurses, medical students, and other health care personnel who provide you with health care services or are involved in your care. For example, if you are being treated for a heart attack and require cardiac rehabilitation, we may disclose your PHI to the Cardiac Rehab department to coordinate your exercise program.

Payment for treatment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you. For example, we may disclose portions of your PHI to our billing department and your health plan to get paid for the health care services we provide to you. We may also provide your PHI to certain of our business associates that assist us in processing our claims for reimbursement for health care that we provided, such as billing companies and claims processing companies.

Health care operations. We may disclose your PHI in order to operate this medical office. For example, we may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you. We may also provide your PHI to our accountants, attorneys, consultants and others, in order to make sure we are complying with the laws that affect us.

Other permitted uses and disclosures. We may also use and disclose your PHI for the following purposes:

As required by law. We may make disclosures that we are required by federal, state or local law to make.

As required by judicial or administrative proceedings. For example, we make disclosures as required by court order.

As required for law enforcement purposes. For example, we make disclosures as required by grand jury subpoena or court-ordered warrant.

For public health activities. For example, we report information about diseases and deaths to government officials in charge of collecting such information.

About decedents and for cadaveric organ, eye or tissue donation purposes. For example, we provide coroners, medical examiners and funeral directors necessary information regarding an individual’s death.

In response to health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.

For research purposes. Under certain conditions, we may provide PHI in order to conduct medical research.

About victims of abuse, neglect or domestic violence. We disclose information regarding victims as required by law.

To avert a serious threat to health or safety. In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.

For specialized government functions. For example, we may disclose PHI of military personnel for military purposes.

For workers’ compensation purposes. We may provide PHI in order to comply with the Workers’ Compensation Law.

When contacting you. We may use PHI to provide appointment reminders or give you information about treatment alternatives, or other health care services we offer.

Disclosures to family, friends or others. Unless you object in whole or in part, we may provide your PHI to a family member, friend or other person that you indicate is involved in your care or in the payment for your health care. In addition, we may use and disclose your protected health information to assist in disaster relief efforts.

Required disclosures. We are required to disclose your PHI to you when you exercise your rights to access your PHI or request an accounting of PHI disclosures, as described below. In addition, we are required to disclose PHI upon the request of the U.S. Department of Health and Human Services, as required by it to determine our compliance with privacy rules.

Other uses and disclosures require your prior written authorization. In other situations not described above, we will ask for your written authorization before using or disclosing your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke it in writing to stop any future uses and disclosures to the extent that we have not taken any action relying on the authorization.

YOUR RIGHTS

You have the following rights with respect to your PHI:

The right to request limits on uses and disclosures of your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to agree to it. If we agree to your request, we will put any limits in writing and abide by them, except in emergency situations. You may not limit the uses and disclosures that we are legally required or permitted to make.

The right to choose how we send PHI to you. We must accommodate any reasonable request to have your PHI sent to you by alternate means or to alternate locations (for example, sending information to your work address rather than your home address).

The right to see and get copies of your PHI. In most cases, you have the right to look at or get copies of your PHI that we have, but you must make the request in writing. If we do not have your PHI but we know who does, we will tell you how to get it. We will respond to you within 10 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you in writing our reasons for the denial and explain your right to have the denial reviewed.

If you request copies of your PHI, we will charge you our reasonable costs, not to exceed 75 cents per page. Instead of providing the PHI you requested, we may provide you with a summary or explanation of the PHI as long as you agree to that and to the cost in advance.

The right to get a list of the disclosures we have made. You have the right to get a list of disclosures of your PHI. The list will not include disclosures relating to treatment, payment or health care operations, as described above, or uses or disclosures that you previously authorized, or disclosures made to you or your family or other persons who are involved in your care or the payment for your care. The list also will not include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or uses and disclosures made before April 14, 2003. We will respond within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. The list will include the date of the disclosure, to whom the PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you $35.00 for each additional request.

The right to correct or update your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add any missing information. You must provide the request and the reason for your request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by us, (iii) Not PHI to which you have the right to access, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you do not file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI.

The right to obtain this notice. You have the right to obtain a paper copy of this notice or receive it by e-mail, or both.

HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

If you think that your privacy rights have been violated, you may file a complaint with the contact person identified below. You may also send a written complaint to the Secretary of the Department of Health and Human Services. We will take no retaliatory action against you if you file a complaint about our privacy practices.

CONTACT PERSON

If you have any questions about this notice or any complaints about our privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact: Privacy Officer, c/o Cardiology Associates, P.C., 30 Harrison Street, Suite 250, Johnson City, New York 13790-2143, telephone number: 607-770-8600.

This notice is effective as of April 14, 2003.