NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION

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

Cardiovascular Group P.C. is dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. Cardiovascular Group P.C. is required by law to abide by the terms of this Notice, and we reserve the right to change the terms of this Notice, making any revision applicable to all the protected health information we maintain. If we revise the terms of this Notice, we will post a revised notice at the Clinic and will maker paper copies of this Notice of Privacy Practices for Protected Health Information available upon request.

HOW YOUR MEDICAL INFORMATION WILL BE USED AND DISCLOSED:

We will use your medical information as part of rendering patient care. For example, your medical information may be used by the health care professional treating you, by the business office to process your payment for the services rendered and by administrative personnel reviewing the quality and appropriateness of the care you receive.

We may also use and/or disclose your information in accordance with federal and state laws for the following purposes:

• We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
  
  
• We may contact you to raise funds for the clinic.
  
  
• We may disclose medical information when required by the United States Department of Health and Human Services as part of an investigation or determination of the Clinic.s compliance with relevant laws.
  
  
• Unless you object, we will include general information, including your name, location in the hospital, your condition described in general terms and your religious affiliation in a directory of individuals located in the Hospital. The directory information, except for your religious affiliation, will be released to people who ask for you by name. Your religious affiliation may be given to members of the clergy, even if they do not ask for you by name.
  
  
• Unless you object, we may use or disclose to family members, other relatives or close personal friends the medical information directly relevant to such person’s involvement with your care.
  
  
• Unless you object, we may use or disclose your medical information to notify a family member, a personal representative or another person responsible for your care of your location, general condition or death.
  
  
• We may disclose your medical information to a public or private entity for the purpose of coordinating with that entity to assist in disaster relief efforts.
  
  
• We may use or disclose your medical information for public health activities, including the reporting of disease, injury, vital events and the conduct of public health surveillance, investigation and/or intervention. We may disclose your medical information to a health oversight agency for oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings. We may disclose your medical information concerning abuse, neglect or violence in accordance with federal and state law.
  
  
• We may disclose your medical information in the course of certain judicial or administrative proceedings.
  
  
• We may disclose your medical information for law enforcement purposes or other specialized governmental functions.
  
  
• We may disclose your medical information to a coroner, medical examiner or a funeral director.
  
  
• If you are an organ donor, we may disclose your medical information to an organ donation and procurement organization.
  
  
• We may use or disclose your medical information for certain research purpose.
  
  
• We may use or disclose your medical information to prevent or lessen a serious threat to the health or safety of another person or the public.
  
  
• We may disclose your medical information as authorized by laws relating to workers. compensation or similar programs.
  
  

We will not use or disclose medical information for any other purpose without your written authorization. Once given, you may revoke your authorization in writing at any time.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION: You have the following rights with respect to your medical information:

The right to request restrictions on certain uses and disclosures of your medical information. We are not required to agree to your requested restriction, but if we do, we will honor it.

The right to receive communications from us in a confidential manner.

The right to inspect and copy your medical information. This right is subject to certain specific exceptions, and you may be charged a reasonable fee for any copies of your records.

The right to request an amendment of your medical information. We may deny your request for certain specific reasons, and, if denied, we will provide you with a written explanation for the denial and information regarding further rights you would have at that point.

The right to receive an accounting of the disclosures of your medical information made by the Clinic in the six years prior to your request (following April 14, 2003), except for disclosures for treatment, payment or Clinic operational purposes, disclosures pursuant to an authorization and certain other specific disclosure types.

The right to request a paper copy of the Notice of Privacy Practices for Protected Health Information.

The right to complain to the Clinic and/or to the United States Department of Health and Human Services if you believe that the Clinic has violated your privacy rights. To complain to the Clinic, please contact:

Practice Administrator
Cardiovascular Group P.C.
755 Walther Road
Lawrenceville, GA 30045
(770) 962-0399

If you choose to file a complaint, you will not be retaliated against in any way. If you would like further information regarding your rights or regarding the uses and disclosure of your medical information, you may contact:

Medical Records Department
Cardiovascular Group P.C.
755 Walther Road
Lawrenceville, GA 30045
(770) 962-0399

THIS NOTICE IS EFFECTIVE AS OF August 6, 2002.