Information: Notice of Privacy Practices

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining privacy of your individually identifiable health information (IIHI). In conducting our business, we will create records regarding you and your treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also 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 this time.

We realize that these laws are complicated, but we must provide you with the following important information.

• How we may use and disclose IIHI
• Your privacy rights in your IIHI
• Our obligations concerning the use and disclosure of your IIHI

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 Practices. 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 for any records that we may create or maintain in the future. Our practice will post a copy of our current Notice of Privacy Practices in our office in a visible location at all times. You may request a copy of our most current Notice of Privacy Practices at any time.

B. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

• Privacy Officer, 531 Old Westminster Pike, Suite 202 and 204, Westminster, MD 21157

C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your IIHI.

1. Treatment. Our practice may use your IIHI to treat you. For example, we may ask you to have laboratory tests (such as blood and urine), and we may use the results to help us reach a diagnosis. We might use your IIHI in order to write a prescription for you. Many of the people who work for our practice - including, but not limited to, our doctors, nurses, medical assistants - may use or disclose your IIHI in order to treat you or to assist others in your treatment.
2. Payment. Our practice may use or disclose your IIHI in order to bill and collect payment for the services you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose IIHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your IIHI to bill you directly for services.
3. Appointment Reminders. Our practice may use and disclose your IIHI to contact you and remind you of an appointment. We use an automated telephone reminder system that will leave a message if you do not answer the phone.
4. Treatment options. Our practice may use and disclose your IIHI to inform you of potential treatment options or alternatives.
5. Health-related Benefits and Services. Our practice may use and disclose your IIHI to inform you of health-related benefits and services that may be of interest to you. For example, with your permission, we will use your IIHI to apply for patient assistance programs through pharmaceutical companies and foundations.
6. Release of Information to family or friends. Our practice will not release any of your IIHI to family or friends without written permission from you.
7. Disclosures Required by Law. Our practice may use and disclose your IIHI when required to do so by federal, state or local law.

D. USE AND DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your identifiable health information.

1. Public Health Risks. Our practice may use and disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:
   • maintaining vital records, such as births and deaths
   • preventing or controlling disease, injury, disability
   • notifying a person regarding potential exposure to a communicable disease
   • notifying a person regarding a potential risk for spreading or contracting a disease or condition
   • reporting reactions to drugs or problems with products or devices (FDA -Medwatch)
   • notifying individuals if a product or device they have been using has been recalled
   • reporting child abuse or neglect
   • notifying appropriate government agencies and authorities regarding potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required by law to disclose this information
2. Health Oversight Activities. Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities include, for example, 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.
3. 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. We also may disclose your IIHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

• 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
  • concerning a death we believe has resulted from criminal conduct
  • regarding criminal conduct at our office
  • in response to a warrant, summons, court order, subpoena or similar legal process
• Deceased Patients. Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we may also release information in order for funeral directors to perform their jobs.
• Serious Threats to Health or Safety. Our practice may use and disclose your IIHI when necessary to reduce or prevent serious threat to your health or safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
• Military. Our practice may use and disclose your IIHI if you are a member of the U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
• National Security. Our practice may use and disclose your IIHI to federal officials for intelligence and national security activities authorized by law.
• Inmates. Our practice may use and disclose your IIHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the safety of other individuals.

E. YOUR RIGHTS REGARDING YOUR IIHI

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

1. 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. For instance, you may ask that we contact you at home, rather than at work. In order to request a type of confidential communication, you must make a written request of the Privacy Officer at Carroll Arthritis, LLC specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your IIHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict 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 with 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. In order to request a restriction in our use or disclosure of your IIHI, you must make a request in writing to the Privacy Officer at Carroll Arthritis, LLC Your request must describe in a clear and concise fashion:
   • the information you wish restricted;
   • whether you are requesting to limit our practice's use, disclosure, or both; and
   • to whom you want the limits to apply.
3. 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 to the Privacy Officer at Carroll Arthritis, LLC, in order to obtain a copy of your IIHI. Our practice charges a fee for the costs of copying, mailing, labor and supplies associated with your request.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to the Privacy Officer at Carroll Arthritis, LLC You must provide us with a reason that supports your request for amendment. We may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the IIHI kept by or for our practice; (c) not part of the IIHI which you would be permitted to inspect or copy; or (d) not created by our practice.
5. 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. To obtain a paper copy of this notice, please ask one of the practice's receptionists.
6. Right to File a Complaint. If you believe your privacy rights have been violated, then you may file a complaint with our practice or the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing and addressed to the Privacy Officer at Carroll Arthritis, LLC You will not be penalized for filing a complaint.
7. Right to Provide 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.