Privacy Statement

Notice of Health Information Privacy Practices

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED WITHIN THIS ORGANIZATION AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE READ THIS CAREFULLY.

Effective Date of this Notice: January 1, 2006

Summit Gastroenterology (SG) is required by law to maintain the privacy of your personal medical information and to provide you with this notice of its privacy policies.

USES AND DISCLOSURES

Treatment:

SG may use your information to provide or coordinate your care. We may disclose all or any portion of your medical information to any of our physicians, other consulting or referring physicians, nurses or nurse practitioners, physician assistants, and other employees who have a legitimate need for such information to provide or coordinate your care. In addition, we may share your information with our own endoscopy centers.

Payment:

We may release your information to determine coverage by an insurer for our services, billing, and claims processing. The information may be released to an insurance company, third party payer, or other organization involved in the payment of your bill. This information may include copies or excerpts of your medical information that are necessary to receive payment.

Routine Operations:

We may use and disclose your information during routine operation of the practice. An example of routine operations would be to contact you to remind you of an appointment or to disclose information to transcriptionists, attorneys, or consultants working for the practice. These entities are called "Business Associates." We require our Business Associates to treat your information in the same manner that we do.

Research:

Under certain circumstances, we may use and disclose your information within approved clinical research studies. Most clinical research studies require specific patient consent; however, there may be some cases where a review of your information without patient contact may be conducted by the researchers.

Regulatory Agencies:

We may disclose your information to state, local, or federal agencies authorized by law to conduct inspections, audits, or investigations of the practice.

Law Enforcement/Litigation:

We may disclose your information for valid law enforcement purposes as required by law or in response to a court order or subpoena.

Public Health:

We may disclose your information to public health authorities as authorized by law and related to the prevention or control of certain diseases.

Workers Compensation:

We may release your information to Workers? Compensation agencies in the event your illness or injury may be related to your work.

Military/Veterans:

If you are a member of the armed forces or a veteran, we may release your information as required by military command authorities.

As Otherwise Required:

We may disclose your information in any situation in which such disclosure is required by law (for example, child or domestic abuse).

PROHIBITED USES

We will not disclose your information to persons outside the practice for purposes other than treatment, payment, or healthcare operations without your authorization in writing. If you provide such an authorization to us, you may revoke it in writing at anytime in the future and we will honor that request.

YOUR RIGHTS RELATED TO YOUR HEALTH INFORMATION

Although all records concerning your treatment at SG are the property of SG you have certain rights concerning this information as follows:

Right to Confidentiality:

You have the right to receive confidential communication of your health information by alternative means or at alternative locations, if you so request in writing.

Right to Inspect and Copy:

You generally have the right to inspect and receive a copy of your health information from SG, unless that is restricted by law or your physician. You will need to pay for copies of any records we provide.

Right to Amend:

You have the right to request an amendment or correction to your health information. If we agree that information is appropriate, we will include that information in your medical record.

Right to Accounting:

You have the right to obtain a record of disclosures that we make of your health information for other than treatment, payment or routine operation of the practice.

Right to Request Restrictions:

You have the right to request restrictions on certain uses and disclosures of your health information. We will abide by these requests to the extent that we are able.

Right to Revoke Authorization:

You have the right to revoke your prior authorization to release your health information except to the extent action was taken in reliance of your original authorization.

Right to Complain:

You have the right to formally complain about our handling of your health information. You may contact the practice administrator below or the Department of Health and Human Services. If you complain, we will not retaliate against you in any way.

CHANGES TO THIS NOTICE

SG will abide by the terms of this Notice currently in effect. However, SG reserves the right to change the terms of the Notice at any time. Any new notice provisions will be effective for all health information from the time that changes are effective within SG.

FOR MORE INFORMATION REGARDING THIS POLICY, PLEASE CONTACT US AT (816) 554-3838