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

Our commitment to your privacy

Our practice is dedicated to maintaining the privacy of your personal health information as part of providing professional care. We also are required by law to keep your information private. These laws are complicated, but we must give you this important information. This notice is a condensed version of the full, legally required NPP. If you would like a copy of the full six page document, you may request one from the front desk or you may review the copy kept in the notebook in the clinic waiting room. However, we can’t cover all the possible situations, so please talk to our Privacy Officer about any questions or problems.

We will use the information about your health which we get from you or from others mainly to provide you with treatment, to arrange payment for our services, and for some other business activities which are called, in the law, health care operations. After you have read this NPP we will ask you to sign a consent form to let us use and share your information. If you do not consent and sign this form, we cannot treat you.

If we or you want to use or disclose (send, share, release) your information for any other purposes we will discuss this with you and ask you to sign an authorization form to allow this.

Of course we will keep your health information private but there are some times when the laws require us to use or share it. For example: 1. When there is a serious threat to your health or safety or the health and safety of another individual or the public. We will only share information with a person or organization which is able to help prevent or reduce the threat. 2. Some lawsuits and legal or court proceedings 3. If a law enforcement official requires us to do so. 4. For Workers Compensation and similar benefit programs

There are some other situations like these which don’t happen very often. They are described in the longer version of the NPP.

Your rights regarding your health information

· You can ask us to communicate about your health and related issues in a particular way or at a certain place which is more private for you. For example, you can ask us to call you at home and not at work to schedule or cancel an appointment. We will try our best to do as you ask.

· You have the right to ask us to limit what we tell people involved in your care or the payment of your care, such as family members and friends. While we don’t have to agree with your request, if we do agree, we will keep our agreement except if it is against the law, or in an emergency, or when the information is necessary to treat you.

· You have the right to look at the health information we have about you such as your medical and billing records. You can even get a copy of these records but we may charge you. Contact our Privacy Officer to arrange how to see your records.

· If you believe the information in your records is incorrect or missing important information, you can ask us to make some kinds of changes (called amending) to your health information. You must make this request in writing and send it to our Privacy Officer. You must tell us the reasons you want to make the changes.

· You have the right to a copy of this notice. If we change this NPP we will post the new version in the notebook in the clinic waiting room and we will announce the changes in our monthly newsletter. You can always request an updated version for your files from our Privacy Officer.

· You have the right to file a complaint if you believe your privacy rights have been violated. You can file a complaint with our Privacy Officer and with the Secretary of the Department of Health and Human Services. All complaints must be in writing. Filing a complaint will not change the health care we provide you in any way.

If you have any questions regarding this notice or our health information privacy policies, please contact our Privacy Officer who is Mary Jane Hershey and can be reached by phone at (614) 764-7900 or by e-mail at nancy.vogel@stryker.com

The effective date of this notice is April 14, 2003