Richmond Gastroenterology Associates, Inc.

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1 Richmond Gastroenterology Associates, Inc. Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFOMRATION. PLEASE REVIEW IT CAREFULLY. If you have any questions about this notice or require additional information, please contact our Privacy Officer, Greg Spruill, Administrator, located at 107 Wadsworth Drive, Richmond, Virginia or (804) Our Responsibility: We understand that the medical information about you and your health is personal and we are committed to protecting that information. By law we are required to maintain the privacy of your medical information and provide you with our Privacy Practices. At Richmond Gastroenterology Associates, Inc. we comply with the Health Information Portability and Accountability Act of 1996 (HIPAA). In conducting our business, we create a record of care (paper and/or electronic), services, and treatment you receive from Richmond Gastroenterology Associates, Inc., in order to provide you with care and to comply with certain legal requirements. We are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain concerning your medical information. This notice also describes your rights to access and control your medical information. We are required to abide by the terms of this Notice of Privacy Practices. Uses and Disclosers: This Notice of Privacy Practices describes how we may use and disclose medical information about you, including demographic information, that may identify you and your related healthcare services to carry out your treatment, obtain payment for our services, to perform the daily healthcare operations of this practice and for other purposes that are permitted or required by law. For Treatment: We may use health information about you to provide your treatment or services. Health information may be disclosed about you to others involved in your care. We may provide your health information to different providers who assist in your care or provide services such as a pharmacy, lab, x-ray, home health, physical therapy, dietary, dietitian, etc. Copies of your health information or various reports may be provided to subsequent healthcare providers to assist with continuity of care.

2 For Payment: We may disclose health information about your treatment and services to bill and collect payment from you, your insurance company, or a third party payer. Your insurance company may require information about your health to determine coverage or to determine if your insurance will cover any services provided. Health Care Operations: We may disclose and use your health information to operate our business. We may disclose and use your information for our operations, to evaluate our quality of care, or to conduct cost-management and business planning activities for our practice. We may disclose your health information to other healthcare providers and entities to assist in their healthcare operations. We may also use and disclose medical information: To business associates we have contracted with to perform and agreed upon service and billing for it; To remind you that you have an appointment with us; To tell you about possible treatment alternatives; To tell you about health-related treatment or services; To assess your satisfaction with our services; To assess ways of improving our practice; For population based activities relating to improving health or reducing healthcare costs; For conducting training programs, accreditation, certification, licensing, credentialing, quality assessment and improvement activities, evaluating practitioner or provider performances, or competence of healthcare professionals or staff; We may leave messages on your answering machine, voice mail, , or text when disclosing medical information, appointment reminders, and billing or collection efforts. Business Associates: There are some services provided in our practice through contracts with business associates. When these services are contacted, we may disclose your medical information to our business associate so that they can perform the service we have asked them to do. These business associates will be proved information so they may bill you, your insurance company, or a third party payer for services provided. Business associates are required by law to safeguard your information. Individuals Involved in Your Care or Payment for Your Care: We may release information about you to a friend or a family member who is involved in your medical care or who help pays for your care. We may disclose information about you to an entity assisting in disaster relief effort so that your family can be notified about your condition, status, and location. Research: We may disclose information to researchers when an institutional reviewed the research proposal and established protocols to ensure privacy of your medical information has approved their research and granted a waiver of the authorization requirement.

3 Future Communications: We may communicate with via newsletters, , phone, mail or other means regarding treatment options, health information, disease management or wellness programs, quality improvement programs, or other similar based initiatives or activities we may be participating in. Organized Health Care Arrangement: Our practice and staff members have organized and are presenting you this document as a joint notice. Information will be shared as necessary to carry out treatment, payment and healthcare operations. Providers may have access to protected medical information in their offices and or facilities to assist in reviewing past treatment as it may affect how they treat you at that time. Affiliated Covered Entity: Protected medical information will be made available to staff personnel at our affiliated locations as necessary to carry out treatment, payment and health care operations. Providers at other locations may have access to protected medical information at their locations to assist in reviewing past treatment as it may affect how they treat you at that time. Public Health Risks: We may disclose information about your medical information to public health authorities that are authorized by law to collect information for the purpose of: Maintaining vital records (births and deaths); Health and/or disease registries; Reporting child abuse or neglect; Preventing or controlling disease, injury or 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; Notifying individuals if a product or device they may be suing has been recalled; Notifying appropriate government agencies and/or authorities regarding the potential abuse or neglect of an adult patient; we will only disclose if patient agrees or we are required or authorized by law to disclose this information; Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance. As required by law, we may also disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. We may also use and disclose medical information for the following types of entities, including but not limited to the following: Correctional Institutions Health Oversight Agencies National Security and Intelligence Agencies Protective Services for the President and Others Food and Drug Administration

4 Public Health or Legal Authorities charges with preventing or controlling disease, injury, or disability Funeral Directors, Coroners and Medical Directors Workers Compensation Agents Organ and Tissue Donation Organizations Military Command Authorities State Specific Requirements: Many states have requirements for reporting including population-based activities relating to improving health or reducing healthcare costs. Some states have separate privacy laws that may apply additional legal requirements. If the state privacy laws are more stringent than federal privacy laws, the state law preempts the federal law. Your Medical Information Rights: Although your medical record is the physical property of the healthcare practitioner, practice, or facility that compiled it, you have the right to: Inspect and Copy: You have a right to inspect and obtain a copy of the medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. Your request must be in writing to our Privacy Officer, Greg Spruill at Richmond Gastroenterology Associates, Inc. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your requests. We may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed healthcare professional chosen by us will conduct reviews. Amend: You may ask us to amend your medical information if you believe it is incorrect or incomplete. You have the right to 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 to our Privacy Officer, Greg Spruill, Administrator, located at 107 Wadsworth Drive, Richmond, Virginia We may deny your request for an amendment and if this occurs, you will be notified for the reason of the denial. An Accounting of Disclosers: You have the right to request an accounting of disclosures. This is a list of certain disclosers we make of your health information for purposes other than treatment, payment or healthcare operations where an authorization was not required. Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery or procedure you had. Any request for a restriction must be sent in writing to our Privacy Contact.

5 We are required to agree to you request only if: 1) Except as otherwise required by law, the discloser is to your health plan and the purpose is related to payment or healthcare operations (and not treatment purposes), and 2) Your information pertains solely to health care services for which you have paid in full. For other requests, we are not required to agree. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you at work or by cell phone instead of your home. The practice will grant requests for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing and the written request includes a mailing address where the individual will receive bills for services rendered by the practice and related correspondence regarding payment for services. Please realize, we reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location. A Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. If the practice has a website, you may print or view a copy of the notice by clicking on the Notice of Privacy link. To exercise any of your rights, please obtain the required forms from the Privacy Contact and submitting your request in writing. Changes to This Notice: We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we receive in the future. The current notice will be available at the front desk and on our website and include the effective date. In addition, each time you register you may ask to see this notice. Complaints: If you believe your privacy rights have been violated, you may file a complaint with the practice by following the process outlined in the practice s Notice of Privacy Practices documentation. You may also file a complaint with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint. Other Uses of Health Information: Other uses and disclosers of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you,

6 you may revoke that permission, in writing, at any time. If you revoke permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosers we have already made with your permission, and that we are required to retain our records of that care we provided to you and documented in the office, clinic, or hospital. If you have any questions about this notice, require additional information, or would like to file a complaint, please contact our Privacy Officer, Greg Spruill, Administrator, located at 107 Wadsworth Drive, Richmond, Virginia

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