Issa F. Baroudi M.D., P.A

Notice of Privacy Practices

This notice tells how medical information about you may be used and disclosed by our practice. In addition we have provided you with information on how you can get access to your medical record information. Please read this information carefully.

Our office respects your privacy. We understand that keeping your personal health information confidential is very important. Our office strives to abide by federal and state laws which requires us to protect the information that we receive from our patients. Our staff is trained to obtain the proper documents for release of personal health information and will not disclose your information without your authorization or unless the law authorizes or requires us to do so. Please understand that we are protecting our patients and apologize if the documentation requirements may seem bothersome.

HIPAA: Health Information Privacy and Accountability Act is a law that protects the privacy of the health information that we create and obtain in order to provide care and services to our patients. Protected Health Information can include health information from other providers, billing and payment information relating to these services, symptoms, test results, diagnosis and treatments. Federal and State laws allows us to use and disclose your protected health information for purposes of treatment, healthcare operations and to disclose this information for payment purposes. You will be asked to sign a Consent Form during the registration process acknowledging that you have received this notice from our office.

Examples of Use and Disclosures of Protected Health Information for Treatment,Payment and Healthcare Operations.

For Treatment:

• Information obtained by a nurse, physician or other member of our healthcare team will be recorded in your medical record and used to help decide what care may be right for you.
• We may also provide information for others providing care for you. This will help them to stayed informed about your care

For Payment:

• If we request payment from your health insurance plan the health plan needs information from us regarding your medical care. Information provided to them may include your diagnosis, procedures performed and medical care.

For HealthCare Operations:

• We may use your medical records to assess quality and improve services.
• We may use and disclose medical records to review the qualifications and performance of our healthcare providers and to train our staff.
• We may contact you to remind you about appointments and give you information about treatment alternatives or other health related benefits or services.
• We may use and disclose your information to conduct or arrange for services including:
  1. Medical quality review by your health plan
  2. Accounting, legal, risk management and insurance services.
  3. Audit functions including fraud and abuse detection and compliance programs.

Your Rights

The records we create and store are the property of Issa F. Baroudi, M.D., P.A. The protected health information within the chart, however, belongs to the patient. As the patient you have the right to:

• Retrieve, Read and ask questions about this notice.
• Ask us to restrict certain uses and disclosures. You must deliver this request to us in writing and we are not required to grant the request.
• Request and receive from us a paper copy of the most current Notice of Privacy Practices for Protected Health Information.
• Request that your receive a copy of your protected health information. You must make this request in writing. There is a form available for this type of request. You may ask us for this form. In addition we may disclose health information about you to assist in disaster relief efforts.

You have the right to object to these uses or disclosures of your information. If you object we will not use or disclose it.

We may use and disclose your Protected Health Information without your authorization as follows:

• With Medical Researches:
  if the research has been approved and has policies to protect the privacy of your health information. We may also share information with medical researchers preparing to conduct a research project.
• To the Food and Drug Administration (FDA):
  relating to problems with products we sell.
• To comply with Workers' Compensation Laws:
  if you make a workers' compensation claim.
• For Public Health and Safety Purposes as allowed or required by
  law:
  1. To prevent or reduce serious or immediate threat to the health and safety of a person or to the public.
  2. To public health or legal authorities to protect public health and safety.
  3. To public health or legal authorities to prevent or control disease, injury or disability.
• To report suspected abuse or neglect: to public authorities.
• To correctional Institutions: if you are in jail or prison as necessary for your health and the health and safety of others.
• For law inforcement purposes:
  such as when we receive a subpoena, court order or other legal process or you are the victim of a crime.
• For health and safety oversight activities:
  we may share health information with the Department of health.
• For Disaster Relief purposes:
  we may share health information with disaster relief agencies to assist in notification of your condition to family or others.
• For work related conditions that could affect employee health:
  an employer may asks us to assess health risks on a job site.
• In course of Judicial or Administrative proceedings:
  at your request or as directed by a subpoena or court order.
• For specialized Government Functions:
  we may share your information for national security purposes.

Other Uses and Disclosures of Protected Health Information

• Uses and disclosures not in this notice will be made only as allowed and required by law with your written authorization.

Effective Date: April 13, 2003