This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review the information carefully. If you have any questions or concerns, please contact our Privacy Officer at 610.869.0953 or by mail at Chester County Family Medicine & Geriatrics, 1011 West Baltimore Pike, Suite 007, West Grove, PA, 19390.

Purpose of this Notice: We are required by law to maintain the privacy of certain confidential health care information, known as Protected Health Information or PHI, and to provide you with a notice of our legal duties and privacy practices and your rights with respect to your PHI. This Notice describes your legal rights, advises you of our privacy practices, and lets you know how Chester County Family Medicine & Geriatrics is permitted to use and disclose PHI about you.

Chester County Family Medicine & Geriatrics is also required to abide by the terms of the version of this Notice currently in effect. We reserve the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all protected health information that we maintain. Any material changes to the Notice will be promptly posted in our facilities and posted to our web site, if we maintain one. You can get a copy of the latest version of this Notice by contacting the Privacy Officer at the above address.

Uses and Disclosures of PHI: Chester County Family Medicine & Geriatrics may use PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission. Examples of our use of your PHI:

• For treatment. This includes such things as verbal and written information that we obtain about you and use pertaining to your medical condition and treatment provided to you by us and other medical personnel (including doctors and nurses who give orders to allow us to provide treatment to you). It also includes information we give to other health care personnel to whom we transfer your care and treatment, and includes transfer of PHI via radio or telephone to the hospital or dispatch center as well as providing the hospital with a copy of the written record we create in the course of providing you with treatment and transport.
• For payment. This includes any activities we must undertake in order to be reimbursed for the services we provide to you, including such things as organizing your PHI and submitting bills to insurance companies (either directly or through a third party billing company), management of billed claims for services rendered, medical necessity determinations and reviews, utilization review, and collection of outstanding accounts. We may also provide information about to another health care provider or entity for the payment activities of the provider or entity that receives the information (such as the hospital to which you are transported);
• For health care operations. This includes such things as quality assurance activities, licensing, and training programs to ensure that our personnel meet our standards of care and follow established policies and procedures, obtaining legal and financial services, conducting business planning, processing grievances and complaints, creating reports that do not individually identify you for data collection purposes, fundraising, and certain marketing activities. In certain circumstances, we may provide information about you to another provider who is or was involved in your care for their health care operations.
• Reminders for Information on Other Services. We may also contact you to provide you with information about alternative services we provide or other health-related benefits and services that may be of interest to you.

Use and Disclosure of PHI Without Your Authorization. Chester County Family Medicine & Geriatrics is permitted to use PHI without your written authorization including:

• 1. For health care fraud and abuse detection or for activities related to compliance with the law;
• 2. To a family member, other relative, or close personal friend or other individual involved in your care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose health information to your family, relatives, or friends if we infer from the circumstances that you would not object. In situations where you are not capable of objecting (because you are not present or due to your incapacity or medical emergency), we may, in our professional judgment, determine that a disclosure to your family member, relative, or friend is in your best interest. In that situation, we will disclose only health information relevant to that person's involvement in your care.
• 3. To a public health authority in certain situations (such as reporting a birth, death or disease as required by law, as part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report adverse events such as product defects, or to notify a person about exposure to a possible communicable disease as required by law);
• 4. For health oversight activities including audits or government investigations, inspections, disciplinary proceedings, and other administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the health care system;
• 5. For judicial and administrative proceedings as required by a court or administrative order, or in some cases in response to a subpoena or other legal process;
• 6. For law enforcement activities in limited situations, such as when there is a warrant for the request, or when the information is needed to locate a suspect or stop a crime;
• 7. For military, national defense and security and other special government functions;
• 8. To avert a serious threat to the health and safety of a person or the public at large;
• 9. For workers' compensation purposes, and in compliance with workers' compensation laws;
• 10. To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or carrying on their duties as authorized by law;
• 11. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation and transplantation;
• 12. For research projects, but this will be subject to strict oversight and approvals and health information will be released only when there is a minimal risk to your privacy and adequate safeguards are in place in accordance with the law;
• 13. We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.

Any other use or disclosure of PHI, other than those listed above will only be made with your written authorization, (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it). You may revoke an authorization at any time, in writing, except to the extent that we have already relied upon that authorization.

Patient Rights: As a patient, you have a number of rights with respect to the protection of your PHI, including:

• The right to access, copy or inspect your PHI. This means you may come to our offices and inspect and copy most of the medical information about you that we maintain. You may also request a copy of your health information in writing by sending a letter to our Privacy Officer at the address listed above. We will normally provide you with access to this information within 30 days of your request. We may also charge you a reasonable fee for you to copy any medical information that you have the right to access. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials. We have available forms to request access to your PHI and we will provide a written response if we deny you access and let you know whether you have appeal rights. If you wish to inspect and copy your medical information, you should contact the Privacy Officer at the address listed above.
• The right to amend your PHI. You have the right to ask us to amend written medical information that we may have about you. We will generally amend your information within 60 days of your request and will notify you when we have amended the information. We are permitted by law to deny your request to amend your medical information only in certain circumstances, like when we believe the information you have asked us to amend is correct. If you wish to request that we amend the medical information that we have about you, you should contact our Privacy Officer in writing at the address listed above.
• The right to request an accounting of our use and disclosure of your PHI. You may request an accounting from us of certain disclosures of your medical information that we have made in the last six years prior to the date of your request. We are not required to give you an accounting of information we have used or disclosed for certain purposes such as for purposes of treatment, payment or health care operations, when we share your health information with our business associates, like our billing company, when we share your health information with a medical facility from/to which we have transported you, or when you have authorized us to release the information. If you wish to request an accounting of the medical information about you that we have used or disclosed that is not exempted from the accounting requirement, you should contact the Privacy Officer in writing at the address listed above.
• The right to request that we restrict the uses and disclosures of your PHI. You have the right to request that we restrict how we use and disclose your medical information that we have about you for treatment, payment or health care operations, or to restrict the information that is provided to family, friends and other individuals involved in your health care. But if you request a restriction and the information you asked us to restrict is needed to provide you with emergency treatment, then we may use the PHI or disclose the PHI to a health care provider to provide you with emergency treatment. Chester County Family Medicine & Geriatrics is not required to agree to any restrictions you request, but any restrictions agreed to by Chester County Family Medicine & Geriatrics are binding on Chester County Family Medicine & Geriatrics.
• The right to request confidential communications. You have the right to request that we communicate with you about health matters in a certain way or to a certain location. You must convey your request in writing to our Privacy Officer at the address listed above. We will not ask the reason for your request; however, you must specify how and where you wish to be contacted or what alternative payment arrangements have been made. For example: at home, at your office, by phone. We will accommodate all reasonable requests for confidential communications. We cannot, however, control how your insurer communicates with you. If you wish to request confidential communication of insurance information, you should contact your insurance company.

Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request. If we maintain a web site, we will prominently post a copy of this Notice on our web site and make the Notice available electronically through the web site. If you allow us, we will forward you this Notice by electronic mail instead of on paper and you may always request a paper copy of the Notice.

Complaints: You also have the right to complain to us, or to the Secretary of the United States Department of Health and Human Services, if you believe your privacy rights have been violated. Should you have any questions, comments or complaints you may direct all inquiries, in writing, to the Privacy Officer at the address listed above. Effective Date of the Notice: April 14, 2003.