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.

Due to newly enacted government regulations, all medical providers are required to prepare and to provide patients with this information.

Our practice is dedicated to maintaining the privacy of your individually identifiable health information. (IIHI). In conducting our business, we will create records regarding you and the treatment and services we render to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. Federal and state laws require us to follow the terms of the notice of privacy practices that we have in effect at this time.

We will have a current copy of our privacy notice posted in our waiting room. We reserve the right to revise or amend this Notice of Privacy Practices. The new notice will apply to all Personal Health Information (PHI) that we have in our possession at the time or PHI we will disclose or come into the possession of in the future. To obtain a copy of the revised Notice, you may request one by phone, by letter, email or in person the next time you visit the office.

We realize that these new laws may be somewhat complicated, but we must provide you with the following important information:

Questions about this Notice may be directed to our Privacy Officer, Dr. Todd N. Cardwell. You may call or write to Dr. Cardwell at Clinical Cardiovascular Specialists, Inc., P. O. Box, Cleveland, OH 44193.

HOW WE WILL USE AND DISCLOSE YOUR PROTECED HEALTH INFORMATION

The following categories describe different ways that we use and disclose PHI. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. In this notice, the word “use” means to review, consult, read, update and study your PHI so that we can provide health care to you to assure that we are caring for you in the best way that we can and to perform other activities permitted or required by law. The word “disclosure” in this Notice means that we are providing your PHI to someone outside of our practice so that he or she can provide care for you, understand your health condition in order to explain it to you, learn more about your particular health condition, so that we can get paid for providing health care to you and other activities permitted or required by law. These are the activities where we may use and disclose your PHI.

For Treatment. One of the most common reasons that we use or disclose your PHI is to provide health care treatment to you. We will use the medical and health information in your medical record to provide treatment to you. We may disclose your PHI to other health care personnel who are involved in taking care of you at the hospital or in other doctor’s offices, so that they can provide health care treatment to you. An example of how we use your PHI in our office to provide you with health care treatment is when a doctor in our office reviews the results of blood work that you had so that he can provide treatment for you. An example of how we disclose your PHI is when we send a copy of your medical record to another doctor who is a specialist that we referred you to for treatment of a specific problem.

For Payment. We may use or disclose your PHI so that we can obtain payment for the health care services that we provide for you. We may send a statement with our return address to you at the address that you provided to us so that we are aware of how much you owe us for your health care treatment. If someone else pays for your health care treatment, such as an insurance company or Medicare or Medicaid, we may send your PHI to them in order to receive payment for our health care services to you. We may also send your PHI to your health insurance provider in order to receive approval in advance for treatment that we would like to provide to you.

For Health Care Operations. We may use or disclose your PHI for our health care operations. Health care operations are the business operations of our office that have to do with maintaining the office as a business and assuring that we provide quality care to our patients. We may share your PHI with billing clerks who prepare the bills for the treatment that we provide to you. We may also share your PHI with other doctors and health care professionals in order to provide you with the best health care possible. We may also share your PHI with others, such as transcriptionists who help us keep good records of the health care provided to you.

For Emergency Treatment. We may use or disclose your PHI to provide you with emergency treatment. If this happens, we will attempt to obtain your consent for the PHI that we used or disclosed in order for you to obtain this emergency treatment as soon after the emergency as possible.

As Required By Law. We may disclose PHI about you when we are required to do so by federal, state or local law. If a law requires that we disclose your PHI, we will do so only to the extent required by the law. Federal law permits and/or requires us to disclose your PHI to agencies that do health care oversight, public health activities, Workers Compensation, Food and Drug Administration, to report suspected child abuse, neglect or domestic violence and similar legally regulated activities.

Lawsuits, Disputes and Subpoenas. If you are involved in a lawsuit or a dispute, we may be required to disclose PHI about you in response to a court or administrative order. We may also be required to disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement. We may be required to disclose information if asked to do so by a law enforcement official:

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION.

You have the following rights regarding protected health information we maintain about you.

Right to Inspect and Copy. You have the right to inspect and copy PHI that may be used to make decisions about your care. Usually, this includes medical and billing records. To inspect and copy protected health information that may be used to make decisions about you, you must submit your request in writing on the form provided by our Practice. We will respond to your request as soon as we can and usually within sixty (60) days of your request. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect the copy in certain very limited circumstances. If you are denied access to your PHI, you may request that the denial be reviewed in certain circumstances. Another licensed health care professional chosen by the Practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Request Alternative 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 only contact you at work or by mail. To request confidential alternative communications, you must make your request in writing on the form provided by the Practice and submitted to the address listed on the first page of this Notice. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us 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. To obtain a paper copy of this Notice, contact the office at the number listed on the first page.

OTHER USES OF PROTECTED HEALTH INFORMATION

Other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose PHI about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose protected health information about you for the reasons covered by your written authorization. Please understand that we are not able to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provided to you.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. We reserve the right to make the revised or changed notice effective for PHI we already have about you as well as any information we create or receive in the future. We will post our revised Notice in our waiting room [and on our website at www.ohiocardiology.com]. If you would like a copy of the revised Notice, just ask us for one the next time you are in our office or call the office and we will mail a copy to you.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our office and with the Secretary of the United States Department of Health and Human Services. To file a complaint with our office, contact our Privacy Officer at the number listed on the first page. To file a complaint with the Secretary of the United States Department of Health and Human Services, send a letter to: Secretary, United States department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201 or an email to: HHS.Mail@hhs.gov. All complaints must be submitted in writing. You will not be penalized for filing a complaint.