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PRIVACY


PRIVACY NOTICE

OF

Norfolk Medical Group

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.

UNDERSTANDING YOUR HEALTH RECORD/INFORMATION

Every time you visit a hospital, physician or other health care provider, a record of your visit is made. This record may include your symptoms, examination and test results, diagnosis, treatment and plans for future care of treatment. Your medical provider uses this information -often referred to as your health record-to plan your care and treatment. The many health care professionals who assist in your care communicate through your health record. Your health information is also used by insurance companies to verify that services we billed for were actually provided. Although your health record belongs to the health care provider or facility that compiled it, you do have certain rights with regard to your health information. Nothing in this Notice of Privacy Practices is intended to or shall limit your rights as provided by state law.

YOUR RIGHTS

You have the right to expect that your health information will be kept secure and used only for legitimate purposes.

You have the right to understand how your health information may be used and disclosed by NMG, LLC.

You have a right to receive this privacy notice that tells you how your health information may be used or disclosed.

You have a right to ask questions about any health privacy issue and have those questions clearly and promptly answered.

You have a (limited) right to know who has seen your health information, and for what purpose. If you make additional requests for such an accounting during any 12-month period, we may charge you a reasonable, cost-based fee.

You have a right to see, and to keep a copy of , all of your health records (except psychotherapy notes). Your request for a copy of your record must be in writing. We may charge you a reasonable, cost-based, copying fee.

You have a right to ask for correction or inclusion of a statement of disagreement for anything in your records that you feel is in error. Your request must be in writing and include supporting documentation.

You have a right to authorize or refuse additional uses of your health information, such as for fundraising, marketing or research.

You have a right to request extra protections for health information you consider especially sensitive and to request that we communicate with you by alternative means.

OUR RESPONSIBILITES

We also have certain responsibilities. These include:

Maintain the privacy of your health information; Providing you with a copy of this Notice; Abiding by the terms of this Notice; Notifying you if we are unable to agree to a requested amendment or restriction; and Accommodating reasonable requests you may have to communicate health information by alternative means or at alternative locations.

If our information practices change, we may change this Notice. If we do so, the change will be effective for information gathered both before and after the effective date of such change. However, before we change our practices, we will post a copy of our new Notice. The effective date of our Notice will always appear at the end of the Notice. We will not use or disclose your health information without your authorization, except as described in the Notice.

DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

We may use or disclose your information for treatment, payment, or health care operations without your permission.

WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION FOR TREATMENT

For example: Information obtained by a nurse, physician, or members of your health care team may be recorded in your record and used to determine the course of your treatment. Health care team members may communicate with one another personally and through the health record to coordinate your care. We may provide your physician or other health care provider with copies of reports that may help determine your future treatment. We may also disclose your information to another health care provider for its payment purposes or its health care operations.

WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION FOR PAYMENT

For example:We may send your bill to you or your insurance company. Your bill may contain information that identifies you, as well as your diagnosis, procedures and supplies used.

WE MAY USE OR DISCLOSE YOU HEALTH INFORMATION FOR HEALTH CARE OPPERATIONS AND INTERNAL BUSINESS PRACTICES

For example: Members of medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in you health record to assess the care and outcomes in you case and others like it. his information is used in our ongoing efforts to improve the quality and effectiveness of the health care and service we provide.

OTHER DISCLOSURES THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION

Unless we are otherwise restricted from doing so, we may also use or disclose your information for the following purposes without your authorization:

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care about you location and general condition.

Communication with family: We may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.

Business Associates: Some services of our organization are provided through contractual arrangements with business associates. These include radiology, certain laboratory services, supplemental staffing, transcription and data management. When services are provided by business associates, we may disclose your health information to our business associates so that they can perform the job we have asked them to do and bill for such services. In addition, we may disclose your health information to accrediting agencies and certain outside consultants. Our business associates must use appropriate safeguards to protect your health information.

Funeral Directors/Medical Examiners: We may disclose your health information to funeral doctors, medical examiner and/or coroners consistent with applicable law so that they can carry out their duties.

Marketing: We may use your information to provide you with information regarding health-related products or services provided by Norfolk Medical Group or information regarding your treatment alternatives. In addition, your health information may be used in face-to-face encounters or to provide you with gifts of nominal value.

Food and Drug Administration (FDA): We may disclose to the FDA, or and entity subject to FDA jurisdiction, your health information for pub luc health purposes related to the quality, safety or effectiveness of an FDA-regulated product or activity for which that person has responsibility. For example, your information may be disclosed in connection with nth reporting of an adverse event, product defect, produce tracking or to provide post marketing surveillance information.

Workers Compensation: We may disclose your health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other programs established by law.

Public Health: When required or permitted by law, we may disclose your health information to public health or legal authorities responsible for preventing or controlling disease, injury, or disability or performing other public health functions. In addition, we may disclose your health information in order to avert a serious threat to health or safety.

Specialized Government Functions: We may disclose your health information for military and veterans activities, national security and intelligence activities, and similar special government functions as required by law.

Correctional Institutions: If you are an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law Enforcement: We amy disclose your health information for law enforcement purposes as required or permitted by law or in response to a valid subpoena, court order or other binding authority.

Disclosures Required by Law: We may use or disclose your health information as required by law provided such use or disclosure complies with and is limited to the relevant requirements of such law.

Health Oversight Agencies: We may disclose your health information to an appropriate heath oversight agency, public authority or attorney involved in health oversight activities.

Judicial and Administrative Proceedings: We may disclose your health information for judicial or administrative proceedings as required or permitted by law or in response to a valid subpoena, court order or other binding authority.

For More Information or to Report a Problem

If you have any questions or would like additional information, you may contact the Privacy Officer at Norfolk Medical Group. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer at the phone number listed at the beginning of this Notice, or the Secretary of Health and Human Services. We will not retaliate against you for filing a complaint.

Effective September 1, 2005