There are laws regarding your personal health information. Under these regulations we are required to advise you of our privacy policy.

“Protected Health Information” is any information about your health that may be used to identify you, including written or oral health information that relates to your physical or mental health.

OUR PLEDGE REGARDING YOUR PROTECTED HEALTH INFORMATION The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at Family Health Center of Joplin. We need to provide you with the quality care and to comply with certain federal and state requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe your rights and duties regarding the use and disclosure of medical information.

OUR LEGAL LIABILITY Law requires us to:

Keep your medical information private. Advise you of our privacy policy, legal duties, and your rights regarding your medical information. Follow the terms of the notice that is now in effect.

We have the right to:

Change our privacy practices and the terms of this notice at any time, provided these changes are permitted by law. Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before the changes.

Notice of change to privacy practices:

1. Before we make an important change in our privacy practices we will change this notice and make the new notice available upon request.

USES AND DISCLOSURE OF YOUR MEDICAL INFORMATION

Listed below are the most common ways we use and disclose protected health information. We will not use or disclose your protected health information in other ways without your specific written authorization. Any authorization may be revoked in writing.

FOR TREATMENT: We may share your medical information with other care providers who are participating in your care including pharmacists, therapists, specialists, nurses, Home Health, etc. FOR PAYMENT: We may use and disclose your medical information for payment purposes. This includes your insurance company with other payers. FOR PRACTICE OPERATION/EVALUATION: This might include measuring and improving the quality of care, performance evaluations of employees, training programs was well as a accreditation, certification, and licenses, etc. NOTIFICATION: In cases of emergencies we will notify a family member or personal representative of your general condition or death. We will share only the information that is directly necessary for your health care. We will also use our professional judgment about allowing someone to pick up medicine, medical supplies, x-ray or medical information for you. We prefer for you to give us a written list of persons authorized to obtain information about your treatment, pick up prescriptions etc. DISASTER RELIEF: Medical information with a public or private organization or person who can legally assist in disaster relief efforts. RESEARCH IN LIMITED CIRCUMSTANCES: Medical information for research purposes in circumstances where the research has been approved by a review board that has reviewed the research proposal and established protocols to ensure the privacy of medical information. FUNERAL DIRECTOR, CORONER, and MEDICAL EXAMINER: To help them carry out their duties, we mat share the medical information of a person who has died with a coroner, medical examiner, funeral director, or an organ procurement organization. WHEN LEGALLY REQUIRED: This practice will comply with and Federal, State or local law that requires it to disclose your protected health information. This may include subpoenas, court orders, crimes, etc. WHEN THERE ARE RISKS TO PUBLIC HEALTH: As permitted or required be law. 1) to prevent, control, or report disease, injury or disability

2) report vital events such as birth or death

3) conduct public health surveillance, investigations and interventions

4) collect or report adverse events and product defects, enable product recalls, repairs or replacements, and conduct post marketing surveillance

5) To notify a person who has been exposed to a communicable disease or who may be at risk of contracting to spread a disease.

6) to report to an employer in cases or worker’s compensation or risk in the workplace

TO REPORT ABUSE, NEGLECT OR DOMESTIC VIOLENCE: We may disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may share your medical information if it is necessary to prevent a serious threat your health or the health and safety of others. We may share medical information when necessary to help law enforcement officials capture a criminal/escapee from legal custody. HEALTH OVERSIGHT ACTIVITIES: We may disclose medical information to an agency providing health oversight for oversight activities authorized by law, including adults, civil, administrative, or criminal investigation or proceedings, inspections, licensure or disciplinary actions or other authorized activities.

4. YOUR RIGHTS: you have the right to: a. Look at or get copies of your medical information. For copies you must make your request in writing.

b. Receive a list of all the times we shared your medical information for purposes other than treatment, payment, and health care operations and other specified exceptions.

c. Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in the case of emergency).

d. Request that we communicate with you about your medical information by different means or to different locations. Your request must be made in writing to Family Health Center of Joplin.

e. Request that we change your medical information. We may deny your request by we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information that you wanted changed. If we accept your request to change that information, we will make reasonable efforts to tell others, including people that you name, of the change and to include the changes in any future sharing of information.

QUESTION AND COMPLAINTS:

If you have any questions about this notice or if you think that we may have violated your privacy rights, please notify any employee of Family Health Center of Joplin. You may also submit a written complain with the U.S. Department of Health and Human Services. We can provide you with the address. We will not retaliate in any way if you choose to file a complaint.

This policy became effective April 14, 2004.