1. Any health care professional authorized to enter information into your medical record created and/or maintained at our Practice; and
2. All employees, students, residents, and other service providers who have access to your health information at our Practice.

The individuals identified above will share your health information with each other for purposes of treatment, payment, and health care operations, as further described in the Notice.

B. USES AND DISCLOSURES OF HEALTH INFORMATION FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS

1. Treatment, Payment and Health Care Operations. The following section describes different ways that we may use and disclose your health information for purposes of treatment, payment, and health care operations. We explain each of these purposes below and include examples of the types of uses or disclosures that may be made for each purpose. We have not listed every type of use or disclosure, but the ways in which we use or disclose your information will fall under one of these purposes.
   
   
   1. Treatment. We may use your health information to provide you with health care treatment and services. We may disclose your health information to doctors, nurses, nursing assistants, technicians, students, or other personnel who are involved in your health care.

      For example, we may order physical therapy services to improve your strength and walking abilities. We will need to talk to the physical therapist so that we can coordinate services and develop a plan of care. We may also need to refer you to another health care provider to receive certain services. We will share information with that health care provider in order to coordinate your care and services.

   2. Payment. We may use or disclose your health information so that we may bill and receive payment from you, an insurance company, or another third party for the health care services you received from us. We may also disclose health information about you to your health plan in order to obtain prior approval for the services we provide to you, or to determine that your health plan will pay for the treatment.

      For example, we may need to give health information to your health plan in order to obtain prior approval to refer you to a health care specialist, such as a neurologist or orthopedic surgeon, or to perform a diagnostic test such as a magnetic resonance imaging scan ("MRI") or a CT scan.

   3. Health Care Operations. We may use or disclose your health information in order to perform the necessary administrative, educational, quality assurance, and business functions of the Practice.

      For example, we may use your health information to evaluate the performance of our staff in caring for you. We also may use your health information to evaluate whether certain treatment or services offered by our Practice are effective. We also may disclose your information to other physicians, nurses, technicians, or health profession students for teaching and learning purposes.

   C. USES AND DISCLOSURES OF HEALTH INFORMATION IN SPECIAL SITUATIONS

   We may use or disclose your health information in certain special situations as described below. For these situations, you have the right to limit these uses and disclosures as provided for in Section F of this Notice.

   1. Appointment Reminders. We may use or disclose your health information for purposes of contacting you to remind you of a health care appointment.

   2. Treatment Alternatives & Health-Related Products and Services. We may use or disclose your health information for purposes of contacting you to inform you of treatment alternatives or health-related products or services that may be of interest to you. For example, if you are diagnosed with a diabetic condition, we may contact you to inform you of a diabetic instruction class that we offer at our Practice.

   3. Family Members and Friends. We may disclose your health information to individuals, such as family members and friends, who are involved in your care or who help pay for your care. We may make such disclosures when: (a) we have your verbal agreement to do so; (b) we make such disclosures and you do not object; or (c) we can infer from the circumstances that you would not object to such disclosures. For example, if your spouse comes into the exam room with you, we will assume that you agree to the disclosure of your information while your spouse is present in the exam room.

      We also may disclose your health information to family members or friends in instances when you are unable to agree or object to such disclosures, provided that we feel it is in your best interests to make such disclosures and the disclosures relate to that family member or friend's involvement in your care. For example, if you present to our Practice with an emergency medical condition, we may share information with the family member or friend that comes with you to our office. We also may share your health information with a family member or friend who calls to request a prescription refill for you.

   D. OTHER PERMITTED OR REQUIRED USES AND DISCLOSURES OF HEALTH INFORMATION

   There are certain instances in which we may be required or permitted by law to use or disclose your health information without your permission. These instances are as follows:

   • As required by law. We may disclose your health information when required by federal, state, or local law to do so. For example, we are required by the Department of Health and Human Services (DHHS) to disclose your health information in order to allow DHHS to evaluate whether we are in compliance with the federal privacy regulations.

   • Public Health Activities. We may disclose your health information to public health authorities that are authorized by law to receive and collect health information for the purpose of preventing or controlling disease, injury, or disability; to report births, deaths, suspected abuse or neglect, reactions to medications; or to facilitate product recalls.

   • Health Oversight Activities. We may disclose your health information to a health oversight agency that is authorized by law to conduct health oversight activities, including audits, investigations, inspections, or licensure and certification surveys. These activities are necessary for the government to monitor the persons or organizations that provide health care to individuals and to ensure compliance with applicable state and federal laws and regulations.

   • Judicial or Administrative Proceedings. We may disclose your health information to courts or administrative agencies charged with the authority to hear and resolve lawsuits or disputes. We may disclose your health information pursuant to a court order, a subpoena, a discovery request, or other lawful process issued by a judge or other person involved in the dispute, but only if efforts have been made to (i) notify you of the request for disclosure or (ii) obtain an order protecting your health information.

   • Worker's Compensation We may disclose your health information to worker's compensation programs when your health condition arises out of a work-related injury.

   • Law Enforcement Official. We may disclose your health information in response to a request received from a law enforcement official to report criminal activity or to respond to a subpoena, court order, warrant, summons, or similar process.

   • Coroners, Medical Examiners, or Funeral Directors. We may disclose your health information to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death. We also may disclose your health information to a funeral director for the purpose of carrying out his/her necessary activities.

   • Organ Procurement Organizations or Tissue Banks. If you are an organ donor, we may disclose your health information to organizations that handle organ procurement, transplantation, or tissue banking for the purpose of facilitating organ or tissue donation or transplantation.

   • To Avert a Serious Threat to Health or Safety. We may use or disclose your health information when necessary to prevent a serious threat to the health or safety of you or other individuals.

   • Research. We may disclose your health information to researchers when the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

   • Military and Veterans. If you are a member of the armed forces, we may use or disclose your health information as required by military command authorities.

   • National Security and Intelligence Activities. We may use or disclose your health information to authorized federal officials for purposes of intelligence, counterintelligence, and other national security activities, as authorized by law.

   • Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may use or disclose your health information to the correctional institution or to the law enforcement official as may be necessary (i) for the institution to provide you with health care; (ii) to protect the health or safety of you or another person; or (iii) for the safety of the correctional institution.

   E. USES AND DISCLOSURES PURSUANT TO YOUR WRITTEN AUTHORIZATION

   Except for the purposes identified in Sections B through D, we will not use or disclose your health information for any other purposes unless we have your specific written authorization. You have the right to revoke a written authorization at any time as long as you do so in writing. If you revoke your authorization, we will no longer use or disclose your health information for the purposes identified in the authorization, except to the extent that we have already taken some action in reliance upon your authorization.

   F. OUR RIGHTS REGARDING YOUR HEALTH INFORMATION

   • Right to Inspect and Copy. You have the right to inspect and obtain a copy of health information about you that is contained in a designated record set for as long as we maintain the health information. A "designated record set" contains medical and billing records and any other records that your physician and the practice use for making decisions about your care.

     Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about your medical record.

   • Right to Accounting of Disclosures. You have the right to request an accounting of the disclosures of your health information made by us. This accounting will not include disclosures of health information that we made for the purposes of treatment, payment or health care operations or pursuant to a written authorization that you signed.

   • Right to Amend. You have the right to request an amendment of your health information that is maintained by or for our Practice and is used to make health care decisions about you. We may deny your request if it is not properly submitted or does not include a reason to support your request. We may also deny your request if the information sought to be amended: (a) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (b) is not part of the information that is kept by or for our Practice; (c) is not part of the information which you are permitted to inspect and copy; or (d) is accurate and complete.

   • Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone, such as a family member or friend, who is involved in your care or in the payment of your care. For example, you could ask that we not use or disclose information regarding a particular treatment that you received. We are not required to agree to your request. If we do agree, that agreement must be in writing and signed by you and us.

   • Right to Request Confidential Communications. You have the right to request that we communicate with you about your health care in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

   • Right to a Paper Copy of this Notice. You have the right to receive a paper copy of this Notice at any time. Even if you agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.

   G. QUESTIONS OR COMPLAINTS

   If you have any questions regarding this Notice or wish to receive additional information about our privacy practices, please contact our Privacy Officer at 419-424-0380 ext 3141. If you believe your privacy rights have been violated, you may file a complaint with our Practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our Practice, contact our Privacy Officer at 200 West Pearl Street, Findlay, Ohio, 45840. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

   This notice becomes effective on April 14, 2003.