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.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED.

      To Provide Treatment: The Clinic may use your health information to coordinate care within the Clinic and with others involved in your care, such as you attending physician and other health care professionals who have agreed to assist the Clinic in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. The Clinic also may disclose your health care information to individuals outside of the Clinic involved in your care including family member, pharmacist, suppliers of medical equipment or other health care professionals.

      To obtain Payment: The Clinic may use include your health information in invoices to collect payment from third parties for the care you receive from the Clinic. For example, the Clinic may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or the Clinic. The Clinic also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for the treatment and the services that will be provided to you.

      To Conduct Health Care Operations: The Clinic may use and disclose health information for its own operations in order to facilitate the function of the Clinic and as necessary to provide quality care to all of the Clinic’s patients. Health care operations include such activities as:

• Quality assessment and improvement activities.
• Activities designed to improve health or reduce health care costs.
• Protocol development, case management and care coordination.
• Contacting health care providers and patients with information about treatment alternatives and other related functions that do not include treatment.
• Professional review and performance evaluation.
• Training programs include those in which students, trainees or practitioners in health learn under supervision.
• Training on non-health care professionals.
• Accreditation, certification, licensing or credentialing activities.
• Review and auditing, including compliance review, medical reviews, legal services and compliance programs.
• Business planning and development including cost management and planning related analyses and formulary development.
• Fundraising for the benefit of the Clinic.

For Fundraising Activities: The Clinic may use information about you including your name, address, phone number and the dates you received care in order to contact you to raise money for the Clinic. The Clinic may also release this information to a related Clinic foundation. If you do not want the Clinic to contact you, notify Privacy Officer and indicate that you do not wish to be contacted.

For Appointment Reminders: The clinic may use and disclose your health information to contact you as a reminder that you have an appointment for a clinic treatment.

For Treatment Alternatives: The Clinic may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR INFORMATION MAY ALSO BE USED AND DISCLOSED (check your State laws to ensure consistency with State law requirements).

When Legally Required: The Clinic will disclose your health information when it is required to do so by any Federal, State or local law.

When There Are Risks to Public Health: The Clinic may disclose your health information for public activities and purposes in order to:

• Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of public health surveillance, investigations and interventions.
• Report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
• Notify a person who has been exposed to a communicable disease or who may be at risk of contacting or spreading a disease.
• Notify an employer an\bout an individual who is a member of the work force as legally required.

To Report Abuse, Neglect Or Domestic Violence: The Clinic is allowed to notify government authorities if the Clinic believes a patient is the victim of abuse, neglect or domestic violence. The Clinic will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.

To Conduct Health Oversight Activities: The Clinic may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. The Clinic, however, may not disclose your health information if you’re the subject of an investigation is not directly related to your receipt of health care or public benefits.

To Connection With Judicial And Administrative Proceedings: The Clinic may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when the Agency makes reasonable effort to either notify you about the request or to obtain an order protecting your health information.

For Law Enforcement Purposes: As permitted or required by State law, the Clinic may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:

• As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena or summons or similar process.
• For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
• Under certain limited circumstances, when you are the victim of a crime.
• To a law enforcement official if the Clinic has a suspicion that your death was the result of criminal conduct including criminal conduct at the Clinic.
• In an emergency in order to report a crime.

To Coroners And Medical Examiners: The Clinic may disclose your health information to coroners and medical examiners for purpose of determining your cause of death or for other duties, as authorized by law.

To Funeral Directors: The Clinic may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, the Clinic may disclose your health information prior to and in reasonable anticipation of your death.

For Organ, Eye Or Tissue Donation: The Clinic may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissues for the purpose of facilitating the donation and transplantation.

For Research Purposes: The clinic may under very selected circumstances, use you health information for research. Before the Clinic discloses any of your health information for such research purposes, the project will be subject to an extensive approval process (If the Clinic intends to routinely conduct research it is important to carefully review the authorization requirement for research exceptions and revise the Notice provisions as needed).

In The Event Of A Serious Threat To Health Or Safety: The Clinic may, consistent with applicable law and ethical standards of conduct, disclose your health information if the Clinic, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

For Specified Government Functions: In certain circumstances, the Federal regulations authorize the Clinic to use or disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the president and others, medical suitability determinations and inmates and law enforcement custody.

For Workers Compensation: The Clinic may release your health information for worker’s compensation or similar programs.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than is stated above, the Clinic will not disclose your health information other than with your written authorization. If you or your representative authorizes the Clinic to use or disclose your health information, you may revoke that authorization in writing at any time.

You have the following rights regarding your health information that the Clinic maintains:

• Right to request restrictions: You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on the clinic's disclosure of your health information to someone who is involved in your care or the payment of your care. However, the Clinic is not required to agree to your request. If you wish to make a request for restrictions, please contact the Privacy Officer.
• Right to receive confidential communications: You have the right to request that the Clinic communicate with you in a certain way. For example, you may ask that the Clinic only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, please contact Privacy Officer. The Clinic will not request that you provide any reason for your request and will attempt to honor your reasonable requests for confidential communications.
• Right to inspect and copy your health information: You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing your health information may be made to the Privacy Officer. If you request a copy of your health information, the Clinic may charge a reasonable fee for copying and assembling costs associated with your request.
• Right to amend health care information: You or your representative has the right to request that the Clinic amend your records, if you believe that your health information is incorrect or incomplete. That request may be made as long as the information is maintained by the Clinic. A request for an amendment of records must be made in writing to Privacy Officer. The Clinic may deny the request if it is not in writing or does not include a reason for the amendment. The request may also be denied if your health information records were not created by the Clinic, if the records that you are requesting are not part of the Clinic’s record, if the health information that you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, by the opinion of the Clinic, the record containing your health information are accurate and complete.
• Right to an accounting: You or your representative have the right to request and accounting of disclosure of your health information made by the Clinic for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to Privacy Officer. The request should specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. The Clinic would provide the first accounting you request during any 12-month period without charge. Subsequent accounting request may be subject to a reasonable cost-based fee.
• Right to a paper copy of this notice: You or your representative has a right to a separate paper copy of this Notice at any time even if you or your representative has received this Notice previously. To obtain a separate paper copy, please contact Privacy Officer.

We will use or disclose protected health information about you when required to do so by applicable law.

CONTACT PERSON:
      The Clinic has designated the Privacy Officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at All saints Care Injury And Rehabilitation Clinic, Inc., 606 Oriole Blvd. suite 102, Duncanville, TX 75116. Tel: 972-708-9191.

EFFECTIVE DATE:This Notice is effective April 14, 2003.