This notice describes how health information about you maybe used and disclosed and how you may be used and disclosed and how you can get access to this information. Please review it carefully.

Introduction

NEEL RAYA MD Inc. is committed to providing you with high quality health care and to forming a relationship with you that is built on trust. That means respecting your privacy and confidentiality of you medical information. We protect your privacy and confidentiality rights by creating and putting into practice policies and procedures that allow access to your personal medical information only for legitimate reasons. We ensure that personal health information is protected during its collection, use, disclosure, storage and destruction in the office of NEEL RAYA MD. We maintain protocols to ensure the confidentiality of your personal information Access to your information is limits to those who need it to perform their jobs for your healthcare needs. This notice is effective April 14, 2003, and applies to all protected health information as defined by federal regulations.

What is PHI – ‘Personal Health Information’

Personal Health Information means all information, recorded or exchanged verbally about an identifiable individual that relates to: the individual’s health, or health care history, including genetic information about the individual or the individual’s family. What NEEL RAYA MD has learned or observed, including conduct or behavior that may be a result of illness or the effect of treatment, the provision of health care to the individual. Individuals include co-workers or families of co-workers when they are patients of NEEL RAYA MD, for healthcare provided to the individual, and includes: the personal health identification number and any other identifying number, symbol, etc. assigned to an individual, any identifying information about the individual that is collected in the course of, and is incidental to, the provision of health care or payment for health care.

Understanding your medical record

As we provide your health care, we are required to maintain a complete copy of your medical history, current condition, treatment plan and all treatment given, including the results of all tests, procedures and therapies. Whether this information is stored in writing, on a computer, or other means, we will keep this information in a safe and secure way that protects your privacy and confidentiality. Typically this record contains your symptoms, examination, test results, diagnosis, treatment, and a plan for future care or treatment. This information serves as means of communication among the many health professionals who contribute to your care. It is a legal document describing the care you received. This document serves as a means by which you or a third party payer can verify that services billed were actually provided. This is a source of information for the public health officials charged to improve the health of the state and nation.

You’re health information rights

Our office will make every effort to honor reasonable restriction preferences from our patients, if it is made in writing

• Right to request restriction on certain uses and disclosures of your health information. (However we are not required by law to agree to a requested restriction).

• Right to request that we communicate your health information in a certain way. You may request that we only communicate your health information privately with no other family member present.

• Right for a written notice of information practices

• Right for access to read, review, and copy your health information, including your complete chart and billing records. We may need to charge you a reasonable fee to duplicate and assemble your copy.

• Right to receive an accounting of disclosures

• Right to ask us to update or modify your medical records if you believe your health information records are incorrect or incomplete. We will be happy to accommodate you as long as our office maintains this information. We will need the request in writing and the reason for the change. Your request may be denied if the health information record in question was not created in this office, is not part of our records or if the records containing your health information are determined to be accurate and complete.

• Right to ask us for a description of how and where your health information was used by our office for any reason other than for treatment, payment, or health operations. Our documentation will enable us to provide information on health information usage from April 14, 2003 and forward. Please let us know in writing the time period for which you are interested. We may need to charge you a reasonable fee for this.

• Right to timeliness of access to records.

• Right to expect respectful care and as much information about their condition as possible.

• Right to obtain a copy of this Notice of Privacy Practices directly from our office at any time.

Our responsibilities

Our Practice is required to:

• Maintain the privacy of your health information.

• Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.

• Abide by the terms of this notice.

• Notify you if we are unable to agree to a requested restriction, and

• Accommodate reasonable requests you may have to communicate your health information.

• We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. We will keep a posted copy of the most current notice in our office containing the effective date. You may obtain a copy of the same upon request.

• We will not use or disclose your health information in a manner other than described in this notice without your written authorization, which you may revoke, except to the extent that action has already been taken.

How the health information may be used

• To provide treatment, for administrative and clinical office procedures.

• To obtain payment for services rendered.

• We may be required by law to provide health information to coroners, funeral directors and medical examiners for the purposes of determining a cause of death and preparing for funeral.

• We may disclose health information to workers compensation to the extent authorized by and necessary to comply with laws.

• We do have an appointment reminder system called HOUSE CALLS which automatically calls the home phone number listed under your name to remind you about your next days appointment with Dr.Raya, if you wish not to be reminded you will need to make a written request and once that has been accepted you will be responsible for missed appointments.

• We may share some information with our business associates such as professionals in emergency room, radiology, laboratory department, transcription service, billing agency this would be necessary to perform the jobs we have requested of them in caring for you. We require these services to appropriately safeguard your information.

• During audits by your insurance company your health information may be reviewed. Government appointed agencies may also audit the health information for quality assurance and compliance reviews.

• We will notify government authorities if we believe a patient is the victim of abuse, neglect, or domestic violence. We will make this disclosure only when we believe we are specifically required or authorized by law or with the patient’s agreement.

• We may be required to disclose to federal officials or military authorities health information necessary to complete an investigation related to public health or national security.

• As permitted or required by State or Federal law, we may disclose your health information to a law enforcement official for certain law enforcement purposes.

• We may share your health information with your family members and others you tell us will be helping you with your home hygiene, treatment, medications, or payment. If you do not want us to share your information you must make a written request about the same and also let us know whom we can contact in case we are unable to get hold of you. In the case of an emergency, where you are unable to tell us what you want, we will use our best judgment when sharing your health information.

OTHER THAN IS STATED ABOVE OR WHERE FEDERAL, STATE OR LOCAL LAW REQUIRES US, WE WILL NOT DISCLOSE YOUR HEALTH INFORMATION OTHER THAN WITH YOUR WRITTEN AUTHORIZATION. YOU MAY REVOKE THAT AUTHORIZATION IN WRITING AT ANY TIME.

Questions or complaints

If you have questions about the privacy of your medical records, please contact Dr.Raya at 740-6546596.

If you believe your privacy rights have been compromised you have the right to express complaints to Dr.Raya or to the Secretary of Human and Health Services. We encourage you to express any concerns you may have regarding the privacy of your information.

Please let us know of your questions or complaints in writing.