Explanation of Forms. Dr. McRae handles medical information about you, and law regulates how that information is handled. To comply with the law, Dr. McRae asks you to receive this notice and, in some circumstances, to sign an authorization form.

Dr. McRae is allowed by law to use and disclose information about you for the purposes essential to providing care (treatment, payment collection, and operating this office).

An authorization allows Dr. McRae to use and disclose information about you for any other reason that is listed in the authorization. Dr. McRae may not refuse to treat you for refusing to sign the authorization. Other rules about your rights regarding medical information are described in this office.

Types of Uses and Disclosures. Medical information about you may be used or disclosed by this Medical Center for treatment, payment, and health care operations. Treatment includes consultation, diagnosis, provision of care, and referrals. Payment includes all those things necessary for billing and collection, such as claims processing. Health care operations include things Dr. McRae does to assess the quality of care, train staff, and manage Dr. McRae’s business. Some examples of disclosures and use are below.

• Example of Treatment Disclosure. Dr. McRae may disclose medical information about you to other physicians, a hospital or other providers to help them diagnose and treat an injury or illness.

• Example of Payment Disclosure. Dr. McRae may disclose medical information about you when health plans or insurers, Medicare, Medicaid, or other payers require the information before paying for your health care services.

• Example of Health Care Operation Use. Dr. McRae may use medical information about you when she hires new staff whose training requires information about the medical needs of our patients. Dr. McRae may also contact the patient to provide appointment reminders.

Other Uses and Disclosures. We may use or disclose your protected health information in the following situations without your authorization. These situations include:

• As Required By Law. We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use of disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

• Public Health. We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury of disability. We may also disclose your protected health authority, to another government agency that is collaborating with the public health authority.

• Communicable Diseases. We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contacting or spreading the disease or condition.

• Health Oversight. We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

• Abuse or Neglect. We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

• Food and Drug Administration. Dr. McRae may disclose a patient’s health information to a person subject to the jurisdiction of the Food and Drug Administration if that person has responsibility to report adverse events, product defects or problems, or biologic product deviations; to track products; to enable product recalls, repairs or replacements; or, to conduct post marketing surveillance.

• Legal Proceedings. We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

• Law Enforcement. We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legals processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of this medical center, and (6) medical emergency (not on this premises) and it is likely that a crime has occurred.

• Coroners, Funeral Directors, and Organ Donation. We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out his duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

• Research. We may disclose your protected 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 that privacy of your protected health information.

• Criminal Activity. Consistent with applicable federal and state laws, we may disclose your protected health information. If we believe that the use or disclose is necessary to prevent of lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

• Military Activity and National Security. When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including the provision of protective services to the President or others legally authorized.

• Workers’ Compensation. Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.

• Inmates. We may use or disclose your protected health information if you are an inmate or in a correctional facility and your physician created or received your protected health information in the course of providing care to you.

• Required Uses and Disclosures. Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the law.

Others Involved in Your Healthcare. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Authorized Uses and Disclosures. Additional uses and disclosure may be made if you have given written authorization, which may be revoked at any time in writing delivered to the site compliance contact, except to the extent Dr. McRae acted in reliance on the authorization.

Restrictions. You have the right to request restrictions on the use and disclosure of medical information about you; however, Dr. McRae will only be bound by the restrictions if Dr. McRae notifies you that it agrees with them.

Confidentiality. You have the right to have Dr. McRae use only confidential means of communicating with you about medical information. This means you may have information delivered to you at a certain time or place, or in a manner that keeps your information confidential.

Access. You have the right to see and receive a copy of information about you kept by Dr. McRae under most circumstances.

Amendment. You have the right to have Dr. McRae amend its records of information about you. Dr. McRae may refuse to amend information that is accurate, that was created by someone else, or is not disclosable to you.

Accounting. You have the right to see a list of disclosures of medical information about you by Dr. McRae, which includes the purposes and recipients of the information.

Copy. You have the right to receive a paper copy of this notice.

Privacy Notice. Dr. McRae is required by law to keep medical information about you private and to give you this notice. Dr. McRae must abide by this notice; however, Dr. McRae reserves the right to amend this notice and make such changes applicable to all medical information maintained by Dr. McRae. A revised notice will be provided to patients of Dr. McRae by posting the new notice in the waiting room.

Complaints. You may complain to Dr. McRae if you believe your privacy rights have been violated by giving a written complaint to the site compliance contact at your doctor’s office. You may also complain to the Secretary of the U.S. Department of Health and Human Services. Dr. McRae will not retaliate against you for making a complaint.

Effective Date. This notice is effective from June 26, 2006 (date first in effect, but not earlier than actual printing or publication of notice) until revised by Dr. McRae.