Notice of Privacy Practices of KEYSTONE PODIATRIC MEDICAL ASSOCIATES, PC Effective Date – April 14, 2003

This "Notice of Privacy Practices" is a detailed explanation of how Keystone Podiatric Medical Associates, PC will protect your "Protected Health Information", how it may be used and how you may get access of those records.

Please review it carefully.

We, Keystone Podiatric Medical Associates, PC, are required by law to maintain the privacy of your Protected Health Information (PHI) and to also post a copy of our "Notice of Privacy Practices". Health information that is required by law to be protected is any information that relates to your past, present or future physical or mental health condition, health care provided to you or any payment for services provided by our office, any information that individually identifies or reasonably can be used to identify you.

You may request a copy of our notice at any time. For copies of the notice, revised copy of the notice or for any questions regarding this notice, you may contact our office manager.

ATTN: Office Manager Keystone Podiatric Medical Assoc., PC PO Box 526 Biglerville, PA 17307

Telephone Number: 717-677-9288

This notice will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this notice at any time provided that such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all protected health information that we maintain, including medical information we created or received before we made the changes.

Keystone Podiatric Medical Associates, PC will not use or disclose your health information without your written authorization, except as stated in more detail in the "Notice of Privacy Practices".

If you have a question, concern or complaint regarding Keystone Podiatric Medical Associates, PC’s Notice of Privacy Practices, please contact the office manager using the above information.

How We May Use and Disclose PHI

Treatment:

1. During an Office visit the doctor and other staff involved in your care will have access to your chart and the contents of it and may discuss among themselves your medical information.
2. We may share and discuss your medical information with another doctor to whom we have referred you for care.
3. We may share and discuss your medical information with another doctor with whom we are consulting regarding your care by phone, fax or e-mail.
4. We may share and discuss your medical information with an outside lab, x-ray center, or other health care facility where we have referred you for testing, health care services or products by phone, fax or e-mail.
5. We may use a patient sign-in sheet in the waiting area, which is accessible to all patients.
6. We may call patients by name from the waiting area when it is time for them to go to an examining room.
7. We may contact you by phone of missed appointments or rescheduling due to office hours being changed.
8. We may contact you by phone with test results and may leave a message on an answering machine or with the person answering the phone, if you are not available.

Payment:

1. We may share your PHI with your health insurance to determine whether you are eligible for coverage or whether treatment is a covered service by phone, fax or e-mail.
2. We may submit a claim form to your health insurance and may send copies of Explanation of Benefits (EOBs) from your primary health insurance to your secondary insurance (if applicable) for reimbursement by phone, fax or e-mail.
3. We may share demographic information with other health care providers who seek this information to obtain payment for health care services provided to you.
4. We may mail you bills in envelopes with our practice name and return address.
5. We may mail a bill to a family member or other person designated as responsible for payment for services rendered to you.
6. We may provide medical information and/or documentation to your health insurance to support the medical necessity of a health service by phone, fax or e-mail.
7. We may allow your health insurance access to your medical records for a medical necessity or quality review audit.
8. We may provide information to a collection agency or our attorney for the purposes of securing payment of a delinquent account by phone, fax or e-mail.

Office Use:

1. We may use and disclose your protected health information for our health care operation purposes.
2. We may disclose information in cases of public health reporting, such as child, elder or domestic abuse or neglect reports, communicable disease reports, FDA related reports, and OSHA requirements for workplace surveillance and injury reports.
3. We may disclose information for certain law enforcement purposes, such as warrants and anything related to a crime or a suspected crime.
4. We may disclose information to a coroner or medical examiner for the purpose of identifying a deceased patient, determining a cause of death, or facilitating their performance of other duties required by law.
5. We may disclose information indirectly at times by other patients over hearing your name being spoken either on the phone or in office conversations among staff, regarding your care.

Your Health Information Rights

Obtaining a Copy:

You may request a copy of the Notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a copy. To obtain a copy, contact the Office Manager/Privacy Officer at Keystone Podiatric Medical Associates, P.C., PO Box 526, Biglerville, PA 17307 717-677-9288 or Toll Free: 1-877-677-0264

Request a Restriction on Certain Uses and Disclosures of your PHI:

You have the right to request additional restrictions on our use or disclosure of PHI about you by sending a written request to the Office Manager/Privacy Officer. We are not required to agree to those restrictions.

Inspect and/or Obtain a Copy of your PHI:

You have the right to access and copy PHI about you contained in our office for as long as the Corporation maintains the PHI. Your records would usually consist of copies of prescriptions, x-rays and billing records. To inspect or copy PHI about you, you must send a written request to the Office Manager/Privacy Officer at Keystone Podiatric Medical Associates. We may charge you a fee for the costs of copying, mailing and supplies that are necessary to fulfill your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.

Requesting PHI Amendment:

If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to the Office Manager/Privacy Officer at Keystone Podiatric Medical Associates. You must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may give a rebuttal to your statement.

Request Communications of your PHI by Alternative Means or Alternative Locations.

For instance, you may request that we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of your PHI, submit a request in writing to the Office Manager/Privacy Officer. Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests.

Keystone Podiatric Medical Associates will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided for above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization.

We, Keystone Podiatric Medical Associates, PC, reserve the right to change this notice at any time. We further reserve the right to make any change effective for all Protected Health Information that we maintain at the time of the change, including information that we created or received prior to the effective date of the change. We will post a copy of our current notice in the waiting room. At any time, patients may review the current Notice by contacting our Office Manager/Privacy Officer.

For More Information or to Report a Problem: If you have questions or would like additional information about Keystone Podiatric Medical Associates, PC’s privacy practices, you may contact the Office Manager/Privacy Officer. If you believe your privacy rights have been violated, you can file a complaint with the Office Manager/Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

KEYSTONE PODIATRIC MEDICAL ASSOCIATES, PC will not use or disclose patients Protected Health Information (PHI) except as allowed by the HIPAA Privacy Rules and the provisions of this manual.

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