Aguirre Specialty Care NOTICE OF PRIVACY PRACTICES 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. Aguirre Specialty Care is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information.If you have questions about any part of this notice or if you want more information about the privacy practices at Aguirre Specialty Care please contact: Elaine Olsen, Chief Operating Officer9800 Mt. Pyramid Ct., #300Englewood, CO80112303-322-0500 Effective Date of This Notice:November 1, 2006 I.How Aguirre Specialty Care may Use or Disclose Your Health Information Aguirre Specialty Care collects health information from you and stores it in a chart and on a computer.This is your medical record.The medical record is the property of Aguirre Specialty Care, but the information in the medical record belongs to you. Aguirre Specialty Care protects the privacy of your health information.The law permits Aguirre Specialty Care to use or disclose your health information for the following purposes: 1.Treatment.Aguirre Specialty Care may share your healthcare information in the process of diagnosis and/or treatment of any illness or condition.This may include, but is not limited to, information shared with other providers of care such as your primary care or referring physician as well as on-call physicians, pharmacists, therapists. 2.Payment. Aguirre Specialty Care may share your health information in order to obtain payment.This may include, but is not limited to, disclosure to insurance carriers and/or third party payors, and/or government agencies.3.Regular Health Care Operations.Your information may be shared with other individuals involved in Aguirre Specialty Care’s regular operations, such as transcriptionists, review organizations, insurance carriers, and research personnel. 4.Information provided to you. 5.Notification and communication with family.We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death.If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification.If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others. 6.Required by law.As required by law, we may use and disclose your health information. 7.Public Health.As required by law, we may disclose your health information to public health authorities for purposes related to:preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. 8.Health oversight activities.We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings. 9.Judicial and administrative proceedings.We may disclose your health information in the course of any administrative or judicial proceeding. 10.Law enforcement.We may disclose your health information to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes. 11.Deceased person information. We may disclose your health information to coroners, medical examiners and funeral directors. 12.Organ donation.We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues. 13.Research.We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board or Aguirre Specialty Care’s privacy board. 14.Public safety.We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public. 15.Specialized government functions.We may disclose your health information for military, national security, or prisoner purposes. 16.Education.We may disclose your health information to medical residents who may be rotating in our office or may be assisting in surgery. 17.Worker’s compensation.We may disclose your health information as necessary to comply with worker’s compensation laws. 18.Marketing.We may contact you to provide appointment reminders or to give you information about other treatments or health-related benefits and services that may be of interest to you. 19.Change of Ownership.In the event that Aguirre Specialty Care is sold or merged with another organization, your health information/record will become the property of the new owner. II.When Aguirre Specialty Care May Not Use or Disclose Your Health Information Except as described in this Notice of Privacy Practices, Aguirre Specialty Care will not use or disclose your health information without your written authorization.If you do authorize Aguirre Specialty Care to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. III.Your Health Information Rights 1.You have the right to request restrictions on certain uses and disclosures of your health information. Aguirre Specialty Care is not required to agree to the restriction that you requested. 2.You have the right to receive your health information through a reasonable alternative means or at an alternative location.Requests must be in writing with a minimum of five (5) days notice.Charges for copies of such information will be in accordance with state guidelines and such payment must be received in advance 3.You have the right to inspect and obtain copies your health information.Charges for such copies will be in accordance with state guidelines.Payment for such copies must be received in advance. 4.You have a right to request that Aguirre Specialty Care amend your health information that is incorrect or incomplete. Aguirre Specialty Care is not required to change your health information and will provide you with information about Aguirre Specialty Care’s denial and how you can disagree with the denial. 5.You have a right to receive an accounting of disclosures of your health information made by Aguirre Specialty Care, except that Aguirre Specialty Care does not have to account for the disclosures described in parts 1 (treatment), 2 (payment), 3 (health care operations), 4 (information provided to you), 5 (directory listings) and 16 (certain government functions) of section I of this Notice of Privacy Practices. 6.You have a right to a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact Elaine Olsen, Chief Operating OfficerAguirre Specialty Care4600 Hale Parkway, Suite 340Denver, Co80220303-322-0500 IV.Changes to this Notice of Privacy Practices Aguirre Specialty Care reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment.Until such amendment is made, Aguirre Specialty Care is required by law to comply with this Notice. Revised notices will be available at Aguirre Specialty Care’s office location and will be made available to any patient who has not had the opportunity to review such changes since their last appointment in the office. V.Complaints Complaints about this Notice of Privacy Practices or how Aguirre Specialty Care handles your health information should be directed to: Elaine Olsen, Chief Operating OfficerAguirre Specialty Care9800 Mt. Pyramid Ct., #300Englewood, CO80112303-322-0500 If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to: Department of Health and Human ServicesOffice of Civil RightsHubert H. Humphrey Bldg.200 Independence Avenue, S.W.Room 509F HHH BuildingWashington, DC20201 You may also address your complaint to one of the regional Offices for Civil Rights.A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.