NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR MEDICAL INFORMATION.

PLEASE REVIEW IT CAREFULLY.

1) OUR PROMISE REGARDING MEDICAL INFORMATION

The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create records for each service you receive at McDonald Pediatrics. We use these records to provide you with quality care and to comply with certain legal requirements. This notice tells you about the ways we may use and share medical information about you. We also describe your rights and our obligated duties in the use and disclosure of medical information.

2) OUR LEGAL OBLIGATED DUTIES

Law Requires Us to:

1. Keep your medical information private.

2. Give you this notice telling you about our privacy practices, legal duties, and you rights.

3. Follow the terms of this notice.

We Have the Right to:

1. Change our privacy practices and terms of this notice at any time, provided that the changes are permitted by law.

2. Make the changes in our privacy practices and the new terms of our notice effective for all medical information we keep, including information previously created before the changes.

Notice of Change to Privacy Practices:

1. Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon your request.

3) USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION

This section describes the different ways we use and disclose medical information. Not every use or disclosure will be listed. However, we have listed all of the different ways we are permitted to use and disclose medical information. WE WILL NOT USE OR DISCLOSE YOUR MEDICAL INFORMATION FOR ANY PURPOSE NOT LISTED BELOW, WITHOUT YOUR SPECIFIC WRITTEN AUTHORIZATION. ANY SPECIFIC WRITTEN AUTHORIZATION YOU PROVIDE MAY BE REVOKED AT ANY TIME BY WRITING TO US AT THE ADDRESS PROVIDED AT THE END OF THIS NOTICE.

FOR TREATMENT: We may use any and/or all of your medical information to provide you with medical treatment or services. We may disclose your medical information to other doctors, nurses, technicians, medical students, or other people who are taking care of you. We may also share medical information about you to your other health care providers to assist them in treatments.

FOR PAYMENT: We may use and disclose your medical information for payment purposes. A statement/invoice for payment may be sent to you or a third-party payer. The information on or accompanying the statement/invoice may include your medical information.

FOR HEALTH CARE OPERATIONS: We may use and disclose your medical information for our interoffice operations. This might include measuring and improving quality, evaluating the performance of employees, conducting training programs, and getting the accreditation, certificates, licenses and credentials we need to serve you.

ADDITIONAL USES AND DISCLOSURES: In addition to using and disclosing your medical information for treatment, payment, and health care operations, we may use and disclose your medical information for the following purposes.

Law enforcement: Under certain circumstances, we may disclose health information to law enforcement officials. These circumstances include reporting required information by certain laws (such as the reporting of certain types of wounds), pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reports regarding suspected victims of crimes at the request of a law enforcement official, reporting death, crimes on our premises, and crimes in emergencies.

Court Orders and Judicial and Administrative Proceedings: We may disclose your medical information in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances, such as a court order or grand jury subpoena, we may share your medical information with law enforcement officials. We may share limited information with a law enforcement official concerning your medical information of a suspect, fugitive, material witness, crime victim or missing person. We may share your medical information of a person in lawful custody with a law enforcement official or correctional institution under certain circumstances.

Public Health Activities: As required by law, we may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect. We may also disclose your medical information to persons subject to jurisdiction of the Food and Drug Administration (FDA) for purposes of reporting adverse events associated with product defects or problems, to enable product recalls, repairs, or replacements, to track products, or to conduct activities required by the FDA. We may also, when we are authorized by law to do so, notify a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease or condition.

Victims of Abuse, Neglect, or Domestic Violence: We may use and disclose your medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may share your medical information if it is necessary to prevent a serious threat to your health or safety or the health and safety of others. We may share medical information when necessary to help law enforcement officials capture a person who has admitted to being a part of a crime or has escaped from legal custody.

Appointment Reminders: We may use and disclose your medical information for purposes of sending or calling you with appointment reminders.

Alternative and Additional Medical Services: We may use and disclose your medical information to furnish you with information about health-related benefits and services that may be of interest to you, and to describe or recommend treatment alternatives.

Revised 01/01/2010