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.

We have a legal duty to safeguard your Protected Health Information (PHI).

This organization is legally required to protect the privacy of your health information. We call this information “protected health information” or “PHI,” and it includes information about you that can be used to identify you in relation to your health status and/or medical record. This information is a compilation of information derived from other sources and information created by this organization. We are required by law to provide you this Notice of Privacy Practices that explains how, when, and why we use and disclose your PHI and to provide proof that you have been given this notice. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use of disclosure. We are legally required to follow the privacy practices that are described in this notice. Please note that we reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI already in our possession. You may also request a copy of this notice. It is our responsibility to record evidence that you have been provided a copy of this information, and we require that you, your responsible party, or your legal representative sign a statement to indicate that it has been provided to you.

These are the ways we may use and disclose your protected health information.

We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your prior authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each category.

1. Uses and Disclosures Relating to Treatment, Payment, and Health Care Operations Do Not Require Your Prior Authorization

Providers using their professional judgment may disclose to a family member, friend, other relative, close personal friend, or any person you identify as a contact, PHI relevant to that person’s involvement in your care or payment related to that care. Our business associates, who are also committed to protection of your PHI, may also require such information, which may be released without authorization. HIPAA laws additionally specify three broad areas in which information may be released without the member’s authorization:

· We will use your PHI for treatment. Example: Information obtained from you or your family member may be used to provide information to health care professionals or others you have indicated as being involved in your care.

· We will use your PHI to obtain payment for services. Example: We will use your PHI to bill for services.

· We will use PHI for operations. Example: Others in our organization may review your record to ensure that we are providing quality services and to contractors who install equipment and to others who may be notified in case of an emergency or our inability to contact you directly.

2. Certain Other Uses and Disclosures Do Not Require Your Authorization.

We may use and disclose your PHI without your authorization for the following reasons:

· When a disclosure is required by federal, state, or local law or for judicial or administrative proceedings. Example: If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court order. When abuse or neglect are suspected, we may also be required to release information. We may also disclose PHI about you in response to a subpoena, but only after you have been notified or the required time to raise objections has elapsed. We must disclose your PHI when required to do so by law.

· To coroners or funeral directors. Example: The law authorizes release of information to coroners or funeral directors for the purpose of determining cause of death or identification.

· For research. Example: We may disclose PHI about you to researchers when their research has been approved by an Institutional Review Board that has reviewed the research proposal and established protocols to assure the privacy of your information.

· For public health activities. Example: As required by law, we may disclose PHI about you to public health or legal authorities charged with controlling disease, injury, or disability.

· For purposes of organ donation. Example: When our members have informed us of their desire to be organ donors, we may provide PHI to the organizations to assist them.

· For workers’ compensation purposes. Example: We may be required to report PHI in order to comply with workers’ compensation laws for any members who may be covered.

· To avoid harm. Example: In order to avoid a threat to you or to the health or safety of another person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.

· For specific functions as required by the government. Example: When government agencies request information that may contain PHI, no authorization is required.

· For reminders or information about health-related services. Example: We may inform you of health-related information which may be helpful to you.

· Emergency situations. Example: If you are unable to communicate, emergency services do not require authorization for disclosure of information.

· To the FDA. Example: We may disclose to the FDA PHI relative to adverse events with respect to drugs, foods, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

There are other uses and disclosures to which you have the opportunity to object.

We may provide information about your status to your family members, friends, or other persons who have been identified by you friends or family members involved in your care. If there are those who you do not wish to have access or to receive information regarding your PHI, please inform our organization by completing the Member Defined Limits on Use and Disclosure form. If the member is unable to provide this information, only a duly authorized person may complete this form.

· Right to Object.

While you have the right to object to disclosures of PHI, objections related to Treatment, Payment, and Operations may make it impossible for our company to serve you. This organization retains the right to refuse service to members who object to the company’s right to use information for treatment, payment, or operations, as any such limits could impede our ability to provide required services. Such objections cannot be retroactive.

· All Other Uses and Disclosures Require Your Prior Written Authorization.

In any other situations not described in above, we will ask for your written authorization before using or disclosing any of your PHI. A form for authorizations is also available for your review. If you choose to sign an authorization to disclose your PHI, you may later revoke that authorization in writing to stop any future uses and disclosures.

You have the following rights with respect to your PHI.

The Right to Request Limits on Uses and Disclosures of Your PHI.

You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. You may not limit the uses and disclosures that we are legally required or allowed to make.

• The Right to See and Obtain Copies of Your PHI.

In most cases, you have the right to look at or get copies of your PHI, but you must make the request in writing on a form designated by this organization. Upon request, you may obtain your PHI within 30 days. If the records are maintained off-site, an additional 30 days may be required to provide the record. There is a charge for copies of the record. A member has the right to specify the address at which he or she will receive such information, and within the limits of the organization’s technology, the form of the communication.

• The Right to Get a List of the Disclosures We Have Made.

You have the right to see a list of the instances in which your PHI has been disclosed. The list will not include any disclosures related to Payment, Treatment, or Health Care Operations, disclosures made in relation to

the purposes of responding to an alarm signal, or those to our business associates or to law enforcement personnel in certain circumstances. Unless the resident objects, other lawful disclosures discussed in this notice are not recorded, as these are routine and considered part of normal operations.

• The Right to Correct or Update Your PHI.

If you believe that PHI we maintain is not correct, you may request in writing that we amend it and provide in writing a reason for the request. We will respond within 60 days of receiving your request. In certain cases, we may deny your request. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. Upon your request, these documents may be attached to your PHI. If the request for correction or update is approved, we will inform you in writing that such changes have been made and will, upon your specific request with names and addresses, notify those who you wish to receive corrected or updated PHI.

• The Right to Complain About Our Privacy Practices

If you think that we might have violated your privacy rights or if you disagree with a decision we made about your access to your PHI, you may file a complaint with the Home & Community Privacy Officer by calling 866-269-5065 ext. 2575 or by writing the Privacy Officer, P.O. Box 952, Hawkinsville, GA 31036. If you are not satisfied with your response, you may send a written complaint to the Secretary of Health and Human Services.

Please note that your PHI may be transmitted electronically, including the use of e-mail, verbally, and by facsimile, as part of normal operations. Such transfer of information is vital to operations of this organization.

Effective Date of This Notice: July 1, 2004.