NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THE INFORMATION. PLEASE REVIEW CAREFULLY.

Protected health information (PHI) is information, including demographic information, that may identify you in the past, present, or future and relates to: health care services you have received; payment of your health care services; and/or, your physical/mental health or condition.

As a health care provider we are required by Federal Law to maintain the privacy of PHI and to provide you with this Notice of our privacy practices.

We are required to abide by the terms of this Notice of Privacy Practices, but reserve the right to change the Notice at any time. Changes in the terms of this Notice will be effective for all PHI that we are maintaining at that time. If a change is made to this Notice, we will post a copy in a prominent location within our practice. We will also provide you with a copy of the revised Notice upon request to our Privacy Official.

PERMITTED USES AND DISCLOSURES

Treatment, Payment, and Health Care Operations. Federal Law allows a health care provider to use and disclose PHI for the purposes of treatment, payment, and health care operations, without your consent of authorization. Examples of the use and disclosure of PHI for treatment, payment, and health care operations are listed below.

* Treatment: Refers to the provision and coordination of health care by a doctor, hospital, or other health care provider.
* Payment: Refers to our activities in billing and collecting payment for treatment and services provided to you.
* Health Care Operations: Refers to the basic business functions necessary to operate our practice. PHI may be used in: reviewing and improving the quality, efficiency, and cost of care that we provide to our patients, reviewing and evaluating skills, qualifications, and performance of your health care providers: providing training for students, trainees, health care providers, or non-health care professionals (for example, billing personnel) to help them practice or improve their skills: cooperating with outside organizations that assess the quality of care we provide; cooperating with organizations that evaluate, certify, or license health care providers or staff in a particular field or specialty; assisting us make plans for the practice's future operations; resolving grievances within our practice; reviewing our activities and using or disclosing PHI in the event that we sell our practice to someone else or combine with another practice; business planning and development, such as cost-management analysis; business management and general administrative activities of our practice, including managing our activities related to complying with the HIPAA Privacy rule and other legal requirements; and, creating "de-identified" information that is not identifiable to any individual.

Other Uses and Disclosures Allowed Without Authorization. Federal Law also allows a health care provider to use and disclose PHI, without your consent, in the following ways:

* To you, as the covered individual.
* To a personal representative designated by you to receive PHI or personal representative designated by law such as the parent or legal guardian of a child, or the surviving family members or representative of the estate of a deceased individual.
* To the Secretary of Health and Human Services (HHS) or any employee of HHS as part of an investigation to determine our compliance with the HIPAA Privacy Rule.
* To a business as part of a contracted agreement to perform services for us as a health care provider.
* To a health oversight agency for activities including, for example, audits, investigations, inspections, licensure for disciplinary activities and other activities conducted by health oversight agencies to monitor the health care system, government health care programs, and compliance with certain laws.
* In response to a court order, subpoena, discovery request of other lawful judicial or administrative proceeding.
* As required for law enforcement purposes. For example, to notify authorities of a criminal act.
* As required to comply with Workers' Compensation or other similar programs established by law.

The examples of permitted uses and disclosures listed above are not provided as an all-inclusive list of the ways in which PHI may be used. They are provided to describe in general the types of uses and disclosures that may be made.

OTHER USES AND DISCLOSURES

Other uses and disclosures of your PHI will only be made upon receiving your written authorization. You may revoke an authorization at any time by providing written notice to us that you wish to revoke an authorization. We will honor a request to revoke as of the day it is received and to the extent that we have not already used or disclosed your PHI in good faith with the authorization.

YOUR RIGHTS IN RELATION TO PROTECTED HEALTH INFORMATION

Right to Request Restrictions on Uses and Disclosures. You have the right to request additional restrictions on PHI that we may use for treatment, payment, and health care operations. You may also request additional restrictions on our disclosure of PHI to certain individuals involved in your care that are otherwise permitted by the Privacy Rule. We are not required to agree to your request. If we do agree with your request, we are required to comply with our agreement except in certain cases, including when the information is needed to treat you in the case of an emergency. To request restrictions, you must make your request in writing to our Privacy Official, In your information please include: (1) the information that you want to restrict; (2) how you want to restrict the information (for example, restricting use to the office only, or restricting disclosure to persons outside this office); and, (3) to whom you want those restrictions to apply.

Right to Receive confidential communication. You have the right to request that communications involving PHI be provided to you at an alternative location by an alternative means of communication. The practice is required to accommodate any reasonable request if the normal method of disclosure would endanger you and the danger is stated in your request. Any such request must be made in writing to the Privacy Official listed in this Notice.

Right to Inspect and Copy. You have the right to request the opportunity to inspect and receive a copy of PHI about you in certain records that we maintain. This includes your medical and billing records but does not include psychotherapy notes or information gathered or prepared for a civil, criminal, or administrative proceeding. We may deny your request to inspect and copy PHI only in limited circumstances. To inspect and copy PHI, please contact our Privacy Official. If you request a copy of PHI about you, we may charge you a reasonable fee for the copying, postage, labor, and supplies used in meeting your request.

Right to amend. You have the right to request that we amend PHI about you as long as our office keeps such information. You must make this type of request in writing to our privacy Official. You must also give us a reason for the request. We may deny your request in certain cases, including if it is not in writing or you do not give us a reason for the request.

Right to Receive Accounting of Disclosure. You have a right to receive and accounting of all disclosures of your PHI, if any, for reasons other than treatment, payment, and health care operations, and disclosures made to you or your personal representative. Your right to an accounting of disclosure applies only PHI created by the Practice after April 14, 2003. The request for accounting of disclosure cannot exceed a period of six years prior to the date of your request. Request for an accounting of disclosures must be submitted in writing to our Privacy Official. The first list that you request in a 12-month period will be free, but we may charge you for our reasonable cost of providing additional lists in the same 12-month period. We will tell you about these costs, and you may choose to cancel your request at any time before costs are incurred.

Right to a Paper Copy of This Notice. You have a right to receive a paper copy of this Notice at any time. You are entitled to a paper copy of this Notice even if you have previously agreed to receive the Notice electronically. To obtain a copy of this Notice, please contact our Privacy Official.

COMPLAINTS. If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the United States Department of Health and Human Services. To file a complaint with our office, please contact our Privacy Official at the address and number listed below. The practice will not retaliate or take action against you for filing a complaint.

QUESTIONS. If you have any questions about this Notice, please contact our Privacy Official at the address and number listed below.

PRIVACY OFFICIAL CONTACT INFORMATION. You may contact our Privacy Official at the following address and phone number.

Orthopedic Specialists of Southwest Florida
Attn: Privacy Official
2531 Cleveland Avenue, Suite 1
Fort Myers, Florida 33901
239-334-7000

EFFECTIVE DATE OF THIS NOTICE. This notice is effective as of April 14, 2003