NOTICE OF PRIVACY POLICY:

CNS Medical Group, PC will maintain the privacy of your personal health information (PHI) in accordance with the Health Insurance Portability Act of 1996 (HIPPA). This includes all information, oral or written.

Generally, we may not use or disclose your personal health information without your consent, and only in accordance with the specific terms of that consent.

The following are circumstances under which we are permitted by law to use or disclose your personal health information:

• Without Your Consent:
  To provide you with services you require or request
  To collect payment for those services
  To conduct other related health care operations otherwise permitted or required by law
• As Required by Law:
  Public health activities including preventing or controlling disease or other injury
  Disclosures regarding victims of abuse, neglect, or domestic violence
  Health oversight activities including audits, civil or criminal investigations
  Judicial and administrative proceedings in response to the order of a court
  Covered entities that are government programs providing public benefits and for workers’ compensation
• All Other Situations, With Your Specific Consent:
  Except as otherwise permitted or required, we may not use or disclose your personal health information without your written authorization. You may revoke your authorization at any time, except to the extent that we have taken action in reliance on such authorization.

Under HIPAA, you have certain rights with respect to your personal health information. The following is a brief overview of your rights and our duties with respect to enforcing those rights:

• Right to Request Restrictions on Use of Disclosure:
  You may request restrictions on the following uses or disclosures:
  To carry out treatment, payment, or healthcare operations
  Disclosures to family members, relatives or close personal friendsInstances in which you are not present or your permission cannot practicably be obtained
  Permitting others to act on your behalf to pick up items of personal health information

While we are not required to agree to any requested restriction, if we agree to a restriction, we are bound not to use or disclose your personal health information in violation of such restriction, except in certain emergency situations. We will not accept a request to restrict uses or disclosures that are otherwise required by law.

You have a right to receive confidential communications of your personal health information. You may request that personal health information from us be sent by alternative means or to an alternative location.

Craig Hospital is the custodian of your medical records. CNS Medical Group, PC does not maintain your medical records. Requests for your medical records should be directed to the Department of Health Information Management at Craig Hospital.

You have the right to receive written accounting of all disclosures of your personal health information We are not required to provide accountings of disclosures for the following purposes:

• Treatment, payment and healthcare operations
• Disclosures pursuant to your authorization
• Disclosures to you
• For a facility directory or to a person involved in your care
• For national security or intelligence purposes
• To correctional institutions
• With respect to disclosures prior to 4/13/03

You may file a complaint with us and with the Secretary of DHHS if you believe that your privacy rights have been violated. You may submit your complaint in writing or electronically to our privacy officer, Judith Lazar, at 3425 S. Clarkson, Englewood, CO 80110, jlazar@craighospital.org. A complaint must be received by us or the Secretary of DHHS within 180 days of when you knew or should have known that the act or omission complained of occurred. You will not be retaliated against for filing any complaint.

ACKNOWLEDGEMENT OF PRIVACY NOTICE: