PRIVACY

Notice of Privacy Practices for Protected Health Information

Lumberton Radiological Associates, P.A. (LRA) is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.

Examples of Use for Treatment include but are not limited to, LRA staff obtaining treatment information and recording it in your health record, another example would be where an LRA physician consults with your personal physician/specialist regarding your particular case.

An example of Use of Your Health Information for Payment Purposes includes but is not limited to submitting payment requests to your health insurance company. Also we might provide to your health insurance company (or other business associate) information regarding medical care given. We will provide information to them about you and the care that you were given.

An example of Use of Your Information for Health Care Operations includes but is not limited to obtaining services from our insurers or other business associates such as quality assessment, outcome evaluations, clinical protocol development, medical review, legal services and insurance. We will share information about you with these insurers and business associates as necessary to obtain these services.

Any disclosures other than for the categories listed above (treatment, payment, or health care operations) will be made only with your written authorization. You also have the right to revoke any previous written authorization. This request to revoke must also be provided to Lumberton Radiological Associates in writing. We will honor this revocation provided that we have not taken action in reliance upon the authorization.

Your Health Information Rights

The health and billing records we maintain are the physical property of Lumberton Radiological Associates. The information however belongs to you. You have a right to:

• Request a restriction on certain uses and disclosures of your health information by delivering the request in writing to our office - we are not required to grant the request but we will comply with any request granted;

• Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information ("Notice") by making a request at our office;

• Request that you be allowed to inspect and copy your health record and billing record - you may exercise this right by delivering the request in writing to our office using the form we provide to you upon request;

• Appeal a denial of access to your protected health information except in certain circumstances;

• Request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office using the form we provide to you upon request (The physician or other health care provider is not required to make such amendments);

• File a Statement of Disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information;

• Obtain an Accounting of Disclosure of Your Health Information as required to be maintained by law by delivering a written request to our office using the form we provide to you upon request. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care;

• Request that communications of your health information be made by alternative means or at an alternative location by delivering the request in writing to our office using the form we give you upon request; and

• Revoke authorizations that you made previously to use or disclose information, except to the extent information or action has already been taken, by delivering a written revocation to our office.

If you want to exercise any of the above rights, please contact the Privacy Officer in person or in writing. He can be reached at 209 West 27th St., Lumberton NC 28358. He will provide you with assistance on the steps to take to exercise your right.

Lumberton Radiological has the following responsibilities:

• Maintain the privacy of your health information as required by law;

• Provide you with a notice as to our duties and privacy practices as they pertain to your health information and records;

• Abide by the terms of this Notice;

• Notify you if we cannot accommodate a requested restriction or request; and

• Accommodate your reasonable requests regarding methods to communicate health information to you.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the "Notice" by calling and requesting a copy or by visiting our office.

Any person/patient may file a complaint with LRA and/or to the Secretary of Health and Human Services if they believe their privacy rights have been violated. To file a complaint with LRA, please contact the Privacy Officer at the following address/phone number: LRA 209 West 27th St. Lumberton NC 28358, telephone 910-738-8222. All complaints will be addressed and the results will be reported to the Privacy Officer. We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services (HHS) as a condition of receiving treatment from the office/hospital nor will we retaliate in any way for filing such a complaint.

Other Disclosures and Uses

Notification - Unless you object, we may use or disclose your protected health information to notify, or assist in notifying a family member, or other person responsible for your care, about your location, and about your general condition.

Communication with Family - Using our best judgment, we may disclose to a family member, other relative, or any other person you authorize, health information relevant to that person's involvement in your care or in payment for such care if you do not object or in an emergency.

Research - We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

Disaster Relief - We may use and disclose your protected health information to assist in disaster relief efforts.

Funeral Directors or Coroners - We may disclose your protected health information to funeral directors or coroners consistent with applicable laws to allow them to carry out their duties.

Marketing - We may contact you to provide you with appointment reminders, with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you.

Fund Raising - We may contact you as part of a fund raising effort.

Food and Drug Administration (FDA) - If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.

Public Health - As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Abuse & Neglect - We may disclose your protected health information to public authorities as allowed by law to report abuse or neglect.

Correctional Institutions - If you are an inmate of a correctional institution, we may disclose to the institution or its agents the protected health information necessary for your health and the health and safety of other individuals.

Law Enforcement - We may disclose your protected health information for law enforcement purposes as required by law, i.e., by a court order, or in cases involving felony prosecutions, or to the extent an individual is in the custody of law enforcement.

Health Oversight - Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.

Judicial/Administrative Proceedings - We may disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order.

Serious Threat to Health or Safety - To avert a serious threat to health or safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety of a person or the public.

For Specialized Governmental Functions - We may disclose your protected health information for specialized government functions authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.

Other Uses - Other uses and disclosures besides those identified in this Notice will be made only as otherwise authorized by law or with written authorization and you may revoke the authorization as previously provided.

Effective Date: April 14, 2003