NOTICEOFPRIVACYPRACTICES

PrivacyOfficer- Mackenzie F.

September 23, 2013

THISNOTICEDESCRIBESHOWMEDICALINFORMATION ABOUTYOUMAYBEUSEDAND DISCLOSEDANDHOWYOUCANGETACCESSTOTHISINFORMATION.PLEASEREVIEWIT CAREFULLY.

Weunderstandtheimportanceofprivacyandarecommittedtomaintainingtheconfidentialityofyour medicalinformation.Wemakearecordofthemedicalcareweprovideandmayreceivesuchrecordsfrom others. Weusetheserecordstoprovideorenableotherhealthcareproviderstoprovidequalitymedical care,toobtainpaymentforservicesprovidedtoyouasallowedbyyourhealthplanandtoenableusto meetourprofessionalandlegalobligationstooperatethismedicalpracticeproperly.Wearerequired by lawtomaintaintheprivacyofprotectedhealthinformation,toprovideindividualswithnoticeofourlegal dutiesandprivacypracticeswith respecttoprotectedhealthinformation,andtonotifyaffectedindividuals following abreachofunsecuredprotectedhealthinformation.Thisnoticedescribeshowwemayuseand disclose yourmedicalinformation. Italsodescribesyourrightsandourlegalobligationswithrespect to yourmedicalinformation.IfyouhaveanyquestionsaboutthisNotice,pleasecontactourPrivacyOfficer listedabove.

A. HowThisMedicalPracticeMayUseorDiscloseYourHealthInformation

Themedicalrecordisthepropertyofthismedicalpractice,buttheinformationinthemedicalrecord belongstoyou.Thelawpermitsustouseordiscloseyourhealthinformationforthefollowingpurposes:

1.Treatment. Weusemedicalinformationaboutyoutoprovideyourmedicalcare. Wedisclosemedicalinformationtoouremployeesandotherswhoareinvolvedin providingthe careyouneed.Forexample,wemayshareyourmedicalinformationwithotherphysicians orotherhealthcareproviderswhowillprovideservicesthatwedonotprovideorwemayshare thisinformationwithapharmacistwho needs ittodispenseaprescriptiontoyou,ora laboratorythatperformsatest. Wemayalsodisclosemedicalinformationtomembersof yourfamilyorotherswhocanhelpyouwhenyouaresickorinjured,orfollowingyourdeath

2.Payment. Weuseanddisclosemedicalinformationaboutyoutoobtainpaymentfor the servicesweprovide. Forexample,wegiveyourhealthplantheinformationitrequires for payment. Wemayalsodiscloseinformationtootherhealthcareproviderstoassistthem inobtainingpaymentforservicestheyhaveprovidedtoyou.

3.HealthCareOperations.Wemayuseanddisclosemedicalinformationaboutyoutooperate thismedicalpractice.Forexample,wemayuseanddisclosethisinformationtoreviewand improvethequalityofcareweprovide,orthecompetenceandqualificationsofour professional staff.Orwemayuseanddisclosethisinformationtogetyourhealthplantoauthorized servicesorreferrals.Wemayalsouse and disclosethisinformationasnecessaryfor medicalreviews,legalservicesandaudits,includingfraudandabusedetectionand complianceprogramsandbusiness planningandmanagement.Wemayalsoshareyour medical informationwithour"business associates,"suchasourbillingservice,thatperform administrativeservicesforus. Wehavea writtencontractwitheachofthesebusiness associatesthatcontainstermsrequiringthemand theirsubcontractorstoprotectthe confidentialityandsecurityofyourmedicalinformation. Althoughfederallawdoesnot protecthealthinformationwhichisdisclosedtosomeoneother thananotherhealthcare provider,healthplan,healthcareclearinghouse,oroneoftheirbusiness associates, California law prohibitsall recipients of healthcare information from further disclosingitexceptasspecificallyrequiredorpermittedbylaw. Wemayalsoshare your informationwithotherhealthcareproviders,healthcareclearinghousesorhealthplans thathavea relationshipwithyou,whentheyrequestthisinformationtohelpthemwith theirquality assessmentandimprovementactivities,theirpatient-safetyactivities,their population-based effortstoimprovehealthorreducehealthcare costs,protocol development,

casemanagementor carecoordinationactivities,theirreviewofcompetence,qualifications andperformanceof healthcareprofessionals,theirtrainingprograms,theiraccreditation, certificationorlicensing activities,theiractivitiesrelatedtocontractsofhealthinsuranceor healthbenefits,ortheirhealth carefraudandabusedetectionandcomplianceefforts. [Participantsinorganizedhealthcare arrangementsonlyshouldadd:Wemayalsoshare medicalinformationaboutyouwiththeother healthcareproviders,healthcareclearinghouses andhealthplansthatparticipatewithusin "organizedhealthcarearrangements" (OHCAs)foranyoftheOHCAs'healthcareoperations. OHCAs include hospitals,physician organizations, health plans, and other entities which collectivelyprovidehealthcareservices. AlistingoftheOHCAsweparticipateinisavailable fromthePrivacyOfficial.]

4.[Optional:AppointmentReminders. Wemayuseanddisclosemedicalinformationtocontact andremindyouaboutappointments.Ifyouarenothome,wemayleavethisinformationonyour answeringmachineorinamessageleftwiththepersonansweringthephone

5.Sign-inSheet. Wemayuseanddisclosemedicalinformationaboutyoubyhavingyou signin whenyouarriveatouroffice.Wemayalsocalloutyournamewhenwearereadytosee you.

6.NotificationandCommunicationwithFamily. Wemaydiscloseyourhealthinformationto notifyorassistinnotifyingafamilymember,yourpersonalrepresentativeor anotherperson responsibleforyourcareaboutyourlocationyourgeneralconditionor,unlessyouhave instructedusotherwise,intheeventofyourdeath. Intheeventofadisaster,wemaydisclose informationtoarelieforganizationsothattheymaycoordinatethesenotificationefforts. We mayalsodisclose informationtosomeone whoisinvolved withyourcareorhelpspayfor your care. Ifyouareableandavailabletoagreeorobject,wewillgiveyoutheopportunityto object priortomakingthesedisclosures,althoughwemaydisclosethisinformationinadisaster even overyour objectionifwebelieveitisnecessarytorespondtothe emergency circumstances. If youareunableorunavailabletoagreeorobject,ourhealth professional willusetheir best judgment in communication with your family and others.

7.Marketing.Providedwedonotreceiveanypaymentformakingthesecommunications,wemay contactyoutoencourageyoutopurchaseoruseproductsorservicesrelatedtoyourtreatment, casemanagementorcarecoordination,ortodirectorrecommendothertreatments,therapies, healthcareprovidersorsettingsofcarethatmaybeofinteresttoyou.Wemaysimilarlydescribe productsorservicesprovidedbythispracticeandtellyouwhichhealth plans weparticipatein., Wemayreceive financialcompensationtotalkwithyouface-to-face,toprovideyouwith small promotionalgifts,ortocoverourcostofremindingyoutotakeandrefillyourmedicationor otherwisecommunicateaboutadrugorbiologicthatiscurrentlyprescribedforyou,butonlyif youeither:(1)haveachronicandseriouslydebilitatingorlife-threateningconditionandthe communicationismadetoeducateoradviseyouabouttreatmentoptionsandotherwisemaintain adherencetoaprescribedcourseoftreatment,or(2)youareacurrenthealthplanenrolleeand thecommunicationislimitedtotheavailabilityofmorecost-effectivepharmaceuticals.Ifwe make these communicationswhile you have a chronic and seriously debilitating or life- threateningcondition,wewillprovidenoticeofthefollowinginatleast14-pointtype:(1)the f act and sourceof the remuneration;and (2) yourrightto opt-outof futureremunerated communicationsbycallingthecommunicator'stoll-freenumber.Wewillnototherwiseuseor discloseyourmedicalinformationformarketingpurposesoracceptanypaymentforother marketingcommunicationswithoutyourpriorwrittenauthorization.Theauthorizationwill disclose whether we receive any financial compensation for any marketing activity you authorize,and we will stop any future marketing activity to the extent you revoke that authorization.

8.SaleofHealthInformation. Wewillnotsellyourhealthinformationwithoutyourpriorwritten authorization.Theauthorizationwilldisclosethatwewillreceivecompensationforyourhealth informationifyouauthorizeustosellit,andwewillstopanyfuturesalesofyourinformationto theextentthatyourevokethatauthorization.

9.Requiredby Law. Asrequiredbylaw, wewilluseand discloseyour healthinformation,butwe willlimitouruseordisclosuretotherelevantrequirementsofthelaw.Whenthelawrequiresus to report abuse, neglect or domestic violence,or respond to judicial or administrative proceedings,ortolawenforcementofficials,wewillfurthercomplywiththerequirementset forthbelowconcerningthoseactivities.

10.PublicHealth. Wemay,andaresometimesrequired bylawtodiscloseyourhealthinformation topublichealthauthoritiesforpurposesrelatedto: preventingorcontrollingdisease,injuryor disability; reporting child, elder or dependent adult abuse or neglect; reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or your personal representative promptly unless in our best professional judgment, we believe the notification would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm

11.HealthOversightActivities.Wemay,andaresometimesrequiredbylawtodiscloseyour health informationtohealthoversight agenciesduring thecourse ofaudits, investigations, inspections, licensure, and other proceedings, subject to the limitations imposed by federal and California law.

12.JudicialandAdministrativeProceedings.Wemay,andaresometimesrequiredbylaw, to discloseyourhealthinformationinthecourseofanyadministrativeorjudicialproceedingtothe extentexpresslyauthorizedbyacourtoradministrativeorder.Wemayalsodiscloseinformation aboutyouinresponsetoasubpoena,discoveryrequestorotherlawfulprocessifreasonable effortshavebeenmadetonotifyyouoftherequestandyouhavenotobjected,orifyour objectionshavebeenresolvedbyacourtoradministrativeorder.

13.LawEnforcement. Wemay,andaresometimesrequiredbylaw,to discloseyour healthinformationtoalawenforcementofficialforpurposessuchasidentifyingoflocatingasuspect, fugitive,materialwitnessormissingperson,complyingwithacourtorder,warrant,grandjury subpoenaandotherlawenforcementpurposes.

14.Coroners.Wemay,andareoftenrequiredbylaw,todiscloseyourhealthinformationto coronersinconnectionwiththeirinvestigationsofdeaths.

15.OrganorTissueDonation. Wemaydiscloseyourhealthinformationtoorganizations involvedinprocuring,bankingortransplantingorgansandtissues.

16.PublicSafety. Wemay,andaresometimesrequired bylaw,todiscloseyourhealth

informationtoappropriatepersonsinordertopreventorlessenaseriousandimminent threattothe healthorsafetyofaparticularpersonorthegeneralpublic.

17.ProofofImmunization.Wewilldiscloseproofofimmunizationtoaschoolwhere the lawrequirestheschoolto havesuchinformationpriortoadmittinga studentifyou haveagreeto thedisclosureonbehalfofyourselforyourdependent.

18.SpecializedGovernmentFunctions. Wemaydiscloseyourhealthinformationfor militaryornationalsecuritypurposesortocorrectionalinstitutionsorlawenforcement officersthathave youintheirlawfulcustody.

19.Worker'sCompensation.Wemaydiscloseyourhealth informationasnecessaryto complywith worker'scompensationlaws. Forexample,totheextentyourcareiscovered byworkers' compensation,wewillmakeperiodicreportstoyouremployeraboutyour condition.Wearealsorequiredbylawtoreportcasesofoccupationalinjury oroccupationalillnesstotheemployer orworkers'compensationinsurer.

20.ChangeofOwnership. Intheeventthatthismedicalpracticeissoldormergedwith another organization,your health information/recordwill become the property of the new owner, althoughyouwillmaintaintherighttorequestthatcopiesofyourhealth informationbe transferredtoanotherphysicianormedicalgroup.

21.BreachNotification.Inthecaseofabreachofunsecuredprotectedhealthinformation,we will notifyyouasrequiredbylaw.Ifyouhaveprovidedus withacurrentemailaddress,we mayuseemailto communicateinformationrelatedtothebreach.Insomecircumstances ourbusinessassociatemayprovidethenotification.Wemayalsoprovidenotificationby othermethodsasappropriate.[Note:Onlyuseemailnotificationifyouarecertainitwill notcontainPHIanditwillnot disclose inappropriate information.For exampleif your email address is"digestivediseaseassociates.com"anemailsentwiththisaddress could,ifintercepted,identifythepatientandtheircondition.]

[Addthefollowingthreeactivities,oranyofthethree,onlyiftheorganizationengagesorintendsto engage in these activities]

22. PsychotherapyNotes. Wewillnotuseordiscloseyourpsychotherapynoteswithoutyourprior

writtenauthorizationexceptforthefollowing:(1)yourtreatment,(2)fortrainingourstaff, studentsandothertrainees,(3)todefendourselvesifyousueusorbringsomeotherlegal proceeding,(4) ifthelawrequiresustodisclosetheinformationtoyouortheSecretaryofHHS or for some other reason, (5) in response to health oversight activities concerning your psychotherapist,(6)toavertaseriousthreattohealthorsafety,or(7)tothecoronerormedical examinerafteryoudie.Totheextentyourevokeanauthorizationtouseordiscloseyour psychotherapynotes,wewillstopusingordisclosingthesenotes.

23.Research. Wemaydiscloseyourhealthinformationtoresearchersconductingresearch withrespecttowhichyourwrittenauthorizationisnotrequiredasapprovedbyan

InstitutionalReviewBoard(IRB) orprivacyboard,incompliancewithgoverninglaw.

24. Fundraising.Wemayuseordiscloseyourdemographicinformation,thedatesthatyou receivedtreatment,thedepartmentofservice,yourtreatingphysician,outcome informationandhealthinsurancestatusinordertocontactyouforourfundraising activities. Ifyoudonotwanttoreceivethesematerials,notifythePrivacyOfficerlistedat thetopofthisNoticeof PrivacyPracticesandwewillstopanyfurtherfundraising communications. Similarly,youshouldnotify thePrivacyOfficeifyoudecideyouwantto startreceivingthesesolicitationsagain.

B. WhenThisMedicalPracticeMayNotUseorDiscloseYourHealthInformation

ExceptasdescribedinthisNoticeof PrivacyPractices,thismedicalpracticewill,consistentwith itslegal obligations,notuseordisclosehealthinformationwhichidentifiesyouwithoutyourwrittenauthorization.Ifyoudoauthorizethismedicalpracticetouseordiscloseyourhealthinformationforanotherpurpose,

youmayrevokeyourauthorizationinwritingatanytime.

C. YourHealthInformationRights

1.RighttoRequestSpecialPrivacyProtections. Youhavetherighttorequestrestrictionson certainusesanddisclosuresofyourhealthinformationbyawrittenrequestspecifyingwhat informationyouwanttolimit,andwhatlimitations onouruseordisclosureofthatinformation youwishtohaveimposed. Ifyoutellusnottodiscloseinformationtoyourcommercialhealth planconcerninghealthcareitemsorservicesforwhichyoupaidforinfullout-of-pocket,we willabide byyourrequest,unlesswemustdisclosetheinformationfortreatmentorlegal reasons.Wereservetherighttoacceptorrejectanyotherrequest,andwillnotifyyouofour

decision.

2. RighttoRequestConfidentialCommunications. Youhavetherighttorequestthatyoureceive

yourhealthinformationinaspecificwayorataspecificlocation. Forexample,youmayask thatwe sendinformationtoa particularemailaccountortoyourworkaddress.Wewill comply with allreasonablerequestssubmittedinwritingwhichspecifyhoworwhereyouwishto receivethesecommunications.

3. Rightto InspectandCopy.Youhavetherighttoinspectandcopyyourhealthinformation,with limitedexceptions. Toaccessyourmedicalinformation,youmustsubmitawritten request detailingwhatinformationyouwantaccessto,whetheryouwanttoinspectitorgetacopyofit, andifyouwantacopy,yourpreferredformandformat. Wewillprovidecopiesin your requested formandformatifitisreadilyproducible,orwewillprovideyouwithanalternative formatyoufindacceptable,orifwecan’tagreeandwemaintaintherecordinan electronic format,yourchoiceofareadableelectronicorhardcopyformat.Wewillalsosenda copytoany otherpersonyoudesignateinwriting.Wewillchargeareasonablefeewhichcoversourcostsfor labor,supplies,postage,andifrequestedandagreedtoinadvance,thecostof preparingan explanationorsummary,asallowedbyfederalandCalifornialaw.Wemaydenyyourrequest underlimitedcircumstances. Ifwedenyyourrequesttoaccessyourchild's recordsorthe recordsofanincapacitatedadultyouarerepresentingbecausewebelieveallowingaccesswould bereasonablylikelytocausesubstantialharmtothepatient, youwillhavearighttoappealour decision. If we denyyourrequestto accessyourpsychotherapynotes,youwillhavetherightto havethemtransferredtoanothermentalhealthprofessional.

4. RighttoAmendorSupplement. Youhavearighttorequestthatweamendyour healthinformationthatyoubelieveisincorrectorincomplete. Youmustmakearequesttoamendin writing,andincludethereasonsyoubelievetheinformationisinaccurateorincomplete.Weare notrequiredtochangeyourhealthinformation,andwillprovideyouwithinformationabout thismedicalpractice'sdenialandhowyoucandisagreewiththedenial.Wemaydenyyourrequest ifwedonothavetheinformation,ifwedidnotcreate theinformation(unlessthepersonorentity that createdtheinformationisnolongeravailableto makethe amendment),ifyouwouldnotbe permittedtoinspectorcopytheinformationatissue,oriftheinformationisaccurate and complete as is. If we deny your request, you may submit a written statement of your disagreementwiththatdecision,andwemay,inturn,prepareawrittenrebuttal.Youalsohave therighttorequestthatweaddtoyourrecordastatementofupto250words concerninganythingintherecordyoubelievetobeincomplete orincorrect.Allinformation relatedtoany requesttoamendorsupplementwillbemaintainedanddisclosedin conjunctionwithany subsequentdisclosureofthedisputedinformation.

5. Righttoan AccountingofDisclosures.Youhavearighttoreceivean accountingofdisclosuresof yourhealthinformationmadebythismedical practice,exceptthatthismedicalpracticedoesnot havetoaccountforthedisclosuresprovidedtoyouorpursuanttoyourwrittenauthorization,or as described in paragraphs 1 (treatment), 2 (payment), 3 (health care operations), 6 (notificationandcommunicationwithfamily)and18(specializedgovernment functions)of SectionAofthisNoticeofPrivacyPracticesordisclosuresforpurposesofresearchorpublic healthwhichexcludedirectpatientidentifiers,orwhichareincidenttoa useordisclosure otherwisepermitted orauthorizedbylaw,orthedisclosurestoahealthoversight agencyorlaw

enforcementofficialtotheextentthismedicalpracticehasreceivednoticefromthatagencyor

officialthatprovidingthisaccountingwouldbereasonablylikelytoimpedetheiractivities.

6. Youhavearighttonoticeofourlegaldutiesandprivacypracticeswithrespecttoyourhealth

information,includingarighttoapapercopyofthisNoticeofPrivacyPractices,evenifyou

havepreviouslyrequesteditsreceiptbyemail. Ifyouwouldliketohaveamoredetailedexplanationoftheserightsorifyouwouldliketoexerciseoneor moreoftheserights,contactour PrivacyOfficer listedatthetopofthisNoticeofPrivacyPractices.

D ChangestothisNoticeofPrivacyPractices

We reserve the right to amend our privacy practices and the terms of this Notice of Privacy Practices at any time in the future. Until such amendment is made, we are required by law to comply with the Notice. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception area, and a copy will be available at each appointment.

[We will also post the current notice on our website, if applicable]

E. Complaints

Complaints about this Notice of Privacy Practices or how this medical practice handles your health information should be directed to our Privacy Officer listed at the top of this Notice of Privacy Practices.

Ifyouarenotsatisfiedwiththemannerinwhichthisofficehandlesacomplaint,youmaysubmitaformal complaintto:

RegionIX

OfficeforCivilRights

U.S.DepartmentofHealthHumanServices

907th Street,Suite4-100

SanFrancisco,CA94103

(415)437-8310;(415)437-8311(TDD) (415)

Thecomplaintformmaybefoundat

Youwillnotbepenalizedinanywayforfilingacomplaint.