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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.

Drs. Gehris, Jordan and Associates are committed to your personal well being. Protecting the privacy and security of the information you share with us is included in that commitment. While we do not sell or trade any information to third parties, we do share information with entities such as your insurance company and quality review organizations as part of our routine and necessary business operations. We do this with the utmost care and sensibility.

This notice is being provided to explain how your personal healthcare information is used, and your rights to review, amend and/or request limitations on the disclosure of this information.

I. Definitions:
A. Disclosure means the release, transfer, provision of access to, or divulging in any other manner of information outside the entity holding the information.
B. Healthcare means care or service related to the health of an individual. Healthcare includes, but is not limited to, diagnostic, therapeutic, rehabilitative care and the sale or dispensing of a drug, equipment, or other item in accordance with a prescription.
C. Protected Health Information means any individually identifiable health information, whether oral or recorded in any form, that is created and relates to the past, present, or future physical or mental health, condition or care of an individual.

II. Your Rights to Privacy and Disclosure
You have the right to request restriction of uses and disclosures of your Protected Health Information as outlined below. However, there are some instances where Drs.Gehris, Jordan and Associates are not required to agree to a requested restriction.
A. At the time you initially receive service at Drs. Gehris, Jordan and Associates, you may request that Drs. Gehris, Jordan and Associates restrict the use or disclosure of your Protected Health Information to carry out treatment, payment, or healthcare operations. To request a restriction of your information, contact our Medical Records Department and say that you want to restrict the release of all or part of your information.
B. You can request to receive confidential communications concerning your health information. To receive your information confidentially, contact our Medical Records Department and direct them to how and where you wish to receive your information.
C. You can inspect and obtain a copy of your protected health information/medical record, unless otherwise protected by law. Contact our Medical Records Department to make a request.
D. You can obtain a copy of this notice at any time. You will receive one at the time of service.
E. You can amend your protected health information by contacting our Medical Records Department. We cannot destroy or otherwise remove the original information, but you may add/amend information in your record pursuant to Drs. Gehris, Jordan and Associates’ policy.
F. You can request an accounting of our disclosures of your protected health information, unless protected by law, by contacting our Medical Records Department.
III. Permitted Disclosures:
Drs. Gehris, Jordan and Associates may not use or disclose protected health information, except as permitted or required by law. The following are permitted uses and disclosure under current laws. We can release information to the following unless otherwise restricted by law:

A. to the patient and/or the personal representative of the patient to whom the information pertains
B. to Drs. Gehris, Jordan and Associates business associates or other healthcare providers, to carry out treatment, payment, or healthcare operations purposes
C. to anyone in compliance with an authorization completed by the patient or patient’s representative, such as that from a healthcare provider regarding psychotherapy notes
D. to others as permitted by and in compliance with some other law or regulation such as those that require us to make certain reports to health oversight agencies, like Maryland’s Department of Health and Mental Hygiene.

Individually identifiable health information is frequently shared with the following types of entities for purposes related to the function and operation of a healthcare facility or physician practice:
• Consulting physicians
• Health insurance companies
• Managed care organizations
• Home Health Care
• Health benefit managers
• State/Federal agencies
• Clinical laboratories

This information is released for the purposes of ensuring continuity of care, billing, to conduct quality assessment and improvement activities, and reviewing the competence or qualifications of healthcare professionals.

We may also use information to contact you and provide appointment reminders and information about treatment alternatives or other health related benefits and services. We may contact you to request funds for Drs. Gehris, Jordan and Associates’ programs and services.

The Federal Health Insurance Portability and Accountability Act (HIPAA) established federal guidelines that require Drs. Gehris, Jordan and Associates to maintain the privacy of your protected health information. It also requires Drs. Gehris, Jordan and Associates to provide you with this Notice of our legal duties and privacy practices with respect to your health information. Further, Drs. Gehris, Jordan and Associates are required to abide by the terms of this Notice and to make the new provisions effective for all protected health information that we maintain. In the event we make changes to this Notice, we will make the changes apparent in the new document, post the changes in a prominent place within our facilities and include them on our website. (www.drsgehrisjordanandassociates.com) We will not individually notify every past patient, but will attempt to abide by the requirements of the Notice in effect at the time of your healthcare.

IV. Questions or Complaints:
Should you have any questions about this Notice, please contact our Privacy Officer at (410) 879-9100, extension 210.

You may lodge a complaint/grievance relevant to any portion of the Notice provisions. It will be reviewed under the terms and parameters of our grievance process. At no time will you be subject to retaliation for filing a complaint. You may also forward your complaint to the Secretary of Health and Human Services in Washington, D.C.

V. Effective date:
The provisions set forth in this Notice took effect on April 14, 2003

This Notice is provided to you on behalf of Drs. Gehris, Jordan, Day and Associates and their medical staff.