Privacy_Notice

PRIVACY NOTICE

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

• Your confidential healthcare information may be disclosed to other healthcare providers for the purpose of providing you
with a continuum of quality healthcare.

• Your confidential healthcare information may be disclosed to your insurance provider for the purpose of receiving
payment for providing you with healthcare services.

• Your confidential healthcare information may be disclosed to public officials or law enforcement agencies in an
investigation in which you are a victim of abuse, a crime or domestic violence.

• Your confidential healthcare information may be disclosed to other healthcare professionals in the case of a healthcare
emergency.

• Your confidential healthcare information may be disclosed to public health organizations or federal organizations in the
matter of communicable diseases, defective devices, or a food or medication reaction.

• Your confidential healthcare information cannot be disclosed for purposes other than those, which are outlined in this
notice.

• Your confidential healthcare information may only be disclosed after receiving written authorization from you. You have
the right to revoke your permission to disclose confidential healthcare information at any time.

• You may be contacted by office personnel to remind you of appointments, healthcare treatment options or other health
services that may be of interest to you. Messages related to follow-up appointments may be left on an answering machine
or with the individual answering the telephone.

• You have the right to restrict the use and disclosure of your confidential healthcare information to family members,
friends, or others involved in your healthcare or payment for health care services. However, the physician office may
choose to refuse your restriction if it is in conflict of providing you with quality healthcare or in the event of a medical
emergency.

• You have the right to receive confidential communication about your healthcare status.

• You have the right to review and request a copy of any and/or all portions of your healthcare information.

• You have the right to request changes be made to your healthcare information.

• You have the right to know who has obtained your confidential healthcare information and for what reason.

• You have the right to have a copy of this Privacy Notice upon request.

• The physician office is required by law to protect the privacy of its patients.

• The physician office will abide by the terms of this notice. We reserve the right to make changes to this notice and
continue to maintain the confidentiality of all healthcare information.

• You have the right to complain to the Privacy Officer of this office and to the Secretary of Health and Human Services if
you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your
complaint to: ATTN: Privacy Officer, South McAllen Sleep Lab and Clinic, 2010 S Cynthia, Suite 105, McAllen, TX 78503.

• All complaints will be investigated. No personal issue will be raised for filing a complaint with the physician office.

• For further information about this Privacy Notice, please contact the Privacy Officer at (956) 668-8111.

Effective January 2, 2007