At Michael C. Tivnon, M.D., Inc., we are committed to treating and using protected health information about you responsibly. This Notice of Health Practices describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective April 2003 and applies to all protected health information as defined by federal regulations. Understanding your Health Record/Information: Each time you visit Michael C. Tivnon, M.D., Inc., a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

• Basis for planning your care and treatment,
• Means of communication among the many health professionals who contribute to your care,
• Legal document describing the care you received,
• Means by which you or a third-party can verify that services billed were actually provided,
• A source of data for medical research,
• A source of information for public health officials charged with improving the health of the state and nation,
• A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others. Your Health Information Rights: Although your health record is the physical property of Michael C. Tivnon, M.D., Inc., the information belongs to you. You have the right to:

• Obtain a paper copy of this notice of information practices upon request. You may request a copy from our HIPAA Compliance Officer.
• Inspect and copy (at a fee) your health record as provided for in 45 CFR 164.524. You have the right to request the opportunity to inspect and receive a copy of protected health information about you in certain records that we maintain. This includes your medical and billing records but does not include psychotherapy notes or information gathered or prepared for a civil, criminal, or administrative proceeding. We may deny your request to inspect and copy protected health information only in limited circumstances. To inspect and copy protected health information please contact our Medical Records Clerk. If you request a copy of protected health information about you, we may charge you a reasonable fee for copying, postage, labor and supplies used in meeting your request.
• Amend your health record as provided in 45 CFR 164.528. You have the right to request that we amend protected health information about you as long as the original information is saved for future reference. To make this type of request you must submit your request in writing to our Compliance Officer. You must also give us a reason for your request. We may deny your request in certain cases, including if it is not in writing or if you do not give us a reason for the request.
• Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528. You have the right to request an accounting of certain disclosures that we have made of protected health information about you. This is a list of disclosures made by us during a specified period of up to six years other than disclosures made for treatment, payment, health care operations, disclosure to you directly, disclosures made to personal representatives as directed by you, certain notification purposes (law enforcement, public health, etc.), and disclosures made before April 14, 2003. If you wish to make such a request, please contact our Compliance Officer. Copying costs may occur which will be quoted before hand. You have the ability to cancel your request.
• Request communications of your health information by alternative means or at alternative locations. You may specify how you would like to be contacted (regular mail to a post office box and not your home, email and not by phone). We are required to accommodate reasonable requests.
• Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522. You have the right to request additional restrictions on the protected health information that we may use for treatment, payment and health care operations. You may also request additional restrictions on our disclosure of protected health information to certain individuals involved in your care that otherwise are permitted by the Privacy Rule. We are not required to agree to your request. If we do agree to your request, we are required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency. To request restrictions, you must make your request in writing to our Compliance Officer, Vonda Peralez. In your request please include (1) the information that you want to restrict; (2) how you want to restrict the information (restricting use outside of our office, etc.); and (3) to whom you want those restrictions to apply.
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our Responsibilities:

Michael C. Tivnon, M.D., Inc., is required to:

• Maintain the privacy of your health information,
• Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you,
• Abide by the terms of this notice,
• Notify you if we are unable to agree to a requested restriction, and
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to make changes to this Notice and to make the new provisions effective for all protected health information we maintain. Should information to this Notice change, we will post a copy in our office in a prominent location. You will also receive an updated notice at your next visit or you may ask for a revised copy from our HIPAA Compliance Officer. We will not use or disclose your health information without authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have received a written revocation of the authorization according to the procedures included in the authorization. For more information or to Report a Problem: If you have questions and would like additional information, you may contact the practice's Privacy Officer. If you believe your privacy rights have been violated, you may file a complaint with our Compliance Privacy Officer or with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights. The address for the OCR is listed below:

Office for Civil Rights U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Room 509F, HHH Building Washington, D.C. 20201

HIPAA Compliance Privacy Officer Contact Information

You may contact our Compliance Privacy Officer at the following address and phone number: HIPAA Compliance Officer, Vonda Peralez 300 Old River Road, #150 Bakersfield, CA 93311 661-663-7600

Examples of Disclosures for Treatment, Payment, and Health Operations:

We may use and disclose your protected health information for treatment, payments, or health care operations. The following are categories with examples. Please remember that we cannot list every type of use or disclosure that may fall within each category.

Treatment:

We may use and disclose protected health information about you to provide, coordinate or manage your health care and related services. We may consult with other health care providers regarding your treatment and coordinate and manage your health care with other. For example, we may use and disclose protected health information when you need a prescription, lab work, a test, or other health care services. In addition, we may use and disclose protected health information about you when referring you to another health care provider. For example, if you are referred to another physician, we may disclose protected health information to your new physician regarding whether you are allergic to any medications.

Payment:

We may use and disclose protected health information so that we can bill and collect payment for the treatment and services provided to you. Before providing treatment or services, we may share details with your health plan concerning the services you are scheduled to receive. For example, we may ask for payment approval from your health plan before we provide care or services. We may use and disclose protected health information to find out if your health plan will cover the cost of care and services we provide. W may use and disclose protected health information to confirm you are receiving the appropriate amount of care to obtain payment for services. We may use and disclose protected health information for billing, claims management, and collection activities. We may disclose limited protected health information to consumer reporting agencies relating to collection of payments owed to use. We may also disclose protected health information to another health care provider or to a company or health plan required to comply with the HIPAA Privacy Rule for the payment activities or that health care provider, company, or health plan. For example, we may allow a health insurance company to review protected health information for the insurance company's activities to determine the insurance benefits to be paid for your care.

Workers Compensation:

We may disclose protected health information to authorized personnel relating to your workers compensation claim. We may also release health information relating to your workers compensation claim to your employer.

Health Care Operations:

We may use and disclose protected health information in performing business activities, which are called health care operations. Health care operations include doing things that allow us to improve the quality of care we provide and to reduce health care costs. We may use and disclose protected health information about you in the following health care operations:

• Reviewing and improving the quality, efficiency and cost of care that we provide to our patients. For example, we may use protected health information about you to develop ways to assist our physicians and staff in deciding how we can improve the medial treatment we provided to others.
• Improving health care and lowering costs for groups of people who9 have similar health problems and helping to manage and coordinate the care for these groups of people. We may use protected health information to identify groups of people with similar health problems to give them information, for instance, about treatment alternatives, and educational classes.
• Reviewing and evaluating the skills, qualifications, and performance of health care providers taking care of you and our other patients.
• Cooperating with outside organizations that assess the quality of the care that we provide.
• Cooperating with various people who review our activities. For example, protected health information may be seen by doctors reviewing the services provided to you, and by accountants, lawyers, and others who assist us in complying with the law and managing our business.
• Assisting us in making plans for our practice's future operations.
• Resolving grievances within our practices
• Reviewing our activities and using or disclosing protected health information in the event that we sell our practice to someone else or combine with another practice.
• Business management and general administrative activities of our practice, including managing our activities related to complying with the HIPAA Privacy Rule and other legal requirements.

If another health care provider, company, or health plan that is required to comply with the HIPAA Privacy Rule has or once had a relationship with you, we may disclose protected health information about you for certain health care operations of that health care provider or company. For example, such health care operations may include reviewing and improving the quality, efficiency and cost of care provided to you, reviewing and evaluating the skills, qualifications, and performance of health care provider, providing training programs for student, trainees, health care provider, or non-health care professionals, cooperating with outside organizations that evaluate, certify, or license health care providers or staff in a particular field or specialty, and assisting with legal compliance activities of that health care provider or company. We may also disclose protected health information for the health care operations of an organized health care arrangement in which we participate. An example of an organized health care arrangement is the joint care provided by a hospital and the doctors who see patients at the hospital.

Communication from our office:

We may contact you to remind you of appointments and to provide you with information about treatment alternatives or other health related benefits and services that may be of interest to you.

Other Uses and Disclosures We Can Make Without Your Written Authorization or Opportunity to Agree or Object:

We may use and disclose protected health information about you in the following circumstances without your authorization or opportunity to agree or object, provided that we comply with certain conditions that may apply. Required by law: We may use and disclose protected health information as required by federal, state, or local law. Any disclosure complies with the law and is limited to the requirements of the law. Public Health Activities: We may use or disclose protected health information to public health authorities or other authorized persons to carry out certain activities related to public health including the following activities:

• To prevent or control disease, injury, or disability.
• To report disease, injury, or death,
• To report child abuse or neglect,
• To report reactions to medications or problems with products or devices regulated by the federal Food and Drug Administration or other activities related to quality, safety, or effectiveness of FDA-regulated products or activities,
• To locate and notify persons of recalls of products they may be using,
• To notify a person who may have been exposed to a communicable disease in order to control.

All other uses and disclosures of protected health information about you will only be made with your written authorization. If you have authorized us to use or disclose protected health information about you, you may revoke your authorization at any time, except to the extent we have taken action based on the authorization.