Notice of Privacy Practices

Effective Apri 14, 2003

As required by the Privacy Regulations created as a result of the ..
Health Insurance Portability and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUAllY IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI).ln conducting our business, we will create records regarding you and the treatment and services we provide, to you. We are required by law to maintain the confidentiality of health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the same time.

We realize that these laws are complicated, but we must provide you with the following important information.

How we may use and disclose your IIHI
Your privacy rights !n your IIHI
Our obligations concerning the use and disclosure of your IIHI

The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Western Arkansas Plastic & Reconstructive Surgery Center
101 Phoenix Village Mall, Ft. Smith, AR 72901

C. WE MAY USE AND DISCLOSE YOUR INDIVIDUAllY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOllOWING WAYS:

The following categories describe the different ways in which we may use and disclose your IIHI.

1. Treatment - Our practice may use your IIHI to treat you. For example, we may ask you to have laboratory tests, X-rays, etc., and we may use the results to help us reach a diagnosis. We may use your IIHI in order to write a prescription for you, or we may disclose your IIHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice - including, but not limited to, our doctors and nurses - may use or disclose your IIHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your IIHI to others who may assist in your care, such as your spouse, children or parents.