THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. Introduction

This Notice of Privacy Practices describes how Brunswick Gastroenterology may use and disclose your protected health information (PHI) to provide treatment to you; to seek payment for the medical services you receive; and to support the health care operations of our practice.

PHI includes your demographic information such as name, address, social security number, telephone/ FAX number, and names of relatives; past, present or future information about your physical or mental health or condition; and information about the medical services provided to you, including payment information, if any of that information may be used to identify you.

The Notice describes uses and disclosures of your PHI that are permitted or required by state or federal law and those that require your authorization. Also, it advises you of your rights to access and control your PHI.

We may amend this Notice of Privacy Practices periodically and you may obtain a current copy of the Notice by contacting the office staff at any time.

We regard the safeguarding of your PHI as an important duty. The elements of this Notice, your signature documenting receipt of the Notice, and any authorizations you may be asked to sign are required by state and federal law for your protection.

If you have any questions about Brunswick Gastroenterology's Notice of Privacy Practices, please contact our Privacy Contact, Valerie Chow, RN, at (207) 725-1355.

2. Safeguarding PHI Within the Office

We have in place appropriate administrative, technical, and physical safeguards to protect the privacy of your PHI. We regularly train our staff on the obligation to protect the privacy of your PHI. We hold medical records in a secure area within the office. Only staff members who have a "need to know" are permitted access to your medical records and other PHI. Our staff understands the legal and ethical obligation to protect your PHI and that a violation of this Notice of Privacy Practices will result in discipline in accordance with our personnel policy.

3. Uses and Disclosures of PHI Permitted by Federal or State Law

You may refuse, in writing, to allow Brunswick Gastroenterology to use your PHI as stated in this Notice. However, if you do, Brunswick Gastroenterology can refuse to treat you. The following categories describe different ways that we are permitted to use medical information.

• Treatment.We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other office personnel who are involved in your care. The office also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside the office who may be involved in your medical care after you leave the office, such as family members, clergy or others we use to provide services that are part of your care.
• Payment. We may use and disclose medical information about you so that the treatment and services you receive at the office, hospital, ambulatory surgery center, nursing home or other site may be billed to and payment may be collected from you, an insurance company or a third party. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
• Health Care Operations. We may use and disclose medical information about you for office operations. These uses and disclosures are necessary to run the office and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many office patients to decide what additional services the office should offer, what services are not needed, and whether new treatments are effective. We may also disclose information to doctors, nurses, medical students, and other office personnel for review and learning purposes. We may also use a patient sign-in sheet at the front desk; we may call you by name in the waiting room when we are ready to serve you; and we may contact you by mail, answering machine or voicemail as a reminder of scheduled appointments or as a reminder that it is time for you to schedule a follow-up visit. Also, we may notify you about possible treatment options or alternatives, or health related benefits, that may be of interest to you. When we involve third parties, such as billing services, in our business activities, we will have them sign a "business associate" agreement obligating them to safeguard your PHI according to the same legal standards we follow.

4. Uses and Disclosures of PHI Based Upon Your Written Authorization

From time to time, you may request that Brunswick Gastroenterology Associates disclose limited PHI to specified individuals or companies for a defined purpose and timeframe. These situations may include disclosures of sensitive PHI, such as HIV status or information about sexually transmitted diseases, mental or psychiatric treatment, or substance abuse services. Also, you may authorize disclosures to individuals who are not involved in treatment, payment, or health care operations, such as attorneys if you are involved in litigation either on your own or another's behalf. If you wish us to make disclosures in these situations, we will ask you to sign our "Authorization to Use and Disclose Protected Health Information".

5. Uses and Disclosures of PHI that Are Permitted or Required by Law

In some circumstances, we may use or disclose your PHI without your authorization. State and federal privacy law permit or require such use or disclosure regardless of your authorization because it is in the best interest of our society at large that the use or disclosure of PHI be made in these situations.

• Emergencies. If you are incapacitated and require emergency medical treatment, we will use and disclose your PHI to ensure you receive the necessary medical services.
• Communication barriers. If there are substantial communication barriers and your physician, using his or her professional judgment, infers that you authorize the use or disclosure of your PHI Brunswick Gastroenterology Associates will make the use or disclosure.
• Required by law. We may disclose PHI to the extent required by law and in a manner limited to the specific requirements of the law.
• Public health activities. We may disclose your PHI to an authorized public authority to prevent or control disease, injury, or disability or to comply with state child or adult abuse or neglect law.
• Health oversight activities. We may disclose your PHI to a health oversight agency for audits, investigations, inspections, and other activities necessary for the appropriate oversight of the health care system and the government benefit programs such as Medicaid and Medicare.
• Judicial and administrative proceedings. We may disclose your PHI in the course of any judicial or administrative proceeding in response to an order expressly directing disclosure and within certain limits in response to a subpoena, discovery request, or other lawful process.
• Law enforcement activities. We may disclose your PHI to a law enforcement officer for law enforcement purposes.
• Coroners, medical examiners, & funeral directors. We may disclose your PHI to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other lawful duties. We also may disclose your PHI to enable a funeral director to carry out his or her lawful duties.
• Research. We may disclose your PHI for certain medical or scientific research where the researchers have a protocol to ensure the privacy of your PHI.
• Serious threats to health or safety. We may disclose your PHI to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
• Armed forces personnel & national security. We may disclose the PHI of members of the armed forces for activities deemed necessary by appropriate military command authorities to assure proper execution of the military mission. We also may disclose your PHI to certain federal officials for lawful intelligence, counterintelligence, and other national security activities.
• Worker's compensation. We may disclose your PHI as authorized by and to the extent necessary to comply with the Maine Workers' Compensation Act or other similar programs that provide benefits for work-related injuries or illness without regard to fault.
• You & DHHS. We must disclose your PHI to you upon request and to the Secretary of the U.S. Department of Health & Human Services to investigate or determine Brunswick Gastroenterology Associate's compliance with the privacy law.

6. Your Rights Regarding PHI

• Right to request restriction of uses and disclosures. You have the right to request that we not use or disclose any part of your PHI unless it is a use or disclosure required by law. Please advise us of the specific PHI you wish restricted and the individual(s) who should not receive the restricted PHI. We are not required to agree to your restriction request, but if we do agree to the request, we will not use or disclose the restricted PHI unless it is necessary for emergency treatment. In that case, we will ask that the recipient not further use or disclose the restricted PHI.
• Right of access to PHI. You have the right to inspect and obtain a copy of your PHI in a "designated record set" (your medical and billing records) as long as we maintain the PHI in such format. However, you do not have the right of access to psychotherapy notes or information compiled in reasonable anticipation of a civil, criminal, or administrative proceeding. Also your right of access may be limited if providing certain PHI to you may endanger the health or safety of yourself or others. To request access to your PHI, please make your request in writing to our Privacy Contact. We will respond to your request as soon as possible, but no later than 30 days from the date of your request. We have the right to charge a reasonable fee for providing copies of your PHI.
• Right to confidential communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you at work or by mail. To request confidential communications, you must make you request in writing to Brunswick Gastroenterolgoy. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
• Right to amend PHI. You have the right to request that we amend the PHI in your "designated record set" for as long as we maintain the PHI in such format. Please make your request in writing to our Privacy Contact. We will respond to your request as soon as possible, but no later that 60 days from the date of your request. If we deny your request for amendment, you have the right to submit a written statement of reasonable length disagreeing with the denial and we have the right to submit a rebuttal statement. A record of any disagreement about amendment will become part of your medical records and may be included in subsequent disclosures of your PHI.
• Right to accounting disclosures. Subject to certain limitations, you have the right to a written accounting of disclosures by us of your PHI for not more than 6 years prior to the date of your request. Your right to an accounting applies to disclosures other than those for treatment, payment, or health care operations; to yourself; to your family and close friends involved in your care; or for notification purposes. Please make your request in writing to our Privacy Contact. We will respond to your request as soon as possible, but no later than 60 days from the date of your request. We will provide you with one accounting every 12 months free of charge. We will charge a reasonable fee based upon our costs for any subsequent accounting requests.
• Right to a copy of our Notice of Privacy Practices. You have a right to a paper copy of our Notice. You will be provided a copy the first time that you are seen in the office. We may periodically amend this Notice of Privacy Practices and you may obtain an updated Notice from our office staff at any time.

7. Complaint Procedure

• Within the practice. If you have a complaint about the denial of any of the specific rights listed in Section 6 above, about our Notice of Privacy Practices, or about our compliance with state and federal privacy law, please make your complaint in writing to our Privacy Contact. We will respond to your complaint in writing within the timeframes listed in Section 6 above or in any case within 60 days of the date of your complaint.
• Outside of the practice. If you believe that we are not complying with our legal obligations to protect the privacy of your PHI, you may file a complaint with the Secretary of the U.S. Department of Health & Human Services. You must make your complaint to the Secretary in writing within 180 days of the act or omission forming the basis of your complaint.