Notice of Patient Information Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read carefully.

Cloud Surgical Solutions' Legal Duty

Cloud Surgical Solutions is required by law to protect the privacy of your personal health information, provide this notice about our information practices and follow the information practices that are described below.

Understanding Your Health Information

Each time you visit our office 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 panning your care and treatment
• A means for communication among the many health professionals who contribute to your care
• A legal document describing the care you received
• A means by which you or a third-party payer can verify that services billed were actually provided
• A tool in educating health professionals
• A source of data for medical research
• A source of information for public health officials charged with improving the health of the nation
• A source of data for our practice planning and marketing
• A tool with which we can assess & continually work to improve the care we render & the outcomes we achieve.

An understanding of what is in your record and how your health information is used will help you to (1) ensure its accuracy, (2) better understand who, what, when, where, and why others may access your health information, and (3) make more informed decisions when authorizing disclosure to others.

Your Health Information Rights

Although your health record is the physical property of this office, the information belongs to you. As provided for in the HIPAA Privacy Regulation, 45 CFR Part 160, you have the right to:

• Request a restriction on certain uses & disclosures of your information
• Obtain a paper copy of this Notice of Privacy Practices upon request
• Inspect & copy your health record
• Request an amendment to your health record
• Obtain an accounting of disclosures of your health information
• Request communications of your heath information by alternative means or at alternative locations
• Revoke your authorization to use or disclose health information except to the extend that action has already been taken.

Examples Of Disclosures For Treatment, Payment, And Health Operations

Treatment: We will use your health information for treatment. For example, information obtained by the physician or another member of our staff will be recorded in your record and used to determine the course of treatment that should work best for you. Your provider will document in your record any expectations he or she has for the members of our staff. Our staff will then record the actions they took and their observations. In that way, the provider will know how you are responding to treatment. We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you.

Payment: We will use your health information for payment. For example, a bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

Health Care Operations: We will use your health information for regular health operations. For example, members of our staff may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

Business Associates: There are some services provided in our practice through contacts with Business Associates. Examples include diagnostic services, certain laboratory tests, and a transcription service we use for documenting your record. When these services are contracted, we may disclose your health information to our Business Associates so that it can perform the job we've asked it to do. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

Communication With Family: Our staff, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Funeral Directors: We may disclose health information to funeral directors consistent with applicable lay to carry out their duties.

Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and healthy and safety of other individuals.

Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Reports: Federal law makes provision for your health information to be release to an appropriate health oversight agency, public health authority, or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.

EFFECTIVE DATE: April 15, 2003
COPY AVAILABLE UPON REQUEST

For More Information Or To Report A Problem

If you have questions and would like additional information you may contact the Privacy Officer of this office. If you believe your privacy rights have been violated you can file a complaint with the Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Concerns and Complaints

If you are concerned that Cloud Surgical Solutions may have violated your privacy rights or if you disagree with any decisions we have made regarding access or disclosure of your personal health information, please contact our practice manager at the address listed below.

You may also send a written complaint to the US Department of Health and Human Services.

For further information on Cloud Surgical Solutions' health information practices or if you have a complaint, please contact the privacy officer at Cloud Surgical Solutions.

Elaine Butler
Privacy Officer
Cloud Surgical Solutions
117 Foothills Drive
Morganton, North Carolina 28655
Telephone: 828.437.0847
Fax: 828.432.9722

Changes to this Policy

Cloud Surgical Solutions may change or update this policy at any time. When changes are made, a new "Notice of Information Practices" will be posted in the waiting room and patient exam areas and will be provided at your next visit. You may also request an updated copy of our notice at any time.

EFFECTIVE DATE: April 15, 2003
COPY AVAILABLE UPON REQUEST