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

Each time you visit a healthcare provider, a record of your visit is made. Typically, these records contain your symptoms, examination and test results, diagnoses, treatment plans and billing related information. This Notice applies to all of the records of your care generated by Connecticut GI Providers.

Our responsibilities

Connecticut GI, PC is required by law to maintain the privacy of your health information and to provide you with a description of our legal duties and privacy practices regarding your health information. The current Notice will be posted in the reception area. In addition, we will also provide you with a copy of this Notice that we request you acknowledge with your signature. We are required by law to abide by the terms of this Notice and notify you if we make changes to this Notice, which may be at any time. Changes to the Notice will apply to your medical information that we already maintain as well as new information received after the

change occurs. If we change the notice, it will be posted in the reception area. You may also request that a revised Notice be sent to you in the mail or you may ask for one at your next appointment or appropriate visit. This Notice will also serve to advise you as to your rights with regards to your medical information.

YOUR RIGHTS REGARDING USES AND DISCLOSURES OF YOUR PERSONAL HEALTH

INFORMATION

The following categories describe examples of the way we

use and disclose medical information.

For treatment: We may use medical information about

you to provide, coordinate and manage your treatment or

services. We may disclose medical information about you

to other doctors, nurses, technicians, or other personnel

who are involved in your care. We may also provide a

subsequent healthcare provider with copies of various

reports that should assist him or her in treating you.

For payment: We may use and disclose medical

information about your treatment and services to bill and

collect payment from you, your insurance company or

a third party payer. For example, we need to give your

insurance company information before it approves or pays

for the health care services we recommend for you.

For health care operations: We may use or disclose as

needed, your health information in order to support our

routine health care operations. These operations include,

but are not limited to, quality assessments, medical reviews,

training activities, licensing, marketing, legal advice, billing

and collections, accounting support, transcription services,

or arranging for other healthcare operations. We may use or

disclose your protected health information to communicate

with you by telephone or mail for reminders and follow-up

appointments or procedure scheduling.

Business Associates: There are some services provided in

our organization through contracts with business associates.

Examples include quality assurances, accounting, legal

services, billing and collection services, and transcription

services. When these services are contracted, we may

disclose your health information to our business associates

so that they can perform the job that we have asked them

to do and bill you or your third party payer for services

rendered. To protect your health information, however,

we require the business associate to appropriately safeguard

your information through a written contract. Furthermore,

Business Associates are required by law to implement, and

comply with, their own HIPAA Policies and Procedures and

Security Standards.

How we secure your Electronic Personal Health

Information (e-PHI)

In accordance with the HIPAA Security Rule, there are

administrative, physical and technical safeguards in place to

ensure the confidentiality, integrity and security of your

e-PHI that is created, received, used or maintained by

Connecticut GI,PC.

Permitted and Required uses and disclosures that may be

made with your authorization or opportunity to object

Individuals involved with your care or payments for

your care: Unless you object, we may release medical

information about you to a friend or family member who is

involved in medical care or who helps to pay for your care.

In addition, we may disclose medical information about

you to an entity assisting relief effort so that your family

can be notified about your condition, status and location.

Permitted and Required Uses and Disclosures That May

be Made Without Your Authorization or opportunity to

object

As required by law. We may use and disclose health

information to do the following types of entities, including

but not limited to:

Food and Drug Administration

Public Health or legal authorities charged with preventing

or controlling disease, injury or disability

Law enforcement/Legal proceedings as required by law or

in response to a valid subpoena.

Correctional institutions

Worker’s Compensation Agents

Organ and tissue Donation Organizations

Military Command Authorities

Health Oversight Agencies

Funeral Directors, Coroners and Medical Directors

National Security and Intelligence Agencies

The Authority that receives reports on abuse and neglect

Your Health Information Rights

Although your health record is the physical property of

Connecticut GI, PC, you have the right to:

Inspect and Copy: You have the right to inspect and copy

medical information that may be used to make decisions about

your care. We ask that you submit your requests in writing.

Amend: If you feel that the medical information we have

about you is incorrect or incomplete, you may ask us to

amend the information by submitting a request in writing.

You have the right to request an amendment for as long as

we keep the information. We may deny your request for

an amendment and if this occurs, you will be notified of

the reason for the denial.

An accounting of disclosures: You have the right to

request an accounting of our disclosures of medical

information about you except for certain circumstances,

including disclosures for treatment, payment, health carerrr

operations or where you specifically authorized a disclosure.

Connecticut GI, PC will impose a fee for each subsequent

request for an accounting within the 12 month period. We

ask that you submit these requests in writing.