Notice of Privacy Practices

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.

If you have any questions about this Notice please contact our Privacy Officer. Admitting or Emergency Room Registration Staff will provide you with the name.

Who Will Follow This Notice: This notice describes our facility's practices and that of any programs associated with Jupiter Medical Center, Inc. including but not limited to its subsidiary organizations such as the Hospital and Jupiter Medical Center Pavilion. Any health care professional authorized to enter information into your file or record and all employees, staff and other personnel will follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or operation purposes described in the notice.

Our Pledge Regarding Medical Information: We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive in our facility. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care.

This notice will tell you about the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

• Make sure that medical information that identifies you is kept private.
• Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
• Follow the terms of the notice that is currently in effect.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical health, mental health or condition and related health care services.

Changes to This Notice: We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facility in key locations and on our Internet site. This notice will contain the effective date. In addition, each time you are in our facility for treatment we will offer you a copy of the current notice in effect.

Complaints: If you believe your privacy rights have been violated, you may file a complaint with our facility or with the Secretary of the Department of Health and Human Services in Washington D.C. We will not retaliate or penalize you for filing a complaint.

To file a complaint with us, please contact the Privacy Officer. Your complaint should provide specific details to help us in investigating the potential problem.

To file a complaint with the Secretary of Health and Human Services, contact the Office for Civil Rights,
U.S. Department of Health & Human Services, 61 Forsyth Street, SW. - Suite 3B70, Atlanta, GA 30323, or as instructed on www.hhs.gov/ocr/hipaa.

How We May Use and Disclosure Your Medical Information

The following categories describe different ways that we use and disclose medical information. Each category of uses or disclosures will be explained but not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment: We may use medical information about you to provide you with medical treatment. We may disclose medical information about you to doctors, nurses, counselors, physician assistants, nurse practitioners, Admissions & Billing Office staff, Health Information Services Office staff, Compliance staff or other personnel who are involved in taking care of you. Different departments of our facility also may share medical information about you in order to provide for your needs, such as prescriptions, lab work or dental work. We also may disclose medical information about you to people outside the facility who may be involved in your medical care or others we use to provide services that are part of your care, such as your HMO and your DSS caseworker. When required to, we will obtain your authorization before disclosing any of your information. Only the minimally necessary information will be revealed during any disclosures.

Communication with Family: Health professionals, using their best judgment, may disclose to a family member, 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.

For Health Care Operations: We may use medical information about you to support our quality assessment and improvement activities, including outcomes evaluation and development of clinical guidelines, population based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination, contacting health care providers with information about treatment alternatives; and related functions that do not include treatment.

We may use your medical information to review the competence or qualifications of health care professionals, evaluating practitioner and provider performance, health plan performance, conducting training programs in which students, trainees, care providers, training of non-health care professionals, accreditation, certification, licensing, or credentialing activities.

We may use your medical information to conduct or arrange health care review, legal services, and auditing functions, including fraud and abuse detection and compliance programs, underwriting, premium rating and other activities relating to the creation, renewal or replacement of a contract of health insurance or health benefits, and ceding, securing, or placing a contract for reinsurance of risk relating to claims for health care including stop loss and excess of loss insurance.

We may use your medical information for business planning and development, such as cost-management and planning related analyses related to managing and operating Jupiter Medical Center, Inc., including formulary development and administration, development of improvement methods of payment or coverage policies and business management and general administrative activities of Jupiter Medical Center, Inc. including but not limited to: Management activities relating to implementation of and compliance of the HIPAA privacy rules, customer service including data analyses, resolution of internal grievances and due diligence in the connection of the sale or transfer of assets to a potential successor of interest.

For Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about treatment you received so your health plan will pay us or reimburse you. 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.

Appointment Reminders: We may also use and disclose medical information to contact you as a reminder that you have an appointment or missed an appointment for treatment in order to reschedule the appointment.

Treatment Aftercare Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment aftercare options that will benefit you.

Research: Under certain circumstances, we may use and disclose minimally necessary medical information about you for research purposes. All research projects, however, are subject to a special approval process through the Jupiter Medical Center Institutional Review Board.

Fundraising: We may use certain information (name, address, telephone number, dates of service, age, and gender) to contact you in the future to raise money for our organization. We may also provide this information to our institutionally related foundation, for the same purpose. The money raised will be used to expand and improve the services and programs we provide the community. If you do not wish to be contacted as part of our fundraising efforts, please contact our Privacy Officer.

As Required By Law: We will disclose minimally necessary medical information about you when required to do so by federal, state or local law.

To Avert A Serious Threat To Health Or Safety: We may use and disclose minimally necessary medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

Special Situations

Worker's Compensation: We may release minimally necessary medical information about you for worker's compensation or similar programs. These programs provide benefits for work related injuries or illness. State and/or federal law control the release of such information.

Public Health Risks: We may disclose minimally necessary medical information about you for public health activities. These activities generally include the following:

• To prevent or control disease, injury or disability;
• To report child abuse or neglect by making a telephone report to the Child Abuse Hotline and to follow this report with a written confirmation;
• To report reaction to medication or problems with products;
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; or
• To notify the appropriate government authority if we believe a client has been the victim of domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities: We may disclose minimally necessary medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose minimally necessary medical information about you in response to a proper court order or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement: We may release minimally necessary medical information about you if asked to do so by a law enforcement official:

• In response to a proper court order or similar process.
• In response to a subpoena for a member of the Jupiter Medical Center staff.
• About criminal conduct involving our facility; and
• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or location of person who committed the crime if the crime is on agency premises or against agency personnel.

Medical Examiners: We may also release minimally necessary medical information about you to a medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.

National Security and Intelligence Activities: We may release minimally necessary medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Your Rights Regarding Medical Information About You

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy: You have the right to inspect and receive a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.

To inspect and receive a copy of medical information that may be used to make decisions about you, you must submit your request to the Medical Information Department. If you request a copy of the information, we may charge a fee for the costs of retrieving, copying, mailing, and any other supplies associated with your request.

Right to Amend: If you feel that any of the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by our facility.

To request an amendment, your request must be made in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• is not part of the medical information kept by our facility;
• is not part of the information which you would be permitted to inspect and copy; or
• is accurate and complete.

Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures". This is a list of the disclosures we have made of your medical information.

We are not required to account for routine disclosures, for example disclosures between Jupiter Medical Center staff regarding your care.

To request this accounting of disclosures, you must submit your request in writing, to the Medical Information Department. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first accounting you request within a twelve-month period will not include a cost for providing the disclosure list.

For additional accountings, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request 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 only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the Medical Information Department. 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 a Copy of This Notice: You have the right to a copy of this notice. You may ask us to give you a copy of this notice at any time. To request a copy of this notice, you must make your request in writing to the Privacy Officer.

Right to Request Restrictions: Even though all disclosures we already make are minimally necessary, you have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care. Finally, you have the right to request a restriction on the people who are able to obtain the information we disclose. However, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request a restriction or limitation, your request must be made in writing and submitted to the Privacy Officer.

Version 2.0 - Effective April 30, 2003 | Revised Version 2.1 - Effective June 16, 2008