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 of Privacy Practices, please contact our Privacy Officer.

This Notice of Privacy Practices describes how North Coast Cancer Care, Inc. may use and disclose your health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. The notice also explains your rights to access and amend your health information and receive an accounting of disclosures of this information. Your individually identifiable health information is information that may identify you and that relates to your past, present, or future physical or mental health or condition; health care services, you receive; or payment for your care.

North Coast Cancer Care, Inc. will create a record of the services we provide you, and this record will include your health information. We need to maintain this information to ensure that you receive quality care to meet certain legal requirements related to providing you care. We understand that your health information is personal, and we are committed to protecting your privacy and ensuring that your medical information is not used inappropriately.

North Coast Cancer Care, Inc. is required by law to:

• maintain the confidentiality of your medical information;
• provide you a Notice of Privacy Practices that outlines our legal duties for protecting the privacy of your medical information and that explains your rights to have your medical information protected;
• abide by the terms of the Notice of Privacy Practices.

We reserve the right to change the Notice of Privacy Practices. The new notice will be effective for all protected health information that North Coast Cancer Care, Inc. maintains at that time. We will provide you a copy of the new notice if you call our office and request it, or we will provide you a copy at your next appointment. You may also obtain a copy of the revised notice at our website, www.northcoastcancercare.com.

USES AND DISCLOSURES BASED ON REGULATORY CONSENT

The federal medical records privacy regulation authorized the use and disclosure of protected health information for treatment, payment, and health care operations.

USES OF DISCLOSURES OF PROTECTED HEALTH INFORMATION

This notice describes the categories of uses and disclosures of health information that may occur. For each category some examples of possible uses and disclosures are included. We have not listed every possible use or disclosure of your health information, but every use or disclosure that occurs will correspond to one of eh categories listed below.

For Treatment: North Coast Cancer Care, Inc. will use your health information to provide your treatment. We will share your health information with others in the practice who are involved in your care. For example, your health information will be disclosed to the oncology nurses who participate in your care. We might also disclose your protected health information to another oncologist for the purpose of a consultation. If we have the necessary approval from you, we might also share your health information with an oncologist, home health care agency, or hospice to be sure those health care providers have all the information necessary to diagnose and treat you.

For Payment: North Coast Cancer Care, Inc. will use and disclose your health information in order to receive payment from you, an insurance company, or a third party for the services provided to you. We may contact you for additional information in order to process your claim. We may share your health information with payers to obtain prior approval authorization, and we may contact you, your insurance company, or your employee benefit manager if your claim is rejected or to resolve issues regarding your insurance benefits.

With your permission, we may share your health information with pharmaceutical company patient assistance programs and patient support organizations in order to assist you in obtaining payment for your care or payment for certain parts of your care.

For Health Care Operations: North Coast Cancer Care, Inc. may use or disclose your health information in order to support the business activities of the practice.

We may ask you to sign your name to a sign-in sheet at the registration desk and we may call your name in the waiting room when we call you for your appointment.

OTHER USES AND DISCLOSURES

Appointment Reminders: We may use your health information to send you a reminder of an appointment.

Treatment Alternatives and Health-Related Benefits and Services: North Coast Cancer Care, Inc. may use your health information to inform you of services or programs that we believe would be beneficial to you. We may call, mail, or e-mail you information about these services or goods. For example, we may contact you to make you aware of new products; supply product information; or inform you a new patient assistance program that may be available to you. At no time will your health information be released to third parties to allow them to communicate with you directly regarding new products or services, unless you have authorized such disclosure.

If you do not wish to receive these materials, you may contact our Privacy Official, who is Brian R. Murphy, M.D. and/or Practice Manager, to request that these materials not be sent to you.

Newsletters and Other Information: North Coast Cancer Care, Inc. may use your health information in order to send you educational materials.

If you do not wish to receive these materials, you may contact our Privacy Official, who is Brian R. Murphy, M.D. and/or Practice Manager, to request that these materials not be sent to you.

Individuals Involved in Your Care or Payment for Your Care: North Coast Cancer Care, Inc. may release your medical information with your permission, including information about your condition, to a friend or family member who is involved in your medical care or who helps pay for your care. We may also disclose medical information about you to disaster relief organizations so that your family can be notified about your condition, status, and location.

Emergency Situations: We may use or disclose your health information in an emergency treatment situation to ensure that you receive quality care. If this happens, your consent will be sought as soon as. possible after the delivery of care.

Communication Barriers: We may use and disclose your protected health information if we determine that there is a communication barrier that prevents you from authorizing the use or disclosure of your health information but we conclude, using our professional judgement, that it is your intent to authorize such use or disclosure.

As Required By Law: North Coast Cancer Care, Inc. may use and disclose your medical information when required to do so be federal, state, or local law.

To Avert a Serious Threat to health or Safety: North Coast Cancer Care, Inc. may use and disclose your medical information if necessary to prevent serious harm to your health and safety or the health and safety of the public or another person. Any such use of disclosure would only be to an individual who could intervene to prevent the harm.

SPECIAL CIRCUMSTANCES

Public Health Risks: North Coast Cancer Care, Inc. may disclose information about you for a number of public health activities. These include disclosures

• to prevent or control disease, injury, or disability;
• to report births and deaths;
• to report child abuse or neglect;
• to report adverse events, product defects, or problems; to track products; to notify individuals of product recalls; and to conduct post-marking surveillance as required by the Food and Drug Administration; and to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. These disclosures will be made only if you agree or to the extent required by law.

Research: We may use or disclose your health information for certain research purposes. Your health information may be released without your authorization only if an Institutional Review Board (IRB) or specially constituted Privacy Board reviews the research protocol, assesses a number of specific issues, and determines that appropriate safeguards are in place to allow the use of health information in the research project. In most circumstances, your health information will be used in research only if you authorize that disclosure and use.

Health Oversight: We may disclose health information for oversight activities authorized by law. These activities include monitoring of the health care system; eligibility determinations in government benefit programs; government regulatory activities; and compliance with civil rights laws.

Workers Compensation: We may disclose information about you to workers compensation programs.

Law Enforcement: We may disclose your health information to a law enforcement official for several different purposes:

• to comply with a court order, warrant, subpoena, summons, or other similar process;
• to assist in identifying or locating a suspect, fugitive, material witness, or missing person;
• about the victim of a crime if unable to obtain the victim(s) agreement;
• about criminal conduct at our facility;
• to report such a crime, the location of a crime, and the identity, description and location of the perpetrator of such crime, in an emergency situation.

Lawsuits: If you are involved in a lawsuit, we may disclose your health information in response to a court or administrative order. We may also release your health information to a party in the lawsuit, but only in response to a subpoena, discovery request, or other lawful process and only if the party has made reasonable efforts to inform you ofthe request or secure an order protecting the requested information.

Organ Donation: If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation; or to an organ donation bank.

National Security and Intelligence Activities: We may disclose your health information to authorized federal officials to facilitate protective services to the President and others, including foreign heads of state.

Military and Veterans’ Activities: If you are a member of the Armed Forces, we may disclose your medical information to military command authorities. Medical information about foreign military personnel may be disclosed to foreign military authorities.

Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to those authorities to assist them in providing you health care, protecting your health and safety or the health and safety of others, or for the safety of the correctional institution..

Required Uses and Disclosures: As required by the law, we must make disclosure to you and to the Secretary of Health and Human Services to determine our compliance with federal medical privacy regulations.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

Right to Request Restrictions: You have the right to request restriction on the use and disclosure of your health information for treatment, payment, and health care operations. You may also request limits on the health information that is released to individuals, such as family members or friends, who are involved in your care or the payment for your care.

Right to Inspect and Copy: You have a right to inspect and copy your medical record or health information that is used by your health care providers to make decisions about your care. Billing information would generally be considered to be part of your medical record, however, you will not have access to psychotherapy notes or information that is compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding.

To inspect and copy medical information that may be used to make decisions about your care, you must submit your request in writing to our Privacy Officer, Brian R. Murphy, M.D. and/or Practice Manager. If you request a copy of the information, you may be charged a fee for the costs of copying and mailing and for other supplies that are required to respond to your request.

If we deny your request to review your medical record, you may appeal that denial.

Right to Amend: You have the right to request that we amend the information in your medical record, for as long as we keep your medical record. You must make a written request for amendment that includes the reason(s) for your request and submit it to our Privacy Officer.

We may deny your request if it is not in writing or does not include a reason to support the request. We may also deny your request if the information that you wish to amend

• was not created by North Coast Cancer Care, Inc., unless the person or entity that created the information is not able to act on the requested amendment;
• is not part of the medical record kept by North Coast Cancer Care, Inc.;
• is not part of the information which is available for inspection and copying; or
• is complete and accurate.

Right to Accounting of Disclosures: You have the right to request an accounting of disclosures of your medical information for purposes except for treatment, payment, and health care operations. Certain disclosures, including those we made to you and to family members and friends involved in your care and those you authorize, will be excluded from the accounting.

You have a right to an accounting of disclosures that occur after April 14, 2003 and to disclosures for up to a six-year period. Your request must specify the time period for which you wish to receive an accounting.

The first accounting within a 12-month period will be provided to you free of charge. For additional accountings of disclosures provided to you during any 12-month period, we may charge you for the costs of preparing the accounting. We will notify you of the charges and you may withdraw or modify your request before any charges are incurred.

Right to Request Confidential Communications: You may request that we communicate with you in a certain manner or at a certain location regarding the services you receive form North Coast Cancer Care, Inc. For example, you may request that we only contact you by mail and you may request that all correspondence be directed to your work address.

You must make your request in writing to our Privacy Officer. You are not required to provide a reason for your request. We will honor all reasonable requests.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice, even if you have agreed to receive this notice electronically by visiting our web site at www.northcoastcancercare.com. You may also receive a copy of this notice at any time by contacting:

Privacy Officer
North Coast Cancer Care, Inc.
1674 Sycamore Line
Sandusky, Ohio 44870

 419-626-9090

CHANGES TO THIS NOTICE

We reserve the right to change this notice. If we change the notice, we may make it effective for health information we already have as well as for information about you that we receive in the future.

COMPLAINTS

If you believe your health information has been used or disclosed improperly or your privacy rights have been violated, you may file a written complaint with

Privacy Officer
North Coast Cancer Care, Inc.
1674 Sycamore Line
Sandusky, Ohio 44870

 419-626-9090

OR