CHARLESTON ENT, LLC

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.

UNDERSTANDING YOUR PROTECTED HEALTH INFORMATION (PHI)

Charleston ENT Associates and its affiliates (including but not limited to Charleston ENT Authority, Charleston ENT Physicians) participate in a clinically integrated health care setting. As a result of this clinical integration, these organizations function as an Organized Health Care Arrangement (OHCA) as defined by the Health Insurance Portability and Accountability Act (HIPPA). For purposes of this notice, the members of Charleston ENT OHCA are collectively referred to in this document as "Charleston ENT." We collect or receive this information about your past, present or future health condition to provide health care to you, to receive payment for this health care, or to operate the clinics.

HOW MAY WE USE AND RELEASE YOUR PROTECTED HEALTH INFORMATION (PHI)

A. The following uses do NOT require your authorization, except where required by SC law:

1. For treatment. Your PHI may be discussed by caregivers to determine your plan of care. For example, the physicians, nurses, medical students and other health care personnel may share PHI in order to coordinate the services you may need.

2. To obtain payment. We may use and disclose PHI to obtain payment for services from you, an insurance company or a third party. For example, we may use the information to send a claim to your insurance company.

3. For health care operations. We may use and disclose PHI for clinic operations. For example, we may use the information to review our treatment and services and to evaluate the performance of our staff in caring for you.

4. For public health activities. We report to public health authorities, as required by law, information regarding births, deaths, various diseases, reactions to medications and medical products.

5. Victims of abuse, neglect, domestic violence. Your PHI may be released, as required by law, to the South Carolina Department of Social Services when cases of abuse and neglect are suspected.

6. Health oversight activities. We will release information for federal or state audits, civil, administrative or criminal investigations, inspections, licensure or disciplinary actions as required by law.

7. Judicial and administrative proceedings. Your PHI may be released in response to a subpoena or court order.

8. Law enforcement or national security purposes. Your PHI may be released as part of an investigation by law enforcement.

9. Uses and disclosures about patients who have died. We provide coroners, medical examiners and funeral directors necessary information related to an individual's death.

10. To avoid harm. In order to avoid a serious threat to the health and safety of a person or the public, we may release limited information to law enforcement personnel or persons able to prevent or lessen such harm.

11. For workers compensation purposes. We may release your PHI to comply with workers compensation laws.

12. Marketing. We may send you information on the latest treatment, support groups and other resources affecting your health.

13. Fundraising activities. We may use your PHI to communicate with you to raise funds to support health care services and educational programs we provide the community. You have the right to opt out of receiving fundraising communications with each solicitation.

14. Appointment reminders and health-related benefits and services. We may contact you with a reminder that you have an appointment.

B. You may object to the following uses of PHI:

1. Information shared with family, friends or others. Unless you object, we may release your PHI to a family member, friend, or other person involved with your care or the payment of your care.

2. Health Plan. You have the right to request that we not disclose certain PHI to your health plan for health services or items when you pay for those services or items in full.

C. Your prior written authorization is required (to release your PHI) in the following situations:

You may revoke your authorization by submitting a written notice to the privacy contact identified below. If we have a written authorization to release your PHI, it may occur before we receive your revocation

1. Any uses or disclosures beyond treatment, payment or healthcare operations and not specified in parts A & B above.

2. Psychotherapy notes.

3. Any circumstances where we seek to sell your information.

WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

Although your health record is the physical property of Charleston ENT, the information belongs to you, and you have the following rights with respect to your PHI:

A. The Right to Request Limits on How We Use and Release Your PHI. You have the right to ask that we limit how we use and release your PHI. We will consider your request, but we are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. Your request must be in writing and state (1) the information you want to limit; (2) whether you want to limit our use, disclosure or both; (3) to whom you want the limits to apply, for example, disclosures to your spouse; and (4) an expiration date.

B. The Right to Choose How We Communicate PHI with You. You have the right to request that we communicate with you about PHI in a certain way or at a certain location (for example, sending information to your work address rather than your home address). You must make your request in writing and specify how and where you wish to be contacted. We will accommodate reasonable requests.

C. The Right to See and Get Copies of your PHI. You have the right to inspect and receive a copy of your PHI (including an electronic copy), which is contained in a designated record set that may be used to make decisions about your care. You must submit your request in writing. If you request a copy of this information, we may charge a fee for copying, mailing or other costs associated with your request. We may deny your request to inspect and receive a copy in certain very limited circumstances. If you are denied access to PHI, you may request that the denial be reviewed.

D. The Right to Get a List of Instances of When and to Whom We Have Disclosed Your PHI. This list may not include uses such as those made for treatment, payment, or health care operations, directly to you, to your family, or in our facility directory as described above in more that six years prior to the date of your request.

E. The Right to Amend Your PHI. If you believe there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we amend the existing information or add the missing information. You must provide the request and your reason for the request in writing. We may deny your request in writing if the PHI is correct and complete or if it originated in another facility's record.

F. The Right to Receive a Paper or Electronic Copy of This Notice: You may ask us to give you a copy of this Notice at any time. For the above requests (and to receive forms) please contact: Health Information Services (Medical Records). Attention: Release of Information/2295 Henry Tecklenburg Drive, Charleston, SC 29414. The phone number is (843) 766-7103.

G. The Right to Revoke an Authorization. If you choose to sign an authorization to release your PHI, you can later revoke that authorization in writing. This revocation will stop any future release of your health information except as allowed or required by law.

H. The Right to be notified of a Breach. If there is a breach of our unsecured PHI, we will notify you of the breach in writing.

HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

If you think your privacy rights may have been violated, or you disagree with a decision we made about access to your PHI, you may file a complaint with the office listed in the next section of this notice. Please be assured that you will not be penalized and there will be no retaliation for voicing a concern or filing a complaint. We are committed to the delivery of quality health care in a confidential and private environment.

PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

If you have any questions about this Notice or any complaints about our privacy practices please call the Privacy Officer at (843) 766-7103, or contact in writing: HIPAA Privacy Officer/2295 Henry Tecklenburg Drive/Charleston, SC 29414. You also may send a written complaint to the Office of Civil Rights. The address will be provided at your request.

CHANGES TO THIS NOTICE

We reserve the right to change the terms of this Notice at any time. We also reserve the right to make the revised or changed Notice effective for existing as well as future PHI. This Notice will always contain the effective date. You may view this notice and any revisions to it at: http://www.charlestonent.com

EFFECTIVE DATE OF THIS NOTICE

This Notice went into effect on April 14, 2003

Revised June 2014