Without specific written authorization, federal and state law allows us to use and disclose your healthcare records for the purposes of treatment and healthcare operations. State law requires us to get your authorization to disclose this information for payment purposes.

-Treatment means providing, coordinating and managing healthcare and related services by one or more healthcare providers. For example, we may need to share information with other providers or specialists involved in your care.

-Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. For example, we disclose treatment information when billing a medical insurance plan.

-Health Care Operations include the business aspects of running our practice. For example, patient information may be used for training purposes or quality assessment.

Unless you request otherwise, Pacific Institute of Medical Sciences (PIMS) may use or disclose health information to a family member, friend or other personal representative to the extent necessary to help with your healthcare or with payment for your healthcare. Any other uses and disclosures will be made only as allowed or required by law or with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have certain rights in regards to your protected health information, which you can exercise by presenting a written request to our Privacy Officer at the practice address listed below. Patient rights relative their healthcare information:

· The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends or any other person identified by you. WPC is, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
· The right to request to receive confidential communications of protected health information from us by alternative means or at alternative locations.
· The right to access, inspect and copy your protected health information. You may obtain a request form from us. We may charge you a cost-based fee for expenses such as copies and staff time.
· The right to request an amendment to your protected health information.
· The right to receive an accounting of disclosures of protected health information outside of treatment, payment and healthcare operations.
· The right to obtain a paper copy of this notice from us upon request.

We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information.

This notice is effective as of June 1, 2003 and we are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain. Revisions of our Notice of Privacy Practices will be posted on the effective date and you may request a written copy of the Revised Notice from Pacific Institute of Medical Sciences (PIMS) (address below).

You have the right to file a formal, written complaint with us at the address below, or with the Department of Health & Human Services, Office of Civil Rights, in the event you feel your privacy rights have been violated. We will not retaliate against you for filing a complaint.