MAGNOLIA HEALTHCARE MANAGEMENT

PATIENT PRIVACY PRACTICES

The privacy of your protected health information is important to us. Please review this notice carefully, as it describes how we use and maintained your health records. This Notice also describes your rights as to Protected Health Information (PHI).

PLEASE CONTACT OUR COMPLIANCE OFFICER WITH ANY QUESTIONS THAT YOU MAY HAVE REGARDING THIS NOTICE.

Your Protected Health Information

Whenever you receive or request medical services from use, we create PHI about you and about the care and services you receive or request. We need this information to provide you with quality care and to comply with certain legal requirements. It is our goal to make sure that the PHI we receive about you is kept strictly private. It is necessary, however, to use it or share this information with others from time to time, but only under proper circumstances.

This notice describes how we may properly use and share your PHI and also describes your rights to access your PHI. In reviewing this Notice, it may appear that your PHI is used or share in many ways. But, this is a comprehensive list and certain events may never occur or might happen only once or a few times. For the most part, you PHI is used or shared only in connection with your healthcare.

HOW WE USE OR SHARE PHI

Typical Uses and Sharing

Your PHI may be used or disclosed for these typical situations, without your prior authorization:

Treatment: We may disclose your PHI to a clinic, physician, hospital or other provider who requests this information to treat you.

Payment: We may use and disclose your PHI to pay claims for covered services provided to you.

Healthcare Operations: We may use and disclose your PHI to determine the fees owing from your health plan or insurer, to conduct quality improvement activities, to engage in care coordination and case management, and other similar activities.

Insurers, HMOs, Plan Sponsors: We may disclose your PHI to your insurer, HMO or to your employer or other plan sponsor in connection with your treatment or payment for services.

Healthcare Information: We may use your PHI to contact you with information about health related services, appointment reminders or treatment alternatives. If you do not wish to receive this type of information, you may request to opt out of receiving this information by notifying our Compliance Officer. However, you will still continue to receive information made available to you generally, such as newsletters or updates.

You, Family and Friends: We may disclose your PHI to you. We may also disclose information to a family member, friend or other person if you are unavailable to agree such as in a medical emergency or disaster relief. We will disclose this information only to the extent necessary to help with your health care or with payment for your health care.

Public Health and Safety: We may use and disclose your PHI to the extent necessary to avert a serious and imminent threat to your health or safety or the health or safety of others. We may disclose your PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence or other crimes.

Outside Service: We may also need to share your PHI with outside individuals or companies that perform services for us, and that may need access to your information to do so. We ask that any outside service safeguard the privacy of your PHI in their possession.

Unintended Disclosure: We will try our best to prevent this, but it is possible that others may learn of PHI because they hear or see information that is not meant for them. For example, another patient in our waiting room might overhear a conversation between you and the doctor. We use reasonable efforts to try to prevent any such disclosure from occurring.

Authorized Use or Disclosure: If you specifically authorize us to do so in writing, we will share your PHI to persons not involved with your care. This might include your employer or a distant relative. We will provide the necessary form for this authorization. You may cancel this authorization at any time.

Unusual Uses or Disclosures:

Among the unusual uses or disclosures that may occur without your prior authorization are the following:

Required by Law: We will use or disclosure your PHI when we are required to do so by law.

Process and Proceedings: We may disclose your PHI in response to a court or administrative order, subpoena, discovery request or other lawful purposes.

Law Enforcement: We may disclose limited information to a law enforcement official concerning the PHI of a suspect, fugitive, material witness, crime victim or missing person. We may disclose the PHI of an inmate or other person in lawful custody to a law enforcement official or correctional institution under certain circumstances.

Military and National Security: We may disclose to Military authorities the PHI of Armed Forces personnel. We may disclose to authorized federal officials PHI required for lawful intelligence, counterintelligence and other national security activities.

INDIVIDUAL RIGHTS

You have rights with respect to your PHI. If you have any questions about these rights or want to exercise any of these rights, please contact our Compliance Officer, who will assist you.

Inspect and Copy Your Records: Except for certain mental health information that may be included in your records, you may inspect and receive a copy of your PHI. Your request must be in writing, and we will charge a fee to provide a copy.

Request Restrictions: You may request restrictions on how your PHI is used or disclosed. You can request, in writing, that we place additional restrictions on the use or disclosure of your PHI. We are not required to agree to these additional restrictions, but if we elect to do so, we will abide by our agreement (except in an emergency).

Receive Confidential Communications: You can specify how and where we would send PHI. For example, you may want all such information in writing, rather than left as a voice message. Or, you may request that we send all correspondence for you to your work address. We will accommodate reasonable requests.

Amend Your Record: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend or change the information. However, we might not agree to your request. There are various reasons why we may deny your request for an amendment. If you submit a request for amendment, we will provide you with more information about the process. We will notify you in writing regarding our action on your request.

WHAT WE DO TO PROTECT YOUR PRIVACY

There are many methods we use to protect PHI across our operations, including your PHI in written word, spoken word or in a computer

• We have policies and rules that comply with the law to protect PHI.
• We limit who may see PHI. Only our staff who have a need to know PHI may use and share PHI.
• Our staff is trained on how to protect and secure your PHI.
• Our staff must agree in writing to follow the rules and polices that protect and secure PHI.
• We secure PHI in our computers. PHI in our computers is kept private by using firewalls and passwords.
• We require our network of doctors and other types or providers to also protect your privacy and your PHI.
• We give you written information, such as this on our duties and privacy practices about your PHI.

OUR RIGHT TO CHANGE NOTICE

We reserve the right to change this notice. We may modify or change our privacy practices from time to time, particularly as new laws and regulation become effective. Any changes will be effective for all the PHI that we maintain, even information in existence before the change. If we materially modify our privacy practices, we will provide you with a new notice advising you of these changes.

COMPLAINTS

If you believe that your PHI was not handled properly, or feel that we have not allowed you to exercise your rights, you may file a compliant with our Compliance Officer. All complaints must be submitted in writing. We respect your rights and will not retaliate against you or stop your care if you feel it necessary to file a complaint.

Contact Information

For a copy of our entire privacy policy, or if you have questions, please contact your IPA, as follows:

McKinley Medical Group Compliance Officer

P.O. Box 7969, Riverside, CA 92513

Phone: (951) 359-0779

Fax: (951) 689-6644

Physicians Health Network Compliance Officer

3410 La Sierra Ave., #F305, Riverside, CA 92503

Phone: (951) 359-0779

Fax: (951) 689-6644