1. 1. Any health care professional authorized to enter information into your medical record created and/or maintained at our practice;
2. 2. All employees, students, volunteers, and other service providers who have access to your health information at our practice;

1. Morgantown Surgical Associates, Inc. is permitted to make uses and disclosures of protected health information for treatment, payment and health care operations, as described in the following examples below. We have not listed every type of use or disclosure, but the ways in which we use or disclose your information will fall under one of these purposes.
   1. For treatment – Example, we may order a diagnostic test such as a CT scan to evaluate your condition. We will need to talk to the Radiologist so that we can determine and develop a plan of care. We will share information with your health care provider in order to coordinate your care and services.
   2. For payment – Example, we may need to give health information to your health plan in order to obtain prior approval to perform diagnostic tests such as colonoscopies or perform surgical procedures such as hernia repairs.
   3. For health care operations – Example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use your health information to evaluate whether certain treatment or services offered by our practice are effective.

1. As required by law. We may disclose your health information when required by federal, state, or local law to do so. For example, we are required by the Department of Health and Human Services (DHHS) to disclose your health information in order to allow DHHS to evaluate whether we comply with the federal privacy regulations.
2. Public Health Activities. We may disclose your health information to public health authorities that are authorized by law to receive and collect health information for the purposes of preventing or controlling disease, injury, or disability; to report deaths, suspected abuse or neglect, reactions to medications; or to facilitate product recalls.
3. Health Oversight Activities. We may disclose your health information to a health oversight agency that is authorized by law to conduct health oversight activities, including audits, investigations, inspections, or licensure and certification surveys. These activities are necessary for the government to monitor the persons or organizations that provide health care to individuals and to ensure compliance with applicable state and federal laws and regulations.
4. Judicial or administrative proceedings. We may disclose your health information to courts or administrative agencies charged with the authority to hear and resolve lawsuits or disputes. We may disclose your health information pursuant to a court order, a subpoena, a discovery request, or other lawful process issued by the judge or other person involved in the dispute, but only if efforts have been made to (1) notify you of the request for disclosure or (2) obtain an order protecting your health information.
5. Worker's Compensation. We may disclose your health information to worker's compensation programs when you health condition arises out of work-related illness or injury.
6. Law Enforcement Official. We may disclose your health information in response to a request received from a law enforcement official to report criminal activity or to respond to a subpoena, court order, warrant, summons, or similar process.
7. Coroners, Medical Examiners, or Funeral Directors. We may disclose your health information to a coroner or medical examiner for the purposes of identifying a deceased individual or to determine the cause of death. We also may disclose your health information to a funeral director for carrying out his/her necessary activities.
8. Organ Procurement Organizations or Tissue Banks. If you are an organ donor, we may disclose your health information to organizations that handle organ procurement, or tissue banking for the purpose of facilitating organ or tissue donations or transplantation.
9. To Avert a Serious Treat to Health or Safety. We may use or disclose your health information when necessary to prevent a serious threat the health or safety of you or other individuals.
10. Military and Veterans. If you are a member of the armed forces, we may disclose your health information as required by military command authorities.
11. National Security and Intelligence Activities. We may use and disclose your health information to authorized federal officials for purposes of intelligence, counterintelligence, and other national security activities, as authorized by law.
12. Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may use or disclose your health information to the correctional institution or to the law enforcement official. It may be necessary for the following reasons: (1) for the institution to provide you with health care; (2) to protect the health or safety of you or another person; (3) for the safety and security of the correctional institution.

1. Morgantown Surgical Associates, Inc. may contact the individual to provide appointment reminders or information about treatment alternatives or other heath-related benefits and services that may be of interest to the individual or patient. For example, we may leave appointment reminders, results of laboratory tests such as prothrombin time and Coumadin adjustments, and/or other normal diagnostic tests on your answering machine or with a family member or other person who may answer the telephones at the number that you have given us in order to contact you.
2. Morgantown Surgical Associates, Inc. may disclose your health information to individuals, such as family members and friends, who are involved in your care or who help pay for your care. We may make such disclosures when: (1) we have your verbal agreement to do so; (2) we make such disclosures and you do not object; or (3) we can infer from the circumstances that you would not object to such disclosures. For example, if your spouse comes into the exam room with you, we will assume that you agree to our disclosure of your information while your spouse is present in the room.

1. You have the right to request restrictions on certain uses and disclosures of protected health information for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone, such as a family member or friend, who is involved with your care or in the payment of your care. For example, you could ask that we not use or disclose information regarding a particular treatment that you received. However, Morgantown Surgical Associates, Inc. is not required to agree to your request. If we do agree, that agreement must be in writing and signed by you and us.
2. You have the right to receive confidential communications of protected health information, as applicable. For example, you can ask that we only contact you at work or by mail.
3. You have the right to inspect and copy protected health information that may be used to make decisions about your care. We may deny your request to inspect and copy your health information in certain limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed.
4. You have the right to amend protected health information that is maintained by or for our practice and is used to make health decisions about you. We may deny your request if it is not properly submitted or does not include a reason to support your request. We may also deny your request if the information to be amended was: (a) not created by us, unless the person or entity that created the information is no longer available to make the amendment; (b) is not part of the information that is kept by or for our practice; (c) is not part of the information which you are permitted to inspect and copy; or (d) is accurate and complete.
5. You have the right to receive an accounting of disclosures of protected health information made by us. This accounting will not include disclosures of health information that we made for purposes of treatment, payment, or health care operations or pursuant to a written authorization that you have signed. This accounting will not include disclosures before April 14, 2003 or that are otherwise not required by law to be included in the accounting.
6. You have the right to obtain a paper copy of the Notice from the covered entity upon request at any time. This right extends to an individual who has agreed to receive the Notice electronically.

Morgantown Surgical Associates, Inc.'s contact person for matters relating to complaints is:
Katrina J. Fleming, Privacy Officer
200 Wedgewood Drive, Suite 202
Morgantown, WV 26505