Privacy Statement
Medtec • Effective Date 4/14/03

Notice Of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR PROTECTED HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY
We are dedicated to maintaining the privacy of your Protected Health Information (hereafter referred to as “PHI”) and follow strict policies in accordance with state and federal privacy laws to keep your PHI private. PHI is information about you, including demographic data, that can reasonably be used to identify you and that relates to your past, present, or future physical or mental health, the provision of health care to you or the payment for that care. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

• How we may use and disclose your PHI
• Your privacy rights in your PHI
• Our obligations concerning the use and disclosure of your PHI

The terms of this notice apply to all records containing your PHI that are in our possession. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that are in our possession. We will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.

B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
the Secretary/Treasurer of Medtec at 269-373-8878.

C. WE MAY USE AND DISCLOSE YOUR PHI IN THE FOLLOWING WAYS
We do not sell your PHI to anyone or disclose your PHI to other companies who may want to sell to you. We must have your written authorization to use and disclose your PHI, except for the following disclosures:
1. To You and Your Personal Representative: We may disclose your PHI to you or to your personal representative (someone who has the legal right to act for you).
2. Payment. We may use and disclose your PHI in order to bill and collect payment for the services and items you have received from your health care provider. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts. Your PHI may be used by a collection agency of our choosing in order to secure payment for the health care you have received.
3. Health Care Operations. We may use and disclose your PHI to operate our business including for example:

• We may use and disclose your PHI in the prevention, detection, and investigation of fraud and abuse
• We may use and disclose your PHI in performing business management and other general administrative activities including systems management and customer service.

4. Release of Information to Others Involved in Your Care. We may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you. For example, a child may be involved in the care of an elderly relative or a parent or guardian may ask that a babysitter take their child to the doctor’s office for treatment of a cold. In these examples, the child or babysitter may have access to this patient’s medical information.
5. Disclosures Required By Law. We will use and disclose your PHI when we are required to do so by federal, state or local law.
6. To our Business Associates: We may use and disclose your PHI to third parties who provide services for us. An example of this would be a facility that provides storage for medical records or an agency we may employ to perform mass destruction of obsolete data. In all cases where we use a third party of this type, we will have a written contract with that third party designed to protect the privacy of your PHI.

D. DISCLOSURES YOU MAY REQUEST
You may request disclosures of PHI that we have by contacting your Health Care Provider. They will inform you what their policies are in this regard.

E. YOUR RIGHTS REGARDING YOUR PHI
You have the following rights regarding the PHI that we maintain about you:
1. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, call 269-373-8878.
2. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, call 269-373-8878. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Again, if you have any questions regarding this notice or our health information privacy policies, please call 269-373-8878.