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.

In the course of providing services or products to you, it is necessary for us to obtain personal medical or other relevant information about you. Government regulations define how this information may be used or disclosed to others. Lingraphica is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information. This notice describes how information which you provide may be used. We are required to abide by the terms of this notice. Lingraphica reserves the right to change the terms of its notice and to make the new notice provisions effective for all protected health information that we maintain. If there is a change in the way that your information will be used, we are responsible to notify you of the change. Such notification may be made by mail, electronic communication, or other form of communication directed to you.

I. Lingraphica must provide to you notice of our privacy practices to use or disclose medical information as described below. You will be asked to sign and date an acknowledgement of this notice. You may request restrictions on how your medical information will be used or disclosed. Lingraphica may or may not agree with your requested restriction. But if we agree to your requested restriction, we must honor your request.

A. Upon providing Privacy Notice, Lingraphica is permitted to use and disclose your health information as summarized below:
• Your information may be disclosed to you.
• Your information may be disclosed to your personal representative or to your parent or guardian if you are a minor.
• Your information may be used or disclosed for the purposes of providing medical treatment, receiving payment for services provided and for administration of healthcare operations related to your care. Examples of such disclosures for treatment purposes include use of your health information by primary and consulting physicians, X-ray or other diagnostic lab tests, and nursing care. Examples of disclosure for healthcare operations may include disclosure to a pharmacy for prescriptions. Examples of disclosure for payment may include patient billing and insurance claim processing.
• Information may be used or disclosed pursuant to an agreement with you in compliance with any current or prior written authorization.
• Your information may be used or disclosed without your consent if consent is not required. Examples of such instances include emergency treatment, or instances when we are required by law to provide treatment, or in situations where there is an inability to communicate, or where there is an indirect treatment relationship, or if information is created for the treatment of an inmate of a correction facility.
• Information may be used or disclosed for non-medical purposes pursuant to and in compliance with your written privacy authorization.
• Information may be used or disclosed in the reporting of a crime.

B. Lingraphica is required to disclose protected health information as summarized below:

• To you upon your request
• To the Secretary of Health and Human Services when required to investigate compliance with government regulations
• When required by law or legal process

C. When using or disclosing your medical information to others, we will try to de-identify personal information when possible, and we will /make a reasonable effort to limit disclosure to the minimum degree necessary for the purpose of the disclosure.

II. Lingraphica must obtain your written authorization to use or disclose medical information for any other use or disclosure not set forth in this notice. Written authorization is a separate form which you must sign and date. The authorization must identify the person or entity making the disclosure, identify the person or entity receiving the disclosure, describe the purpose for the disclosure, the nature of the information being disclosed, and the expiration date of the disclosure. You have the right to refuse to sign the authorization and you have the right to revoke an authorization. You may request to inspect or to copy the information being disclosed, and you may request to receive a copy of the authorization. You must recognize that any information provided to others through the authorization may not be subject to privacy protections. When your authorization is provided, we must use or disclose your information in a manner that complies with your authorization. We may not condition the provision of treatment, products or services on your authorization.

Upon receiving your authorization, Lingraphica is permitted to use and disclose your health information as summarized below:

• Your authorization is required for any use or disclosure of psychotherapy notes.
• Your authorization is required for any non-medical use or disclosure of your health information or for reasons not related to carrying out treatment, payment or healthcare operations. An example of such disclosure is for marketing purposes.

III. Lingraphica may use or disclose certain information without consent or authorization provided that you are informed in advance and given an opportunity to agree or object to such use or disclosure of health information in the circumstances described below:

• We may use or disclose your information in emergency circumstances if we believe it is in the best interest for your treatment or care, and such disclosure is consistent with any prior expressed preference.
• We may disclose information to your family members involved in your care.
• We may disclose information to your next of kin.
• In providing treatment or services to you when you are present and have the capacity to make a sound decision, we may request your consent or provide an opportunity to object to certain use or disclosure of information, or if we reasonably infer from the circumstances that you do not object to the disclosure.
• In providing treatment or services to you when you are not present or do not have the capacity to make a sound decision, we may make a decision to use or disclose information which we feel is in your best interest to an authorized public or private entity.
• In providing treatment or services to you when you are not present or do not have the capacity to make a sound decision, we may make a decision to use or disclose information to an authorized public or private entity when such disclosure is necessary for disaster relief.

IV. Lingraphica may use or disclose certain information without consent or authorization or opportunity to agree or object, as described below:

• We may use or disclose information as required by law.
• We may use or disclose information as required for public health purposes including disclosure subject to the following requirements:
  • report of child abuse
  • jurisdiction of Food and Drug Administration
  • exposure to communicable disease
  • to employer for a job-related accident report or exam, if Lingraphica has been requested by the employer to provide you with healthcare.
  • information about victims of abuse neglect or violence
  • such disclosures are made to the extent required by law, but you will be notified of such disclosures.
• We may disclose information for health agency oversight purposes such as accrediting, auditing or inspections.
• We may disclose information in the course of judicial or administrative proceedings in response to a court order or subpoena or other lawful process.
• We may disclose information to law enforcement officials for law enforcement purposes or for reporting a victim of crime.
• We may use or disclose information when necessary to avert a serious threat to health or safety.
• We may use or disclose information on military personnel to the respective military command structure or in cases of national security.

V. Lingraphica may use or disclose your health information which is unique to our organization.

A. If we engage in any of the activities checked below, we may use or disclose your health information in the manner described:
• We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services.
• We may contact you to raise funds on behalf of our organization.
• We may disclose information to the sponsor of the health plan, or health insurance issuer or HMO.

B. You have the following individual rights with respect to privacy of protected health information. You have the right to:
• request restrictions on certain uses and disclosures of protected health information, but Lingraphica is not required to agree to a requested restriction
• grant and revoke authorization for certain non-medical uses and disclosures of protected health information
• receive confidential communications of protected health information
• inspect and copy protected health information
• amend protected health information
• receive a paper copy of this Privacy Notice, even if you have already agreed to receive this notice electronically
• file a complaint with us or the Secretary of the U.S. Department of Health and Human Services if you believe that your privacy rights were violated.

C. Complaints

In the event that you have a complaint about our handling of your private information, you may contact our Privacy Officer at 609-683-7124 (direct and confidential telephone line). You may also contact the government: Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave., Washington, D.C. 20201. You will not be retaliated against in any way as a result of filing a complaint.