NOTICE OF PRIVACY PRACTICES

The Endoscopy Center of Fairfield

 425 Post Road Fairfield, Connecticut 06824

 THIS NOTE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE

USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS

INFORMATION. PLEASE REVIEW IT CAREFULLY.

The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”) is a federal

program that requires that all medical records and other individually identifiable health

information used or disclosed by us in any form, whether electronically, on paper, or

orally, are kept properly confidential. This Act gives you, the patient, significant new

rights to understand and control how your health information is used. “HIPAA” provides

penalties for covered entities that misuse personal health information.

As required by “HIPAA”, we have prepared this explanation of how we are required to

maintain the privacy of your health information and how we may use and disclose your

health information.

We may use and disclose your medical records only for each of the following purposes:

treatment, payment and health care operations.

· Treatment means providing, coordinating or managing health care and related

services by one or more health care providers. An example of this would include

a physical examination.

· Payment means such activities as obtaining reimbursement for services,

confirming coverage, billing or collection activities, and utilization review. An

example of this would be sending a bill for your visit to your insurance company

for payment.

· Health care operations include the business aspects of running our practice, such

as conducting quality assessment and improvement activities, auditing functions,

cost- management analysis, and customer service. An example would be an

internal quality assessment review.

We also create and distribute de- identified health information by removing all references

to individually identifiable information.

We may contact you to provide appointment reminders or information about treatment

alternatives or other health-related and services that may be of interest to you.

Any other uses and disclosures will be made only 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 the following rights with respect to your protected health information, which

you can exercise by presenting a written request to the Privacy Officer:

· 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. We are,

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 reasonable requests to receive confidential communications of

protected health information from us by alternative means or at alternative

locations.

· The right to inspect and copy your protected health information.

· The right to amend your protected health information.

· The right to receive an accounting of disclosures of protected health information.

· 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 April 14, 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 make the new notice provisions effective for

all protected health information that we maintain. We will post and you may request a

written copy of a revised Notice of Privacy Practices from this office.

You have recourse if you feel that your privacy protections have been violated. You have

the right to file written complaint with our office, or with the Department of Health &

Human Services, Office of Civil Rights, about violations of the provisions of this notice

or the policies and procedures of our office. We will not retaliate against you for filing a

complaint.

If you believe your privacy rights have been violated, you may file a complaint with the

office.

Please contact the Privacy Officer, Johanna Hughes  (203) 292-9000