Notice of Privacy Practices

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.

Our Commitment to Your Privacy

The physicians and staff affiliated with Vellora Health are committed to protecting the privacy of your medical information. This Notice of Privacy Practices ("Notice") describes how we may use and disclose your protected health information (PHI) and explains your rights regarding your medical records.

We are required by law to maintain the privacy of your PHI, provide you with this Notice of our legal duties and privacy practices, and follow the terms of the Notice currently in effect.

How We May Use and Disclose Your Health Information

Treatment

We may use your health information to provide, coordinate, and manage your healthcare. For example:

• Physicians may review your medical history to determine appropriate treatment
• We may share your information with other healthcare providers involved in your care
• We may contact you to remind you of appointments

Payment

We may use and disclose your health information to obtain payment for services. This includes:

• Submitting claims to Workers' Compensation insurance carriers
• Billing your employer or their insurance for work-related injuries
• Processing Personal Injury liens and settlements
• Verifying coverage and obtaining prior authorization

Healthcare Operations

We may use your health information for our healthcare operations, including:

• Quality assessment and improvement activities
• Training programs and professional education
• Accreditation, certification, and licensing activities
• Business planning and management

Workers' Compensation

We may disclose your health information as authorized by Workers' Compensation laws, including:

• Reports to your employer and their insurance carrier
• PR-2 Progress Reports and medical-legal documentation
• Qualified Medical Evaluator (QME) reports
• Information requested by the Workers' Compensation Appeals Board

Legal Proceedings

We may disclose your health information in response to:

• Court orders and subpoenas
• Discovery requests in litigation
• Administrative tribunal proceedings

Other Permitted Disclosures

We may also use or disclose your health information:

• As required by law
• For public health activities
• To report suspected abuse, neglect, or domestic violence
• To health oversight agencies for audits and investigations
• To law enforcement as required by law
• To coroners, medical examiners, and funeral directors
• For research purposes under certain conditions
• To avert a serious threat to health or safety
• For specialized government functions

Your Authorization

Except as described above, we will not use or disclose your health information without your written authorization. You may revoke an authorization at any time by submitting a written request, but revocation will not affect disclosures already made based on your prior authorization.

Your Rights Regarding Your Health Information

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your medical records. We may charge a reasonable fee for copying costs. We must respond to your request within 30 days.

Right to Amend

You have the right to request amendments to your medical records if you believe information is incorrect or incomplete. We may deny your request under certain circumstances, but we will provide a written explanation.

Right to an Accounting of Disclosures

You have the right to receive a list of disclosures we have made of your health information for purposes other than treatment, payment, healthcare operations, and certain other activities for the past six years.

Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your health information for treatment, payment, or healthcare operations. We are not required to agree to your request, except in certain circumstances involving payment.

Right to Request Confidential Communications

You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may request that we contact you only at work or only by mail.

Right to a Paper Copy

You have the right to obtain a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

Changes to This Notice

We reserve the right to change this Notice and make the new provisions effective for all health information we maintain. If we make a significant change, we will post the revised Notice in our offices and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Contact Information

For more information about this Notice or to exercise your rights, please contact: