Privacy Notice

Effective Date: April 14, 2003

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.

WHO WILL FOLLOW THIS NOTICE?
This notice describes the practices of My Doctor, LLC (MY DOCTOR) and the practices that will be followed by all MY DOCTOR staff that handle your medical information.

OUR PLEDGE REGARDING YOUR MEDICAL INFORMATION
MY DOCTOR understands that medical information about you and your health is personal. We are committed to protecting medical information about you. This notice applies to all of the records of your medical care that are received or created by MY DOCTOR.

Your other medical treatment providers (e.g., doctors, hospitals, home health agencies, etc.) may have different policies or notices regarding the use and disclosure of your medical information.

This notice will tell you about the ways in which MY DOCTOR may use and disclose medical information about you. We also describe your rights and certain obligations MY DOCTOR has regarding the use and disclosure of medical information. Law to requires us to:

• Make sure that medical information that identifies you is kept private;
• Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
• Follow the terms of the Notice that is currently in effect.

USES AND DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
By becoming a patient of MY DOCTOR, you are giving consent for MY DOCTOR to use your medical information for certain activities, including treatment, payment and other health care operations.

We may use and disclose medical information about you so that MY DOCTOR and its medical professionals can treat you. We may also use and disclose medical information about you so that we may be paid for the medical treatment we provide you. We may also use and disclose medical information about you for MY DOCTOR health care operations; in other words, those other tasks that we need to perform to make sure that you are provided the highest quality of medical care.

The following uses of your medical information may be made without any additional authorization from you. (Not every use or disclosure is listed, but be assured that all uses and disclosures made by MY DOCTOR are only those that are permitted under the law):

MY DOCTOR performs a variety of quality assurance activities. Your medical information may be used in case management, accreditation, and/or chart review services conducted by both MY DOCTOR personnel and business associates. MY DOCTOR uses only the medical information necessary to carry out these services.

MY DOCTOR may contact you concerning future appointments. This system will contact your phone number with an appointment reminder. The information that could be left is limited to the location of your appointment and date and time of appointment. If you do not want to receive automated appointment reminders, contact MY DOCTOR physician’s office.

USES AND DISCLOSURES FOR HEALTH-RELATED BENEFITS OR SERVICES
From time to time, MY DOCTOR may use and disclose medical information to tell you about certain health-related benefits or services that may be of interest to you.

USES AND DISCLOSURES REQUIRED BY LAW
We will disclose medical information about you when required to do so by federal, state, or local law.

DISCLOSURES FOR HEALTH OVERSIGHT ACTIVITIES
We may disclose medical information to a health oversight agency for activities authorized by law. These activities include, for example, audits, investigations, and inspections. These activities are necessary for the government to monitor the health care system, the delivery of health care, etc.

DISCLOSURES FOR LAWSUITS AND DISPUTES
If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court order or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

DISCLOSURES TO LAW ENFORCEMENT
We may release medical information if asked to do so by a law enforcement official, in response to a court order, subpoena, warrant, summons, or similar process. Other related disclosures may include disclosures to national security and intelligence agencies, as well as disclosures to authorized federal officials for the protection of the President of the United States or other authorized persons or foreign heads of state.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your medical care. Usually this right includes both medical and billing records. You must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. Your request to inspect and copy your information may only be denied in very limited circumstances and you have a right to request that any such denial be reviewed.

Right to Request Restrictions: You have the right to request that we restrict the use and disclosure of your medical information for treatment, payment and health care operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to My Doctor, LLC. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.

Right to Confidential Communications: You also have the right to request to receive private health information by alternative means or at alternative locations. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to Amend: If you feel that the medical information we have about you is incorrect or incomplete, you have the right to request that your medical information be amended. Only the health care entity (e.g., doctor, hospital, clinic, etc.) that created your medical information is responsible for amending it. For more information regarding the procedures for submitting such a request, contact your MY DOCTOR physician’s office.

Right to an Accounting of Disclosures: You have a right to an accounting of disclosures of your medical information, for purposes other than treatment, payment or health care operations by MY DOCTOR or any of the people or companies who perform treatment, payment or health care operations on our behalf. To request this list of disclosures we made of medical information about you, you must submit a request in writing to My Doctor, LLC. Your request must state a time period, which may not be longer than six (6) years prior to the date of your request and may not include dates before April 14, 2003. Your request should indicate the form in which you want the list (for example, on paper or electronically).

Right to a Paper Copy of this Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.

• You may obtain a copy of this notice at our web site: www.MYDOCTORLLC.com
• To obtain a paper copy of this notice, contact MY DOCTOR physician’s office.

CHANGES TO THIS NOTICE
MY DOCTOR reserves the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you, as well as any information we create or receive in the future. We will post a copy of the current notice on My Doctor’s web site: www.MYDOCTORLLC.com. The notice will contain, in the top right-hand corner, the effective date.

FURTHER INFORMATION AND COMPLAINTS
If you want to learn more about these procedures, if you believe your privacy rights have been violated and/or that MY DOCTOR has not followed this policy, you may file a complaint with MY DOCTOR or with the Secretary of the Department of Health and Human Services. To file a complaint with MY DOCTOR, contact:

My Doctor LLC

9050 Montgomery Road, Suite B

Cincinnati, OH 45242

All complaints must be submitted in writing. You will not be penalized for filing a complaint.