Protected Information. While receiving care from our facility, information regarding your medical history, treatment, and payment for your health care may be originated and/or received by us. Information which can be used to identify you and which relates to your past, present or future medical condition, receipt of health care or payment for health care is considered Protected Information.

Our Responsibilities. Federal law imposes certain obligations and duties upon us as covered health care providers with respect to your Protected Information. Specifically, we are required to:

• Provide you with notice of our legal duties and our facilities’ policies regarding the use and disclosure of your Protected Information

• Maintain the confidentiality of your Protected Information in accordance with state and federal law

• Honor your requested restrictions regarding the use and disclosure of your Protected Information unless under the law we are authorized to release your Protected Information without your authorization, in which case you will be notified within a reasonable period of time

• Allow you to receive a copy your Protected Information during our regular business hours within thirty (30) days of your request.

• Act on your request to amend Protected Information within sixty (60) days and notify you of any delay which would require us to extend the deadline by the permitted thirty (30) day extension

• Accommodate reasonable requests to communicate Protected Information by alternative means or methods

How Your Protected Information May be Used and Disclosed. Generally, your Protected Information may be used and disclosed by us only with your express written authorization. However, there are some exceptions to this general rule.

• Treatment: We will use your Protected Information to provide, coordinate, and manage your care and treatment. For example, a clinic physician may share your Protected Information with another physician for a consultation or referral.

• Payment: We will use your Protected Information to receive payment for the services we provide. For example, we will disclose Protected Information in order to submit bills or claims to insurance companies and/or Medicare or Medicaid.

• Health Care Operations: We will use your Protected Information for certain activities related to the functioning of the clinics. For example, we may use or disclose Protected Information for quality assurance activities, legal services, underwriting, and other business management and administrative activities.

• Appointment Reminders and Other Health Information: We may use your Protected Information to send you reminders about future appointments. Your Protected Information may also be used to provide you with information about new or alternative treatments or other health care services.

These clinics may also use or disclose your Protected Information for the following purposes:

• Unless you have informed us otherwise, your Protected Information may be used to notify a family member or other person responsible for your care. In most cases, Protected Information disclosed for notification purposes will be limited to your name, location and general condition. In addition, unless you have informed us otherwise, Protected Information may be released to a family member or close personal friend who is involved in your care to the extent necessary for them to participate in your care. For example, we may provide limited Protected Information to allow a family member to pick up a prescription or x-ray for you.

• Under emergency conditions, to government or other groups that assist in emergencies or disasters.

• Clinics also may disclose or use your Protected Information without your consent in the following cases: when required by law; for public health activities; relating to victims of abuse/neglect/domestic violence, if required/authorized by law and/or if you agree; for health oversight activities; for judicial and administrative proceedings to the extent permitted by law; for law enforcement purposes, as permitted or required by law; to coroners/medical examiners/funeral directors, as permitted by law; for organ donation purposes; for research purposes; to avert a serious threat to health or safety; for certain specialized government functions, such as military discharge, and national security and intelligence; and for workers’ compensation purposes.

• More stringent laws. Some of your Protected Information may be subject to other laws and regulations and afforded greater protection than what is outlined in this notice. For instance, HIV/AIDS, substance abuse, and mental health information are often given more protection. In the event your Protected Information is afforded greater protection under federal or state law, we will comply with the applicable law.

Your Rights. Federal law grants you certain rights with respect to your Protected Information. Specifically, you have the right to:

• Receive a copy of this Notice of Privacy Practices

• Request that certain uses and disclosures of your Protected Information be restricted. We may, however, refuse your request if release of such information without your consent/authorization is permitted by law

• Access your Protected Information by completing our Request for Access form

• Request that your Protected Information be amended by completing our Request for Amendment form

• Obtain an accounting of certain disclosures by us of your Protected Information for the past six years, this accounting will only cover disclosures made after April 14, 2003;

• Revoke any prior authorizations or consents for use or disclosure of Protected Information, except to the extent that action has already been taken

• Request communications of your Protected Information are done by alternative means or at alternative locations

• If you feel your Protected Information privacy rights have been violated, you may file a complaint with the Clinics at (712) 336-5311, and/or the Secretary of Health and Human Services. Filing a complaint will not affect the quality of the services you receive from the Clinics and you will not be retaliated against for filing a complaint.

• You may contact our facilities’ privacy officer regarding your Protected Information at (712) 336-5311.

The effective date of this notice is April 14, 2003. We are required by law to maintain the privacy of Protected Health Information and to provide individuals with this notice of our legal duties and privacy practices with respect to health information. We are required to abide by the terms of the notice currently in effect. We reserve the right to change the terms of this notice and to make new notice provisions effective for all Protected Health Information maintained by us. If the terms of this notice are changed, we will post the revised notice in our facilities and on our website at  www.ilortho.com. We will provide individuals with a revised notice upon request.