Notice of Privacy Practices

Our Pledge Regarding Your Protected Health Information (PHI)

We understand that medical information about you and your health is personal. We are committed to protecting your medical information. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by VIP Medical Service LLC. This notice will tell you about the ways in which we may use and disclose your PHI. We also describe your rights and certain obligations we have regarding the use and disclosure of PHI.

How We May Use and Disclose Your PHI

The following categories describe different ways that we use and disclose PHI without your written authorization.

• For Treatment: We may use your PHI to provide you with medical treatment or services. We may disclose PHI to doctors, nurses, technicians, or other personnel who are involved in taking care of you.
• For Payment: We may use and disclose your PHI so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party.
• For Health Care Operations: We may use and disclose PHI for our healthcare operations. These uses are necessary to run our practice and make sure that all of our patients receive quality care.
• As Required By Law: We will disclose PHI when required to do so by federal, state, or local law.

Your Rights Regarding Your PHI

You have the following rights regarding PHI we maintain about you:

• Right to Inspect and Copy: You have the right to inspect and copy your PHI. To do so, you must submit your request in writing to our Privacy Officer.
• Right to Amend: If you feel that PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our practice.
• Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of your PHI for purposes other than treatment, payment, and healthcare operations.
• Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose for treatment, payment, or health care operations.
• Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.
• 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.

Our Responsibilities

VIP Medical Service LLC is required by law to:

• Maintain the privacy of your PHI.
• Provide you with this notice of our legal duties and privacy practices with respect to your PHI.
• Notify you following a breach of your unsecured PHI.
• Abide by the terms of the notice currently in effect.

Changes to This Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for PHI we already have as well as any information we receive in the future. We will post a copy of the current notice 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 Department of Health and Human Services. To file a complaint with us, please contact our Privacy Officer at the address below. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Contact Information

If you have any questions about this notice, please contact our Privacy Officer: