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PRIVACY POLICIES

We do not share e-mail addresses or any other information with any other company or organization.
We are HIPAA (Heath Insurance Portability and Accountability Act) compliant with regard to personal
information confidentiality.

NOTICE OF PRIVACY PRACTICES

THIS NOTICE IS REQUIRED BY LAW (FEDERAL REGULATION 45 CFR PARTS 160 & 164) AND
DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION.

THIS NOTICE IS IN EFFECT AND ON AND AFTER APRIL 14, 2003.

Uses and Disclosures of Health Information

We use health information about you for treatment to obtain payment (submit claims and or encounters
to billing services and/or clearinghouses, and/or collection agencies, etc.), for health care operations
(reporting, utilization management, etc.) and to evaluate the quality of care that you receive. We may
use or disclose identifiable health information about you without your authorization for other purposes
such as auditing and research studies when an institutional review board has approved the research.
As required by law, we may disclose your health information to public health or legal authorities
charged with prevention or controlling disease, injury, or disability.

Your Health Information Rights

  • You have the right to inspect and obtain a copy of your health record with a signed
    authorization as provided in 45 CFR 164.524.
  • You have the right to request in writing that we restrict and/or not use or disclose your protected
    health information as provided in 45 CFR 164.522 but we do not have to agree to accept your
    restrictions.
  • You have the right to request in writing that your physician amend your protected health
    information as provided in 45 CFR 164.528.
  • You have the right to request in writing to receive confidential communications from us by
    alternative means or at an alternative location as provided in 45 CFR 164.522.
  • You have the right to obtain a list of instances (accounting of disclosures) where we have
    disclosed your protected health information for purposes other than treatment, payment or health
    care operations as provided in 45 CFR 165.528.
  • You have the right to revoke your authorization to use or disclose health information except
    to the extent that action has already been taken as provided by 45 CFR 164.508.

Our Responsibilities

  • We are required by law to maintain the privacy of your health information.
  • We are required by law to provide you with this notice about our privacy practices.
  • We are required by law to follow the privacy practices that are described in this notice; however,
    we reserve the right to change or modify our practices and to make the new provisions effective
    for all protected health information (PHI) we maintain. Should our information practices change,
    we will post the revised privacy notice.

Questions/Complaints

If you have questions or if you are concerned that we have violated your privacy rights, you may contact
the privacy officer. You may also file a complaint with the U.S. Secretary of Health and Human Service.
There will be no retaliation against you for filing a complaint.

Privacy Officer Telephone: (509) 499-9880.

Location:
Peaks & Plains, Inc.
6326 E. Trent Ave. Ste. A
Spokane Valley, WA 99212-1220
Telephone: 800-585-4201

© 2010 Peaks and Plains Medical Inc.
ACHC BOC