CONDITIONS AND TREATMENTS

PATIENT PRIVACY

Reston Podiatry Associates, Ltd. - Notice of Privacy Practices

Bruce I. Vogel, DPM
Steven A. Gordon, DPM
Lisa A. Beckinella, DPM
Shaun C. Hafner, DPM

THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice is first in effect on April 14th, 2003

This notice covers all information in our written or electronic records which concerns you, your health care, and payments for your health care. It also covers information we may have shared with other organizations to help us provide your care, get paid for providing care, or manage some of our administrative operations.

Reston Podiatry Assoc LTD (RPA) physicians and staff may use and disclose medical information (protected health information or PHI) about an individual for:

 Medical Treatment - i.e; providing medical care services, sending/coordinating medical care information with other health care providers caring for you, ordering and obtaining off site tests/results, writing prescriptions, etc.
 Payment - i.e; submitting insurance claims on your behalf for treatment rendered.
 Healthcare Operations - i.e.; internal business planning activities and quality of care evaluation.

RESTON PODIATRY ASSOCIATES LTD is permitted or required, under specific circumstances, to use or disclose protected health information without the individual's written authorization, including, but not limited to:

 Disclosures required by law
 Disclosures to avert serious threats to health or safety
 Disclosures with reference to workers' compensation or Food and Drug Administration

Other uses and disclosures will be made only with the individual's written authorization, and the individual may revoke such authorization. {Please see below for identifying persons to whom you would allow disclosures of otherwise protected information.}

Reston Podiatry Associates LTD (RPA) may contact the individual to provide appointment reminders or information about treatment or other health-related benefits and services that may be of interest to the individual or patient. RPA will routinely contact patients via telephone or secured email at home and/or work and, unless otherwise requested, may leave messages on the appropriate voice mail or answering service regarding appointments, test results, etc.

Our patients have the following rights regarding their protected health information:

 The right to request restrictions on certain uses and disclosures of protected health information. RPA is not required to agree to a requested restriction, however.
 The right to receive confidential communications or protected health information, as applicable.
 The right to inspect and copy protected health information, as provided in the Privacy Regulation.
 The right to amend protected health information, as provided in the privacy regulation.
 The right to receive an accounting of disclosures of protected health information.
 The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the notice electronically.

ADDITIONAL OR SUPERCEDING RIGHTS FOR: VIRGINIA

Under Virginia State Law, you have these additional rights and restrictions:

Results of HIV testing

If we test you for HIV, or receive the results of such tests, we will treat that information as confidential. HIV test results may only be released to the following persons: (1) to your or your legally authorized representative; (2) any person designated in a release signed by you or your authorized representative; (3) the Department of Health; (4) other health care providers for purposes of treating you; (5) health care facility staff committees which monitor, evaluate or review programs or services; (6) medical or epidemiological researchers for use as statistical data only; (7) any person allowed access to such information by court order; (8) any facility which procures, processes, distributes or uses blood, other body fluids, tissues or organs; (9) any person authorized by law to receive such information; (10) your parents or legal custodian if you are a minor; (11) your spouse; and (12) Departments of Health located outside the Commonwealth of Virginia for purposes of disease surveillance and investigation, but only when allowed by the Virginia Department of Health.

Access to Your Health Information

We will respond, within fifteen (15) days of receipt of your written request for copies of your medical records, by providing copies of your records, unless reasons exist to deny access, as stated in this Notice. We will accept a photocopy or facsimile of your original request for copies.

Denial of Access to Your Health Information

We may choose to deny you access to your health information if your attending physician or clinical psychologist has stated in your medical record that furnishing such records would endanger your life or physical safety. If we deny a request for health information based on such a statement, we will permit examination and copying of the medical record by another similar physician or clinical psychologist selected by you, whose licensure, training and experience relative to your condition are at least equivalent to that of the physician or clinical psychologist upon whose opinion the denial is based. The physician or clinical psychologist selected by you will then decide whether to make the record available to you.

Subpoenas for Medical Records

If we receive a subpoena to produce copies of your medical records, we are required to provide written notice to you of that fact. If you believe your records should not be disclosed, and you object to their disclosure, you have the right to file a motion with the clerk of the court to quash (i.e., overturn) the subpoena. You may contact the clerk of the court's office to determine the requirements that must be satisfied for filing such a motion, and you may elect to contact an attorney to represent your interests. Your motion must be filed as soon as possible before we send out records in response to the subpoena. If you elect to file a motion to quash, you must notify us that you are filing the motion so that we will send your records to the clerk of the court in a sealed envelope or package for safekeeping until your motion is decided.

Re-Disclosure of Your Health Information

If we receive health information from a third party, such as another health care provider, we will not re-disclose this information or otherwise reveal the health information beyond the purpose for which we obtained the information without obtaining your consent in writing, except as permitted by state and federal law.

If you request copies, we will charge you for our actual costs of copying, including labor, and postage for mailing under state and federal law.

RPA is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information. RPA is required to abide by the terms of the Notice currently in effect.

RPA reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains. RPA will provide individuals or patients with a revised Notice by posting new regulations in each office.

Individuals may complain to RPA and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated.
RPA's contact person for matters relating to complaints is:
Steven A. Gordon, DPM
PHI Privacy Administrator
Phone: 703- 368-7166 Fax: 703-368-5103
Reston Podiatry Associates, Ltd.
8577-A Sudley Rd, Manassas, VA 20110