Privacy Practices

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Barrow Neurosurgical Associates, Ltd.
PATIENT'S NOTICE OF PRIVACY PRACTICES

Effective Date of this Notice: April 14, 2003

This Notice applies only to the surgeons and staff of Barrow Neurosurgical Associates, Ltd. It does not represent the practice of any other individual physician, physician group, allied health personnel or facility. If you exercise one of the rights listed in this document, you will only be requesting modification of the actions of the surgeons and staff of Barrow Neurosurgical Associates, Ltd. and no other healthcare group or provider.

As required by the privacy regulations of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), this Notice describes how the following information about you (as a patient of BNA) may be used and disclosed, and how you may access your information. The information addressed by the federal law covers your name; any address specification such as street, city, county, precinct, and zip code; all dates except for the year including birthdate, admission date, discharge date, date of death, and all ages over 89; telephone number; fax number; e-mail address; social security number; medical record number; health plan beneficiary number; BNA account number; certificate or license number such as driver's license number; vehicle identifier and serial number including license plate number; medical device identifier and serial number; website address; internet protocol address number; biometric identifier including finger and voice prints; full face photographic images and any comparable image; and, any other unique identifying number characteristic or code. Please review the following Notice carefully.

A. BARROW NEUROSURGICAL ASSOCIATES, LTD.'S (BNA) COMMITMENT TO YOUR PRIVACY

Barrow Neurosurgical Associates, Ltd. (BNA) is committed to maintaining the privacy of your individually identifiable health information. In the process of serving you, BNA will create records about you and the treatment and services provided. BNA is required by federal law to inform you about:

• How BNA may use and disclose your individually identifiable health information
• Your privacy rights concerning your individually identifiable health information
• BNA's obligations concerning the use and disclosure of your individually identifiable health information

The terms of this Notice apply to all records containing your individually identifiable health information that are created or retained by BNA. BNA reserves the right to revise or amend this Patient's Notice of Privacy Practices. Any revision or amendment of this Notice will be effective for all of your records that BNA has created or maintained in the past, and for any of your records that BNA may create or maintain in the future. BNA will post a copy of its most current Notice in its offices in a visible location at all times, and you may request a copy of the most current Notice at any time.

B. IF YOU HAVE QUESITIONS ABOUT THIS NOTICE PLEASE CONTACT:

Privacy Officer
Barrow Neurosurgical Associates, Ltd.
2910 North 3rd Avenue
Phoenix, AZ 85013
Phone: (602) 406-3202

C. BNA MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION IN THE FOLLOWING WAYS:

1. Treatment: BNA may use your individually identifiable health information to treat you. For example, a provider may ask you to have medical imaging studies, and then use the results to help reach a diagnosis. BNA might use your individually identifiable health information in order to write a prescription, and then disclose your individually identifiable health information to a pharmacy when the prescription is ordered. Many of the people who work at BNA — including but not limited to Doctors and Nurse Practitioners — may use or disclose your individually identifiable health information in order to treat you or to assist others in your treatment. BNA may disclose your individually identifiable health information to others who may assist in your care such as your spouse, children or parents. Finally, BNA may disclose your individually identifiable health information to other health care providers such as Residents and an affiliated hospital for purposes related to your treatment.
2. Payment: BNA may use and disclose your individually identifiable health information in order to bill and collect payment from you or a responsible third party for the services and items. BNA may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and BNA may provide your insurer with details regarding your treatment to determine if your insurer will pay for your treatment. BNA may disclose your individually identifiable health information to other health care providers and entities to assist in their billing and collection efforts.
3. Health Care Operations: BNA may use and disclose your individually identifiable health information for management purposes. For example, BNA may use and disclose your information to evaluate the quality of care you received or to conduct cost-management and business-planning activities. BNA may also disclose your individually identifiable health information to other health care providers and entities to assist in managing their health care operations.
4. Teaching: BNA physicians and Nurse Practitioners are faculty members for medical training programs. BNA may use and disclose your individually identifiable health information during educational processes that include but are not limited to supervising the care provided to you by medical and allied health students. Further, because of BNA's commitment to contributing to the level of neurosurgical knowledge, BNA clinicians may disclose your individually identifiable health information to clinical observers committed to protecting your privacy.
5. Appointment Reminders: BNA may use and disclose your individually identifiable health information to contact you and remind you of an appointment.
6. Treatment Options: BNA may use and disclose your individually identifiable health information to inform you of potential treatment options or alternatives.
7. Health-Related Benefits and Services: BNA may use and disclose your individually identifiable health information to inform you of health-related benefits or services that may be of interest to you.
8. Release of Information to Family/Friends: BNA may release your individually identifiable health information to a friend or family member that is involved in your care. For example, a parent or guardian may ask that a babysitter bring their child to the office. In this example, the babysitter may have access to this child's medical information.
9. Disclosures Required by Law: BNA will use and disclose your individually identifiable health information when required to do so by federal, state, or local law.

D. USE AND DISCLOSURE OF YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which BNA may use or disclose your individually identifiable health information:

1. Public Health Risks: BNA may disclose your individually identifiable health information to public health authorities that are authorized by law to collect information for the purposes of:
   1. maintaining vital records, such as deaths
   2. reporting child abuse or neglect
   3. preventing or controlling disease, injury or disability
   4. notifying a person regarding potential exposure to a communicable disease
   5. notifying a person regarding a potential risk for spreading or contracting a disease or condition
   6. reporting reactions to drugs or problems with products or devices
   7. notifying individuals if a product or device they may be using has been recalled
   8. notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect or an adult patient (including domestic violence); however, BNA will only disclose this information if the patient agrees or if we are required to by law to disclose this information
   9. notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance
2. Health Oversight Activities: BNA may disclose your individually identifiable health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings: BNA may use and disclose your individually identifiable health information in response to a court or administrative order if you are involved in a lawsuit or similar proceeding. BNA may also disclose your individually identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if BNA has made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
4. Law Enforcement: BNA may release individually identifiable health information if asked to do so by a law enforcement official:
   1. regarding a crime victim in certain situations, if BNA is unable to obtain the person's agreement
   2. concerning a death BNA believes has resulted from criminal conduct
   3. regarding criminal conduct at a BNA office
   4. in response to a warrant, summons, court order, subpoena or similar legal process
   5. to identify/locate a suspect, material witness, fugitive or missing person
   6. in an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)
5. Deceased Patients: BNA may release individually identifiable health information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, BNA may also release information in order to funeral directors to perform their services.
6. Organ and Tissue Donation: BNA may release your individually identifiable health information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
7. Research: BNA may use and disclose your individually identifiable health information for research that meets the privacy and confidentiality standards of an Institutional Review Board. Your individually identifiable health information will not be published without your authorization.
8. Serious Threats to Health or Safety: BNA may use and disclose your individually identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety to another or the public. Under these circumstances, BNA will only make disclosures to a person or organization able to help prevent the threat.
9. Military: BNA may disclose your individually identifiable health information if you are a member of the United States or foreign military forces (including veterans) and if required by the appropriate authorities.
10. National Security: BNA may disclose your individually identifiable health information to federal officials for intelligence and national security activities authorized by law. BNA may also disclose your individually identifiable health information to federal officials to protect the President or other officials or foreign heads of state, or to conduct investigations.
11. Inmates: BNA may disclose your individually identifiable health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary:
    1. for the institution to provide health care services to you;
    2. for the safety and security of the institution; and/or
    3. to protect your health and safety or the health and safety of other individuals.
12. Worker's Compensation: BNA may release your individually identifiable health information for worker's compensation and similar programs.

E. YOUR RIGHTS REGARDING YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION

You have the following rights regarding the individually identifiable health information that BNA maintains about you:

1. Confidential Communications. You have the right to request that BNA communicate with you about your health and related issues in a particular manner or a certain location. For instance, you may ask that we contact you at home rather than at work. In order to request a type of confidential communication, you must make a written request per instructions from the BNA PRIVACY OFFICER at 602/406-3202 specifying the requested method of contact, or the location where you wish to be contacted. BNA will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions: You have the right to request a restriction in BNA's use or disclosure of your individually identifiable health information for treatment, payment or health care operations. Additionally, you have the right to request that BNA restrict its disclosure of your individually identifiable health information to only certain individuals involved in your care or the payment for your care, such as family members or friends. BNA is not required to agree to your request; however, if BNA agrees, BNA is bound by its agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in BNA's use or disclosure of your individually identifiable health information, you must make a written request per instructions from the BNA PRIVACY OFFICER at 602/406-3202. Your request must describe in a clear and concise fashion:
   1. the information you wish restricted;
   2. whether you are requesting to limit BNA's use, disclosure, or both; and
   3. to whom you want the limits to apply
3. Copies: You have the right to obtain a copy of the individually identifiable health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. Your request must be in writing. Records release forms are available from any of the BNA office locations. In addition, release forms for records held in the Phoenix office may be requested from the Phoenix Medical Records Department by calling 602/406-3753. BNA may charge a fee in compliance with state laws for the costs of copying, mailing, labor and supplies associated with your request. BNA may deny your request for a copy in certain limited circumstances; however, you may request a review of the denial. Another licensed health care professional chosen by BNA will conduct reviews.
4. Inspection: You have the right to inspect individually identifiable health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must make a written request per instructions from the BNA PRIVACY OFFICER at 602/406-3202 in order to inspect your individually identifiable health information. BNA may deny your request to inspect in certain limited circumstances; however, you may request a review of the denial. Another licensed health care professional chosen by BNA will conduct reviews.
5. Amendment: You may ask BNA to amend your individually identifiable health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for BNA. To request an amendment, you must make a written request per instructions from the BNA PRIVACY OFFICER at 602/406-3202. You must provide BNA with a reason that supports your request for amendment. BNA will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is, in BNA's opinion:
   1. accurate and complete;
   2. not part of the individually identifiable health information kept by or for BNA;
   3. not part of the individually identifiable health information which you would be permitted to inspect and copy; or
   4. not created by BNA, unless the individual or entity that created the information is not available to amend the information.
6. Accounting of Disclosures: All BNA patients have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain non-routine disclosures BNA has made of your individually identifiable health information for non-treatment or operations purposes. Use of your individually identifiable health information as part of the routine patient care at BNA is not required to be documented, e.g., the doctor sharing information with the medical secretary or the billing department using your information to file your insurance claim. In order to obtain an accounting of non-routine disclosures, you must make a written request per instructions from the BNA PRIVACY OFFICER at 602/406-3202. All requests for an "accounting of disclosures" must state a time period, which may be for no longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but BNA may charge you for additional lists within the same 12-month period. BNA will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
7. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of this Notice of Privacy Practices. You may ask BNA to give you a copy of this Notice at any time. To obtain a paper copy of this Notice, contact the BNA PRIVACY OFFICER at 602/406-3202.
8. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with BNA or with the Secretary of the Department of Health and Human Services. To file a complaint with BNA, address your written complaint to the BNA PRIVACY OFFICER, 2910 North 3rd Avenue, Phoenix, AZ 85013. To speak with the BNA PRIVACY OFFICER, please leave a message at 602/406-3202. You will not be penalized for filing a complaint.
9. Right to Provide an Authorization for Other Uses and Disclosures. BNA will obtain your written authorization for uses and disclosures that are not identified by this Notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your individually identifiable health information may be revoked at any time in writing. After you revoke your authorization, BNA will no longer use or disclose your individually identifiable health information for the reasons described in the authorization. Please note that BNA is required to retain records of your care.

Again, if you have any questions regarding this Notice or BNA's health information privacy policies, please contact the BNA PRIVACY OFFICER at (602) 406-3202 for further information.