TEXAS SPINE CONSULTANT'S PRIVACY RULE

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

Texas Spine values the privacy of those choosing to use its services and, in this respect, it implements policies and procedures to restrict the use of, and maintain private, your protected health information. The term "protected health information" means your individually identifiable health information. We may use the term "information" below to mean "protected health information."

Use and Disclosure. Texas Spine may use protected health information for the following purposes:

Treatment. To facilitate your care and medical treatment as a patient. In this regard your information will be utilized by the staff and physicians of Texas Spine, or Texas Spine may consult with other health care professionals, to evaluate your health, diagnose your medical condition and provide treatment. For example, Texas Spine may share results of diagnostic imaging in consultation with its staff or other healthcare professionals to develop a treatment plan.

Payment. To permit Texas Spine to obtain payment for its services. In this regard, Texas Spine may provide certain information to health insurance payors, other insurance payors, and credit card companies that you use to make payment of charges. For example, Texas Spine may contain your health insurer and provide the date and type of treatment for which it is charging.

Healthcare Operations. To enable Texas Spine to conduct operations and provide medical services. For example, Texas Spine may tabulate certain types of procedures performed to evaluate its equipment and supply needs and to assist in budgeting forecast.

Public Reporting Laws. To comply with laws requiring the reporting of certain health information to public authorities, including, law enforcement agencies, or in connection with government audits. For example, there are a number of laws that mandate the reporting of certain types of procedures or, in if a patient has a certain communicable disease, Texas Spine would be required to report the disease to the public health department.

Should Texas Spine elect to use your protected health information for any other purpose, it must first obtain your prior written consent. In the event you give your consent to an addition use or purpose, you may later revoke your consent and, thereafter, Texas Spine will no longer use your protected health information for such other use or purpose. Please note that the revocation of your consent will not affect any use and disclosure made during the period your permission was in force.

Additional Permitted Uses. Texas Spine may also use your information to contact you regarding appointment reminders or to furnish you information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Your Rights. You have the following rights with respect to your protected health information:

(a)    The right to request restrictions on the use and disclosure of your information. Texas Spine may, in turn, advise you that it will not be able to comply with your request in which event you may choose to withhold your information.

(b)    The right to receive confidential communications regarding your information.

(c)    The right to inspect and copy your information.

(d)    The right to amend your information.

(e)    The right to an accounting of the disclosures of your information.

(f)    The right, even if you have agreed to receive information electronically, to receive a paper copy of your information.

Texas Spine's Duties. Texas Spine is required by law to maintain your information confidential and private and may use the information only for the purposes and in the manner set forth in this privacy rule. Texas Spine may not use your information for any other purpose without your further permission. Texas Spine reserves the right, however, to make changes to its privacy rule from time to time, provided that any such changes are in compliance with the law. Should Texas Spine elect to make changes to its privacy rule, Texas Spine will provide notice of such changes for a brief period by posting an alert on its web site prior to the effective date of the changes. If you are a frequent visitor to this web site, you may wish to review the Texas Spine Notice of Privacy Rule from time to time to ensure you are familiar with the latest privacy rule observed by Texas Spine. If you are a patient of Texas Spine, we will provide you with copies of any revised privacy policy on your next visit to its offices.

Complaints. If you believe your privacy rights have been violated, you may file a complaint with Texas Spine by contacting Callie Tyner, Privacy Rule Officer, Texas Spine Consultants, LLP, Dallas, Texas, Telephone Number (214) 370-3535. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. No action will be taken against you by reason of filing any such complaint.

Requests to Inspect your Information. Should you wish to inspect or receive a copy of your protected health information, you may obtain a form to request access to your medical records by contacting the office at 214-370-3535.

Contact Person. If you wish to contact Texas Spine for further information regarding our privacy practices, that person is Callie Tyner, Dallas, Texas.

This privacy rule is effective as of January 1, 2009.