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EPC Associates, Inc.
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HIPAA Notice of Privacy Practices Regarding Protected Health Information

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.

At EPC Associates, Inc. we respect your privacy and will protect your health information responsibly and professionally. We're required to maintain the privacy of your health information and to provide you with this notice. Also, we're required to abide by the terms of the notice that's currently in effect.

This notice applies to all members of your group health plan. It describes how we may collect, use and disclose your health information. It also describes your rights concerning your health.

As you read this notice you'll see an important term: "protected health information" or PHI. PHI is information about you, including health and demographic information created and received by us that can reasonably be used to identify you. PHI includes information that relates to your past, present and future physical or mental condition, the provision of health care and payment for that care.

How We Use Or Share Protected Health Information

With your health insurance carrier to handle claim payments
With your health care provider to insure proper payment of claims
With organizations that help us conduct our business operations
We only share information with businesses that agree to keep your information protected

There are state and federal laws that may require or allow us to release your PHI to others. We may be required to provide information for the following reasons:

Health Oversight Activities: We may disclose your PHI to a government agency authorized to oversee the health care system or government programs, or its contractors.
Legal Proceedings: We may disclose you PHI in response to a court or administrative order, subpoena, discovery request or other lawful process, under certain circumstances.
Law Enforcement: We may disclose your PHI to law enforcement officials under limited circumstances. For example, in response to a warrant or subpoena, or for the purpose of identifying or locating a suspect, witness or missing person, or to provide information concerning victims of crimes.
For Public Health Activities: We may disclose your PHI to a government agency that oversees the health care system or government programs for such activities as preventing or controlling disease or activities relating to the quality, safety or effectiveness of an FDA regulated product or activity.
Required By Law: We may disclose your PHI when required to do so by law.
Workers Compensation: We may disclose your PHI when required by Workers' Compensation laws.
Victims of Abuse, Neglect or Domestic Violence: We may disclose your PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, domestic violence or other crimes.
Coroners, Funeral Directors and Organ Donation: In certain instances we may disclose your PHI to coroners or funeral directors and in connection with organ donations.
Research: We may disclose your PHI to researchers if certain established steps are taken to protect your privacy.
Threat to Health or Safety: We may disclose your PHI to the extent necessary to avert a serious and imminent threat to your health or safety or the health or safety of others.
Specialized Government Functions: We may disclose your PHI in certain circumstances or situations to a correctional institution if you are an inmate in a correctional facility, to an authorized federal official when it's required for lawful intelligence or other national security activities, or to an authorized authority of the Armed Forces.

Before we can use or disclose your PHI for any reason other than those listed above, we are required to obtain your written authorization. You may revoke the authorization at any time as long as you do so in writing. Information provided as a result of your authorization will no longer be provided once you revoke the authorization.

What are Your Rights?

You have the right to ask us to restrict our use and disclosure of protected health information for the purposes of treatment, payment or health care operations. This includes uses and disclosures to family members, relatives, close personal friends or other persons identified by you who may be involved with your care or payment for your care. We will consider your request but we are not required to agree to restrict the information.

You have the right to ask to receive confidential communications. You may request that when we send communications to you that contain PHI, we send them to you by alternative means or to an alternative location. You must request this in writing and clearly state that our disclosure of all or part of that communication could endanger you. You must also tell us the alternative location (e.g. fax number, address, etc) to which you would like us to send the information.

You have the right to inspect and obtain a copy of the PHI that we maintain about you in a designated record set. A designated record set contains PHI that we collect, maintain or use to administer or make decisions regarding your enrollment, payment, claims adjudication or case/medical management. Requests to access the information must be made in writing and we will respond in 30 days of receipt of your request.

You have the right to ask us to amend PHI about you. All amendment requests must be made in writing and include a reason for the request. We will respond within 60 days of receiving the request. If the request is approved we will amend the information contained in our records. In certain cases the request may be denied. For example we may deny a request if the information we have on file is accurate or if we didn't create the information. We will notify you in writing of any denial. You may respond by filing a written statement of disagreement with us and we have the right to rebut the disagreement statement. Should this occur, you have the right to request that your original request, our denial and any statement of disagreement, along with our rebuttal be included in future disclosures of the PHI.

You have the right to request an accounting of certain disclosures of PHI. An accounting will show you to whom we provided your PHI. The first accounting in a 12 month period of time will be provided free of charge. Subsequent requests are subject to a reasonable, cost-based fee of which you will be made aware of in advance.

Complaints and Inquiries

You may register a complaint with us or to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. To file a complaint with us, please submit it in writing and address it to:

Joan Clifford
Compliance Officer
EPC Associates, Inc.
85 W. Main Street
Bay Shore NY 11706
631-666-2616

To submit a complaint to the Secretary of the Department of Health and Human Services, please submit it in writing to:

Secretary, Department of Health and Human Services
206 Independence Avenue SW
Washington DC 20201
877-696-6775

Your complaint should include the following:

Your name
The policyholder's name
Contract or policy number
Name of employer or plan sponsor
The identification number on the health plan card
Address or other means of communicating with you in writing
A telephone number where you can be reached
A brief description of the nature of your complaint
The names, if available, of any of our employees with whom you have discussed your complaint
Any other information you think is important in order to resolve your complaint

Please Note: You will not be retaliated against or denied any health plan benefit or service because you file a complaint

This Notice is Effective April 14,2003

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