NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED

AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.

The Health Insurance Portability & Accountability Act of 1996 ("HIPAA") is a

federal program that requires that all medical records and other individually

identifiable health information used or disclosed by us in any form, whether

electronically, on paper, or orally, are kept properly confidential. This Act

gives you, the patient, significant new rights to understand and control how your

health information is used. HIPAA provides penalties for covered entities that

misuse personal health information.

As required by HIPAA, we have prepared this explanation of how we are required to

maintain the privacy of your health information and how we may use and disclose

your health information.

We may use and disclose your medical records only for each of the following

purposes: Treatment, payment and health care operations.

• Treatment means providing, coordinating, or managing health care and

  related services by one or more health care providers. An example of this would

  include teeth cleaning services.

• Payment means such activities as obtaining reimbursement for services,

  confirming coverage, billing or collection activities, and utilization review.

  An example of this would be sending a bill for your visit to your insurance

  company for payment.

• Healthcare operations to include the business aspects of running our

  practice, such as conducting quality assessment and improvement activities,

  auditing functions, cost management analysis, and customer service. An example

  would be an internal quality assessment review.

We may also create and distribute de-identified health information by removing

all references to individually identifiable information.

We may contact you to provide appointment reminders or information about

treatment alternatives or other health-related benefits and services that may be

of interest to you.

Any other uses and disclosures will be made only with your written authorization.

You may revoke such authorization in writing, and we are required to honor and

abide by that written request, except to the extent that we have already taken

actions relying on your authorization.

You have the following rights with respect to your protected health information,

which you can exercise by presenting a written request to the Privacy Officer:

• The right to request restrictions on certain uses and disclosures of

  protected health information, including those related to disclosures to family

  members, other relatives, close personal friends, or any other person identified

  by you. We are, however, not required to agree to a requested restriction. If

  we do agree to a restriction, we must abide by it unless you agree in writing to

  remove it.

• The right to reasonable requests to receive confidential communications of

  protected health information from us by alternative means or at alternative

  locations.

• The right to inspect and copy your protected health information.
• The right to amend your protected health information.
• The right to receive an accounting of disclosures of protected health

  information.

• The right to obtain and we have the obligation to provide to you a paper copy

  of this notice from us at your first service delivery date.

• The right to provide and we are obligated to receive a written

  acknowledgement that you have received a copy of our Notice of Privacy Practices.

We are required by law to maintain the privacy of your protected health

information and to provide you with notice of our legal duties and privacy

practices with respect to protected health information.

This notice is effective as of January 1, 2003, and we are required to abide by

the terms of the Notice of Privacy Practices currently in effect. We reserve the

right to change the terms of our Notice of Privacy Practices and to make the new

notice provisions effective for all protected health information that we

maintain. We will post and you may request a written copy of a revised Notice of

Privacy Practices from this office.

You have recourse if you feel that your privacy protections have been violated.

You have the right to file a formal, written complaint with us at the address

below, or with the Department of Health & Human Services, Office of Civil Rights,

about violations of the provisions of this notice or the policies and procedures

of our office. We will not retaliate against you for filing a complaint.

Please contact us for more information:
Privacy Officer
Christian Loger
Minnesota Allergy and Asthma Consultants, PLLP
675 East Nicollet Blvd., Suite 250
Burnsville, MN 55337
(952) 223-3040

The U.S. Department of Health & Human Services Office of Civil Right
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
For more information about HIPAA or to file a complaint:
Toll free 1-877-696-6775