Ronald G. Christopher, MD

Office Information: 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 it carefully.

Legal Obligations

HealthStar Physicians, P.C. is required by law to maintain the privacy of all medical information within its organization; provide this notice of privacy practices to all members; inform members of out legal obligations; and advise members of additional rights concerning their medical information. HealthStar Physicians must follow the privacy practices contained in this notice from its effective date of April 14, 2003, and continue to do so until this notice is changed or replaced.

HealthStar Physicians, P.C. reserves the right to change our privacy practices and the terms of this notice at any time, provided applicable law permits the changes made in these privacy practices will be effective for all medical information created or received before the changes were made. All members will be notified of any changes be receiving a new notice of privacy practices.

You may request a copy of this notice of privacy practices at any time by contacting HealthStar Physicians, Teri Moore, HIPAA Officer, 420 West Morris Blvd., Suite 400-A, Morristown, TN 37813, 423-581-5925, ext 104.

Uses and Disclosures of Medical Information

Your medical information may be used and disclosed or treatment, payment, and health care operations, for example:

Treatment: Your medical information may be disclosed to a doctor or hospital that asks for it to provide treatment for you.

Payment: Your medical information may be used or disclosed to pay claims for services provided to you by doctors or hospitals which are covered under your health insurance policy.

Health Care Operations: Your medical information may be used and disclosed to determine premiums, conduct quality assessment and improvements activities, to engage in care coordination or case management, to pursue Right of Recovery and Reimbursement/Subrogation, accreditation, conducting and arranging legal serb ices, etc.

Personal Representative: Your medical information may be disclosed to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care but only if you agree we may do so, as described in order to administer your group health plan.

Plan Sponsors: Your medical information and the medical information of others enrolled in your group health plan may be disclosed to your plan sponsor in order to perform plan administration functions. Please see your plan documents for a full description of hate limited uses and disclosures the plan sponsor may make of your medical information in order to administer your group health plan.

Underwriting: Your medical information may be received for underwriting, premium rating or other activities relating to the creation, renewal or replacement of a contract of health insurance or benefits. Your medical information will not be used or further disclosed for any other purpose, except as required by law, unless the contract of health insurance benefits is placed with our company.

Individual Rights

You have the right to look at or get copies of your medical information, with limited exceptions. You may request a format other than photocopies, which will be used unless the company cannot practicably do so. You must make the request in writing to obtain access to your medical information. You may obtain a form to request access by using the contact information at hate end of this notice or you may send us a letter requesting access to hate address located at the end of this notice. If you request copies, there will be a charge of $.25 per page, $10 per hour for staff time to copy your medical information, and postage if you want the copies mailed to you. If you request an alternative format, the charge will be cost-based for providing your medical information in that format. If you prefer, we will prepare a summary or explanation of your medical information for a fee. For a more detailed explanation of the fee structure, please use the information at the end of this notice to contact our office.

You have the right to receive an accounting of the disclosures of your medical information by our company or by a business associate of our company. This accounting will list each disclosure that was made of your medical information for any reason other than treatment, payment, health care operations and certain other activities since April 14, 2003. This accounting will include the date the disclosure was made, the name of hate person or entity the disclosure was made to, a description of the medical information disclose, the reason for the disclosure, and certain other information. If you request an accounting more than once in a 12-month period, there may be a reasonable cost-based charge for responding to ht ese additional requests. For a more detailed explanation of the fee structure, please use the information at hate end of this notice to contact our office.

You have the right to request restrictions on the company's use of disclosure of your medical information. The company is not required to agree to these additional requests, but if in agreement, the company will honor the agreement, except in an emergency. Any agreement to restrictions on the use and disclosure of your medical information must be in writing and signed by a person authorized to make such an agreement on behalf of the company. The company will not be bound unless the agreement is so memorialized in writing.

You have the right to request confidential communications about your medical information by alternative means or alternative locations. You must inform the company that confidential communication by alternative means or to alternative location is required to avoid endangering you. You must make your request in writing and you must state that hate information could endanger you if it is not communicated by the alternative means or to the alternative locations requested. The company must accommodate the request if it is reasonable, specifies the alternative means or location, and continues to permit use to collect premium and pay claims under your health plan.

You have the right to request that the company amend your medical information. Your request must be in writing and it must explain why the information should be amended. The company may deny your request if the medical information you seek to amend was not created by our company or for certain other reasons. If your request is denied, the company will provide a written explanation of the denial. You may respond with a statement of disagreement to be appended to the information you wanted amended. If the company accepts your request to amend the information, the company will make reasonable efforts to inform others, including the people you name, of the amendment and to include the changes in any future disclosures of that information.

If you receive this notice on our web site or by electronic mail (e-mail), you are entitled to receive this notice in written form. To obtain this notice in written form, please use the information at the end of this notice to contact our office.

Marketing: Your medical information may be used to contact you with information about health-related benefits and services or about treatment alternatives that may be of interest to you. Your medical information may be disclosed to a business aconites to assist us in these activities. Unless the information is provided to you be a general newsletter or in person or is for products or services of nominal value, you may opt-out of receiving further information by telling us. (See instructions for opting out at the end of this notice).

Research: Your medical information may be used or disclosed for research purposes in limited circumstances. Medical information of a deceased person may be disclosed to a corner, medical examiner, funeral director or organ procurement organization for certain purposes.

Court or Administrative Order: Medical information may be disclosed in response to a court or administrative order, subpoena, discovery request, or other lawful process, under certain circumstances. Under limited circumstances (i.e. court order, warrant, or grand jury subpoena), medical information may be disclosed to law enforcement officials. In addition, medical information may be disclosed to law enforcement officials concerning a suspect fugitive, material witness, crime victim or missing person. Medical information may be disclosed to law enforcement officials or correctional institution regarding an inmate or other person in lawful custody, in certain circumstances.

Victim of Abuse: Medical information may be released to appropriate authorities under reasonable assumption that you are a possible victim of abuse, neglect or domestic violence or the possible victim of other crimes. Medical information may be released to the extent necessary to avert a serious threat to your health or safety or to hate health or safety of others. Medical information may be disclosed when necessary to assist law enforcement officials to capture and individual who has admitted to participation in a crime or has escaped from lawful custody.

Military Authorities: Medical information of Armed Forces personnel may be disclosed to Military authorities under certain circumstances. Medical information may be disclosed to authorized federal officials as required for lawful intelligence, counterintelligence, and other national security activities.

Effective: April 14, 2003.

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