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.

All Women's Imaging Center Physicians, and staff members as well as any business associates or partners with whom we share your health information, will follow the practices as outlined in this notice.

Protected health information is any health information that identifies you, including demographic data such as your name, date of birth, and Social Security Number. We keep a record of the services our patients receive in order to provide the best possible care. We maintain strict adherence to state and federal laws when working with patient information.

In most cases, you have the right to:

• View and copy your health and billing records.
• Amend your health record, if you believe it is inaccurate or missing important information.
• Request an accounting of disclosures. Upon your request, we will provide you with an accounting of the times, if any, when we have disclosed your health information for reasons other than for treatment, payment or health care operations.
• Request restrictions on disclosures. You may request certain restrictions on how we use your health information. We will notify you if we are unable to agree to your request.
• Specify the manner in which we communicate with you, e.g., by calling you only at work.

To exercise any of these rights, simply submit a request in writing to: Privacy Officer, P.O. Box 14005 , Orange , CA 92863-1405 . A fee may be charged for the cost associated with copying, mailing, or other related expenses that we may incur.

If you have received an electronic copy of this notice, we will provide you with a paper copy upon request or you may go to our website at womensimagingcenter.com and print your own copy. Changes to this notice may occur at any time and apply to medical information we already hold, as well as new information after the change occurs. Prior to any significant policy changes, we will post the notice in our office and on our web site.

Complaints: If you believe that your privacy rights have been violated, you may file a complaint with our Privacy Officer by calling (714) 571-5000 or by writing to: Privacy Office, P.O. Box 14005, Orange, CA 92863-1405. You may also file a complaint with the Secretary of Health and Human Services. You will not be retaliated against for filing a complaint.

Your health information is used for: treatment, such as when we send medical information about you to a referring physician; payment, so that services may be billed to and payment collected from you, an insurance company, Medicare, or a third party; health care operations, so we can conduct quality assessment and improvement activities. Other instances include: public health risks/purposes; participating in audits or inspections; cooperating in judicial and administrative proceedings; for government health data systems; assisting coroners and medical examiners; for workers compensation purposes; in case of emergency; in cases required by law, e.g., helping a patient find a doctor if she referred herself for mammography and needs further consultation.

Unless the disclosure is for treatment, payment or health care operations, or a disclosure that is required by law, we will obtain your written authorization before disclosing your health information. You may revoke your authorization at any time.

We may contact you regarding appointments (reminders, scheduling) and regarding treatment (options, alternatives, information, health-related benefits that may be of interest to you).

Effective Date of Notice: May 1, 2005