Urology Centers of Alabama, PC is required by law to maintain the privacy of Protected Health Information and to provide our patients with notice of this legal duty. We are also obligated by law to inform you of our privacy practices with respect to Protected Health Information.

This notice describes how your medical information may be used and disclosed and how you can get access to this information. Please review it carefully.

It is Urology Centers of Alabama, PC's policy to protect the confidentiality of the protected health and personal information of our patients and to prevent unauthorized access to, or the use or disclosure of such information. This policy applies to all current or former patients of Urology Centers of Alabama, PC.

Individually identifiable health and personal information is any information obtained by Urology Centers of Alabama, PC in connection with providing healthcare treatment, obtaining payment or other related health care operations. This relates to past, present or future information that Urology Centers of Alabama, PC receives from you as our patient.

Urology Centers of Alabama, PC collects personal information to learn about your medical history, medical conditions, render treatment and collect payment for our services. We gather this information from your patient forms, health questionnaires and other forms you will be asked to complete from time to time. In addition, we will assemble information based on our discussions and conversations with you, your personal representative and your family members. Your healthcare plan or insurance carrier may provide information to our office.

We use this information to provide caring and quality medical care to you. Examples include diagnosis, treatment and communications such as follow up and appointment reminders. As part of our standard healthcare operations, we may share information with other physicians, a facility such as a hospital, laboratory, diagnostic service or healthcare provider to efficiently coordinate your treatment plan. For contracted insurers, your information will be used for claims management and to obtain payment from your insurance carrier. As required by your insurance contractor, we will exchange data with your insurance carrier to determine eligibility, benefit and coverage, precertification and utilization review.

In addition your Protected Health Information:

• May be reviewed by our medical staff for possible referral in research studies. You will be contacted prior to the use of your information in a research study.

• We may leave a message on your answering machine or voice mail to contact you about your appointment or to have you call our office.

• Our medical group participates with Blue Cross Blue Shield of Alabama Infosolutions and we will provide your protected health information to this database if they manage your claim benefits.

• We may contact you about treatment alternatives or other health related benefits and services that may be of interest to you. Your information is maintained in our office in our practice management computer system, our electronic medical record computer and in your medical chart. Urology Centers of Alabama, PC limits the access to your protected health information to those employees and business associates who need to know that information.

We do not disclose personal information to third parties unless one of the following exceptions applies:

• We receive explicit authorization from you to release individually identifiable information. This authorization must be in writing and given exact details regarding to whom the disclosure applies, the nature of the date to be released, the applicable dates and signed by the patient (or guardian).

• Federal, state or other applicable law requires us to share protected information or records.

We reserve the right to change the terms of this policy at any time and any change will be effective for all past, present or future information Protected Health Information. If, at any time in the future, we do change this policy or if it is necessary to disclose any of your personal information in a way that is materially different from this policy, Urology Centers of Alabama will give you notice of the change at your next visit to our office.

With some limitations, you have the right to review your health information, amend your records, request special accommodations, request restrictions of your health information and receive an accounting of the disclosures of your information. Urology Centers of Alabama is not obligated to agree to any requested restrictions. You have the right to request that we provide your protected health information to you via an alternative method. If you have a complaint about the management of your health information, contact the Compliance Office at 205-930-0920. You have the right to file a complaint with the Secretary of the Department of Health and Human Services if you believe your privacy right have been violated. There will be no retaliation for filing a complaint.