NOTICE OF PRIVACY PRACTICES

EFFECTIVE DATE: April 6, 2003 -- VERSION: 2

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.

If you have any questions about this notice, please contact the Privacy Officer Liaison for LexMedical at (336) 248-5161 ext. 4475.

WHO WILL FOLLOW THIS NOTICE.

This notice describes LexMedical's (hereafter referred to as "LexMedical" or the "Facility") practices at all its locations and that of:

• Any independent health care professional who is on the Medical Staff and authorized to enter information into your medical record.
• All facilities of LexMedical, Inc. to include:
  • Women's Center of Lexington
  • Women's Center of Salisbury
  • MedChoice
  • North Davidson Center for Family Health
  • Lexington Center for Family Health
  • Davidson Internists
  • Lexington Surgical Associates
  • LexMedical Central Billing Office
• Any member of a volunteer group we allow to help you while you are in the Facility.
• All employees, staff and other LexMedical personnel.
• All students or trainees.
• All these persons, entities, sites and locations follow the terms of this notice. In addition, these persons, entities, sites and locations may share medical information with each other for your treatment or LexMedical operations purposes and the purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION:

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the Facility. Your health information is contained in a medical record that is the physical property of LexMedical. We need this record to provide you with quality care and to comply with certain legal requirements.

This notice applies to all of the records of your care and billing for care generated by LexMedical, whether made by LexMedical personnel or your personal doctor.

This notice will tell you about the ways in which the people listed above may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

• make sure that medical information that identifies you is kept private;
• give you this notice of our legal duties and privacy practices with respect to medical information about you; and
• follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

• For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other LexMedical personnel who are involved in taking care of you at the Facility. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Different departments of the Facility also may share medical information about you in order to coordinate what you need, such as prescriptions, lab work and x-rays. We also may need to disclose medical information about you to people outside LexMedical who may be involved in your medical care before or after you leave the Facility, such as family members, or others who provide services (such as home health agencies) that are part of your care. We will only disclose medical information about you to people outside LexMedical, who are not currently involved in your care at the Facility, with your consent, except for disclosures required by law.
• For Payment. We may need to use and disclose medical information about you so that the treatment and services you receive at the Facility or as given by other providers may be billed to and payment may be collected from you, an insurance company/health plan, or a third party. For example, we may need to give your insurance company/health plan information about surgery you will receive at the Facility or at Lexington Memorial Hospital so your insurance company/health plan will pay us or reimburse you for the surgery. We may also tell your insurance company/health plan about a treatment you are going to receive to obtain prior approval or to determine whether your insurance company/health plan will cover the treatment. We will only disclose with your consent medical information about you to people outside LexMedical to obtain payment, except for certain disclosures required by law.
• For Health Care Operations. We may use and disclose medical information about you for Facility operations. These uses and disclosures are necessary to run the Facility and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the qualifications and performance of our staff and medical staff in caring for you. We may also combine medical information about many LexMedical patients to decide what additional services the Facility should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to LexMedical personnel, doctors, and students for review and learning purposes. We may also combine the medical information we have about you and other patients with medical information from other Facilities to compare how we are doing and see where we can make improvements in the care and services we offer. We will remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who you are. We will only disclose with your consent medical information about you that identifies you to people outside LexMedical, except for certain disclosures that are required by law.
• Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at LexMedical. We will leave a message for you at any telephone number you give us stating the time of the appointment and the name of the person with whom you have the appointment unless we have agreed in writing to your written request to handle appointment reminders differently.
• Treatment Alternatives. We may use and disclose medical information to tell you about or recommend different ways to treat you.
• Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
• Individuals Involved in Your Care. We may disclose medical information about you to a friend or family member who is involved in your medical care, unless you object. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. You can object to these disclosures by telling us that you do not wish any or all individuals involved in your care to receive this information. If you are not present or cannot agree or object, we will use our professional judgment to decide whether it is in your best interest to disclose relevant information to someone who is involved in your care or to an entity assisting in a disaster relief effort.
• Individuals Involved in the Payment for your Care (spouse or other responsible party) – If you have consented to our disclosure of medical information for the purpose of obtaining payment for the care provided to you, such disclosure may also entail, and you have consented to, giving information to other family members who are insured on your policy or to someone who helps pay for your care, and your consent authorizes such disclosure.
• As Required By Law. We will disclose medical information about you when required to do so by federal, state, or local law.
• To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

SPECIAL SITUATIONS

• Workers' Compensation. We may release without your consent medical information about you for workers' compensation or similar programs under appropriate circumstances. These programs provide benefits for work-related injuries or illness.
• Public Health Risks. We may disclose without your consent medical information about you for public health activities. These activities generally include the following:
  • to prevent or control disease, injury, or disability;
  • to report births and deaths;
  • to report suspected abuse or neglect as required by law;
  • to report reactions to medications or problems with products;
  • to notify people of recalls of products they may be using; and
  • to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
• Health Oversight Activities. We may disclose without your consent medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
• Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We also may disclose medical information about you in response to a subpoena or other lawful process by someone else involved in the dispute by furnishing your medical records or information under seal to the court. The copies of your medical record under seal may only be opened by the parties to the case or their attorneys in depositions unless a judge orders otherwise.
• Law Enforcement. We may release without your consent medical information if asked to do so by a law enforcement official:
  • In response to a court order, grand jury demand, or search warrant;
  • About a death or injury we believe may be the result of criminal conduct; or
  • About suspected criminal conduct at the Facility.
• Coroners, and Medical Examiners. We may release without your consent medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
• Security, Intelligence Activities, and Protective Services. We may release with your consent medical information about you to authorized federal or state officials for intelligence, counterintelligence, and other governmental activities authorized by law. We may disclose with your consent medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or to conduct special investigations.
• Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release without your consent medical information about you to the correctional institution or law enforcement official with custody of you on behalf of the correctional institution if necessary: (1) for the Facility to provide you with health care; (2) to protect your health and safety; (3) to obtain payment; or (4) for operations of LMH.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.

You have the following rights regarding medical information we maintain about you:

• Right to Inspect and Copy. You have the right to inspect and receive a copy of medical information that may be used to make decisions about your care, unless your treating physician determines that providing you with such information would be injurious to your well-being. When we deny your request to inspect and receive a copy of your medical information on this basis, you may request that the denial be reviewed. Another licensed health care professional chosen by the Facility will review your request and the denial. The person conducting the review will not be the person who denied your request. We will do what this reviewer decides.
• To inspect and receive a copy of medical information that may be used to make decisions about you, you must submit your request in writing to LexMedical's Compliance Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request and may collect the fee before providing the copy to you. If you agree, we may provide you with a summary of the information instead of providing you with access to it, or with an explanation of the information instead of a copy. Before providing you with such a summary or explanation, we first will obtain your agreement to pay the fees, if any, for preparing the summary or explanation.
• Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for LexMedical.
  
  To request an amendment, your request must be made in writing and submitted to LexMedical's Compliance Officer. In addition, you must provide a reason that supports your request.
  
  We may deny your request for an amendment, if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
  • Was created by a provider other than the Facility, unless the provider who created the information is no longer available to consider or make the amendment;
  • Is not part of the medical information kept by or for LexMedical;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Has been determined to be accurate and complete.
• Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we have made of medical information about you.
  
  To request this list or accounting of disclosures, you must submit your request in writing to LexMedical's Compliance Officer. Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We may collect the fee before providing the list to you.
• Right to Request Restrictions. Except where we are required to disclose the information by law, you have the right to request a restriction or limitation on the medical information we disclose about you to individuals or entities outside of the Facility. You also have the right to request a limitation on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
  
  In some instances, we are not required to agree to your request. If we do agree, we will comply with your requested restriction unless the information is needed to provide you emergency treatment.
  
  To request restrictions, you must make your request in writing to LexMedical's Compliance Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
• Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail, or at a mailing address other than your home address.
  
  To request confidential communications, you must make your request in writing to LexMedical's Compliance Officer and specify how or where you wish to be contacted. We will not ask you the reason for your request. We will accommodate all reasonable requests.
• Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice or any revised notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
  
  To obtain a paper copy of this notice, contact LexMedical's Privacy Officer Liaison at (336)- 236-4685, ext. 1010.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the Facility. The notice will remain in effect for each subsequent visit unless changed. If the notice changes, a copy will be available to you upon request.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with LexMedical or with the Secretary of the Department of Health and Human Services. To file a complaint with LexMedical, contact the Privacy Officer Liaison for LexMedical at 336-248-5161, ext. 4475 or submit written complaint to the Privacy Officer Liaison for LexMedical P.O. Box 1537, Lexington, North Carolina 27293-1537. If you would like to file a complaint anonymously you may call 336-248-5161, ext. 4475. You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION.

Other uses and disclosures of medical information not covered by this notice will be made only with your written permission or as required by law. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the purposes that you had authorized in writing. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.