Rice Medical Center

CHANGES TO THIS NOTICE.

We may change our policies and privacy practices at any time. Changes will
apply to your protected health information we already hold, as well as new
information obtained after the change occurs. When we make a significant
change in our policies, we will change our Notice and post the new Notice in
waiting areas, exam rooms and on our Website at www.ricemedicalcenter.net.
You can receive a copy of the current Notice at any time. The effective date is
listed just below the title. You will be offered a copy of the current Notice
each time you register at our facility for treatment. You will also be asked to
acknowledge in writing your receipt of this Notice.

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION.
" We may use and disclose medical and billing information about you for
treatment (such as sending medical information about you to a specialist as
part of a referral); to obtain payment for treatment (such as sending billing
information to your insurance company or Medicare); and to support our
health care operations (such as comparing patient data to improve treatment
methods).
" We may use and disclose medical and billing information about you without
your prior authorization for several other reasons. Subject to certain
requirements, we may give out protected health information about you
without prior authorization for public health purposes, abuse or neglect
reporting, health oversight audits or inspections, research studies, funeral
arrangements, organ donation, workers' compensation purposes, or during
emergencies. We may also disclose protected health information when
required by law, such as in response to a request from law enforcement
officials in specific circumstances, or in response to valid judicial or
administrative orders.
" We may contact you for appointment reminders, or to tell you about or
recommend possible treatment options, alternatives, health-related benefits or
services that may be of interest to you, or to support fund-raising efforts.
" If admitted as a patient, unless you tell us otherwise, we will list in the
patient directory your name, location in the hospital, your general condition
(good, fair, etc.) and your religious affiliation, and will release all but your
religious affiliation to anyone who asks about you by name. Your religious
affiliation may be disclosed only to a clergy member, even if they do not ask
for you by name.
" We may disclose medical and billing information about you to a friend or
family member who is involved in your medical care or to disaster relief
authorities so that your family can be notified of your location and condition.

OTHER USES OF MEDICAL INFORMATION.
" In any other situation not covered by this Notice, we will ask for your
written authorization before using or disclosing your protected health
information. If you choose to authorize our use of disclosure of your
protected health information, you can later revoke that authorization by
notifying us in writing of your decision.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
" In most cases, you have the right to look at or obtain a copy of medical and
billing information contained in the designated record set that we use to make
decisions about your care. If you request copies, we may charge a fee for the
cost of copying, related supplies or postage. If we deny your request to review
or obtain a copy, you may submit a written request for a review of that
decision.
" If you believe that information in your designated record set is incorrect or
if important information is missing, you have the right to request that we
correct the records. Your request may be submitted in writing. A request for
amendment must provide your reason for the amendment. We could deny
your request to amend a record if the information was not created by us; if it
is not part of the medical or billing information maintained by us; or if we
determine that the record is accurate. You may appeal, in writing, a decision
by us not to amend a record.
" You have the right to a list of those instances where we have disclosed
medical and billing information about you, other than for treatment,
payment, health care operations or where you specifically authorized a
disclosure. When you submit a written request, the request must state the
time period desired for the accounting, which must be less than a six (6)-year
period and starting after April 12, 2003. You may receive the list in paper or
electronic form. The first disclosure list request in a 12-month period will be
provided to you at no cost other requests will be charged in accordance with
our cost to produce the list. We will inform you of the cost before you incur
any charges.
" If this Notice was sent to you electronically, you have the right to a paper
copy of this Notice.
" You have the right to request that your medical and billing information be
communicated to you in a confidential manner, such as sending mail to an
address other than your home. You must notify us in writing of the specific
way or location for us to communicate with you.
" You may request, in writing, that we not use or disclose protected health
information about you for treatment, payment or healthcare operations or to
persons involved in your care except when specifically authorized by you, or
when required by law, or in an emergency. We will consider your request but
we are not legally required to accept it. We will inform you of our decision.
All written requests or appeals should be submitted to our Privacy Office
listed on this Notice.

COMPLAINTS.
" If you are concerned that your privacy rights
may have been violated, or you disagree with a
decision we made about access to your records,
you may contact our Privacy Offices (listed
below). You may also contact Rice Medical Center
Administrator, at 979.234.5571.
" Finally, you may send a written complaint to the
U.S. Department of Health and Human Services
Office of Civil Rights. Our Privacy Office will
provide you the address upon request.
" Under no circumstances will you be penalized or
retaliated against for filing a complaint.

Privacy Office Contact Information:
Administration
600 South Austin
Eagle Lake, Texas 77434
Phone: 979.234.5571
Fax: 979.234.5176

If you have any questions, please contact our
Privacy Office at the address or phone number on
this notice.

WHO WILL FOLLOW THIS NOTICE?
Rice Medical Center provides health care to our
patients, residents, and clients in partnership with
physicians and other professionals and
organizations. The information privacy practices
in this Notice will be followed by:
" Any health care professional who treats you at
any of our locations;
" All departments and units of our organization,
including Rice Medical Center and Rice Medical
Associates medical staff, and other credentialed
health care providers of the medical staff;
" All employed associates, staff or volunteers of
our organization with whom we may share
information as permitted within our organized
health care arrangement;
" Any business associate with whom we share
health information.

OUR PLEDGE TO YOU.
We understand that medical and billing
information about you is personal. We are
committed to protecting the privacy of your
medical and billing information. We created a
designated record of the care and services you
receive to provide quality care and to comply with
legal requirements. This Notice applies to all of
the records of your care that we maintain, whether
created by facility staff or your personal doctor.
Your personal doctor may have different policies
or Notices regarding the doctor's use and
disclosure of your medical and billing information
created in the doctor's office. We are required by
law to:
" Keep medical and billing information about you
private;
" Give you this Notice of our legal duties and
privacy practices with respect to your protected
health information;
" Follow the terms of the Notice currently in
effect.