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.

At Atlanta Cancer Care, we believe that individuals have a right to adequate notice of our policies, procedures and practices with respect to uses and disclosures of protected health information. Atlanta Cancer Care is required by law to maintain the privacy of your health information and to provide you with a notice of our legal duties and privacy practices. We are required to and will abide by the terms in the Notice of Privacy Practices in effect at the time it is provided to you.

Ways in Which We May Use and Disclose Your Protected Health Information

Atlanta Cancer Care may use and disclose protected health information to business associates in the course of providing treatment, securing payment for such treatment, and/or to facilitate the health care operations of our practice. We may also use and disclose protected health information to facilitate the requirements of our business associates' contracts, and to comply with requests from other covered entities to carry out treatment, payment, or health care operations. Below you will find examples of each of these categories.

Treatment
One example of treatment is a visit to our office for the purpose of diagnosis or care of a health issue wherein doctors, nurses, laboratory technicians, medical students and others will share the information about you in the course of your treatment.

Payment
This includes sharing protected health information with an insurer or a third party that may be responsible for collecting payment from a health plan.

Healthcare operations
This means sharing protected health information for the purpose of quality review.

Except for the purposes described above and disclosures required by law, Atlanta Cancer Care will only use or disclose protected health information with your express written authorization and you may revoke the authorization at any time in writing. The revocation will apply only to future uses and disclosures.

Any information Atlanta Cancer Care provides to a third party other than to our business associates or other health care providers with a treatment relationship to you will be de-identified or stripped of any and all personal data which could be used to identify a specific individual.

Atlanta Cancer Care may contact you to provide appointment reminders or to provide you with information about alternative treatments or other health-care services we provide. When receiving communications from us, you may request that we communicate with you at an alternate location or by alternate means, and we will make every effort to accommodate your request.

Your Health Information Rights

With respect to your protected health information, you have the right to request and receive the following from Atlanta Cancer Care:

A Paper Copy of this Notice
You have the right to request a paper copy of this Notice of Privacy Practices even if we have provided a copy to you electronically by e-mail.

Inspection and Copying
You may request a report containing your health information that has been collected by Atlanta Cancer Care for you to inspect or copy. Such requests will be honored within 30 days or as required by law, and you will be notified in writing of Atlanta Cancer Care's receipt of the request and the date upon which the information will be available to you.

Amendment or Correction
You may request that we amend or correct your health information that has been collected by Atlanta Cancer Care. Upon agreement by your health care provider, requests to amend health information will be honored within 30 days or as required by law, and you will be notified in writing of Atlanta Cancer Care's action taken.

Accounting of Disclosures
You may request that we supply you with a listing of the disclosures of your protected health information which have been made by Atlanta Cancer Care except those made for treatment, payment or health care operations, those required by the Final Privacy Rule or made pursuant to other law, and those made pursuant to your explicit authorization. Such requests will be honored within 30 days or as required by law, and you will be notified in writing of the date on which the accounting will be available to you. At a minimum, the accounting of disclosures will include the following information:

• Date of each disclosure
• Name and address of the organization or person who received the protected health information
• A brief description of the information disclosed

Atlanta Cancer Care has also required in our business associate contracts that they offer a means to provide such a listing for you.

Request Restrictions
You may request that certain uses and disclosures of your protected health information be restricted. To do so, you must provide the request in writing using the Request for Restriction on Use or Disclosure form available from our office. Atlanta Cancer Care will determine if the information constitutes required information to carry out treatment, payment or health care operations. If, in our sole opinion, your request does not involve information that is required by us to carry out treatment, payment or health care operations, we will accept your request for restrictions and will notify you if your request will be honored within 30 days or as required by law.

If you believe that your privacy rights have been violated, you may send questions or complaints about this Notice or Atlanta Cancer Care's privacy practices to us and/or to the Secretary of the Department of Health and Human Services. Such communication with us should be directed to:

Chief Privacy Officer
Atlanta Cancer Care
5670 Peachtree Dunwoody Road, Suite 1100
Atlanta, Georgia 30342

The address of the Secretary of Health and Human Services is 200 Independence Ave. SW, Washington, DC 20201. Atlanta Cancer Care will not retaliate against you for filing a complaint with the Secretary of HHS.

Atlanta Cancer Care reserves the right to revise this Notice of Privacy Practices at any time without prior notification. You may request a copy of the revised notice and we will provide it to you.

For additional information, please write us at:
HIPAA Privacy Contact
Atlanta Cancer Care
5670 Peachtree Dunwoody Road, Suite 1100
Atlanta, Georgia 30342

You may also call 404.851.2300 and ask to speak with our HIPAA Privacy Contact.

This Notice of Privacy Practices is effective as of April 14th, 2003.