PRIVACY NOTICE

I. HOW ALBEMARLE HOSPITAL MAY USE OR DISCLOSE YOUR HEALTH INFORMATION

FEDERAL LAW REQUIRES ALBEMARLE HOSPITAL TO MAINTAIN THE PRIVACY OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION AND TO PROVIDE YOU WITH NOTICE OF ITS LEGAL DUTIES AND PRIVACY PRACTICES WITH RESPECT TO SUCH INFORMATION. ALBEMARLE HOSPITAL MUST ABIDE BY THE TERMS AND CONDITIONS OF THIS PRIVACY NOTICE, AS ALBEMARLE HOSPITAL MAY REVISE THIS PRIVACY NOTICE FROM TIME TO TIME.

A. USES OR DISCLOSURES OF HEALTH INFORMATION FOR TREATMENT, PAYMENT & HEALTH CARE OPERATIONS

Albemarle Hospital may use your individually identifiable health information for treatment, payment and health care operations. Examples of treatment, payment and health care operations include:

· "Treatment" could include consulting with or referring your case to another health care provider. The type of health information that could be used or disclosed includes but is not limited to such health conditions as blood type, diagnosis of your condition or pregnancy status. Albemarle Hospital may use or disclose your individually identifiable health information for its own provision of treatment or may disclose such information for the treatment activities of another health care provider.

· "Payment" could include Albemarle Hospital's efforts to obtain reimbursement from you or a responsible third party for services that Albemarle Hospital has provided to you. Albemarle Hospital may use or disclose your individually identifiable information for its own payment or for the payment and activities of another health care provider or health plan or health care clearinghouse.

· "Health care operations" could include activities such as quality assessment and improvement activities and audits of the process of billing you or a third party for health care services Albemarle Hospital provides to you. As part of Albemarle Hospital's treatment of you and operation of a health care organization, Albemarle Hospital may contact you, by phone or by mail, to provide appointment reminders or to provide information about treatment alternatives or other health-related services that may be of interest to you. Albemarle Hospital may also contact you for fundraising purposes. Albemarle Hospital may use or disclose your individually identifiable health information for its own health care operations or for limited health care operations of a health plan, health care clearinghouse, or health care provider that is subject to certain federal health information privacy laws. The entity which receives this information must have or have had a treatment relationship with you and the information we disclose must pertain to that relationship. Limited health care operations include various quality assessment and improvement activities, credentialing and training activities and health care fraud and abuse detection or compliance activities.

B. USES OR DISCLOSURES WE MAY MAKE WITHOUT YOUR AUTHORIZATION

In addition to treatment, payment and health care operations, and unless this Privacy Notice recites a more stringent restriction in Section C, the law permits or requires Albemarle Hospital to make use or disclose individually identifiable health information without your written consent or authorization to: (i) for certain public health activities and purposes including reporting of adverse product events to the Food and Drug Administration, (ii) report suspected abuse, neglect or domestic violence, (iii) submit information to health oversight agencies for oversight activities, such as audits, authorized by law, (iv) in the course of judicial and administrative proceedings, (v) for law enforcement purposes (vi) to a medical examiner, coroner, or funeral director, (vii) to assist an organ procurement organization or organ bank in facilitating organ or tissue donation and transplantation, (viii) to further research, provided that Albemarle Hospital complies with federal requirements, (ix) to avert a serious and imminent threat to public health safety, (x) for specialized government functions including activities related to the military, veterans, or national security, (xi) comply with workers' compensation or similar laws. Albemarle Hospital will make the above uses and/or disclosures of information in accordance with applicable law.

In addition, Albemarle Hospital may use and disclose your individually identifiable health information as follows:

· Business associates: There are some services provided in Albemarle Hospital through contracts with business associates which are vendors, professionals, and others who perform some treatment, payment or health care operations function on behalf of Albemarle Hospital or who otherwise provide services and have access to or use your protected health information. Examples include physician service in the emergency department and radiology, certain laboratory tests and a certain copy service we use when making copies of your health records. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information by requiring that they enter into an appropriate agreement with Albemarle Hospital.

· Directory: Unless you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. If you are unable to object, we may use and disclose this information consistent with your prior expressed preference, if known, and the health professional's judgment.

· Notification: Unless you object, health professionals, using their best judgment, may use or disclose information to notify or assist in notifying a family member, personal representative, or any person responsible for your care, your location, and general condition. If you are unable to object, we may exercise our professional judgment to determine if a disclosure is in your best interest and disclose only information that is directly relevant to the person's involvement with your health care.

· Communication with family: Unless you object, health professionals, using their best judgment, may use or disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care. If you are unable to object, we may exercise our professional judgment to determine if a disclosure is in your best interest and disclose only information that is directly relevant to the person's involvement with your health care.

· Disaster Relief: We may use or disclose information for disaster relief purposes.

· Incidental Uses and Disclosures: We are permitted to use and disclose information incident to another use or disclosure of your protected health information permitted or required under law.

· Limited Data Sets: We may use or disclose a limited data set (i.e., in which certain identifying information has been removed) of your protected health information for purposes or research, public health, or health care operations. Any recipient of that limited data set must agree to appropriately safeguard your information.

C. MORE STRINGENT PROTECTION FOR YOUR HEALTH INFORMATION

In certain cases, North Carolina law provides more stringent privacy protections of your health information than this Privacy Notice recites above. Specifically, the following:

· If you are a patient with AIDS or HIV infection or a communicable disease or condition subject to public health reporting requirements, Albemarle Hospital will only disclose information regarding your AIDS, HIV or communicable disease status with your written permission except (i) if you cannot be identified from the information, (ii) as disclosure is required or permitted under communicable disease law or laws specifically authorizing or requiring disclosure of AIDS information or records, (iii) if a subpoena or court order requires disclosure, or (iv) if release is necessary to protect public health. When you sign a written consent, you are agreeing that Albemarle Hospital may disclose or use this information for treatment, payment and health care operations purposes. If Albemarle Hospital reveals your information for any purpose other than treatment, payment or health care operations purposes, then you must sign a different permission form.

· If you provide confidential information to a social worker, the social worker will not reveal that information to anyone unless you give permission in writing. When you sign a written consent, you are agreeing that a social worker may share information you have provided to the social worker when the social worker discloses this information for treatment, payment and health care operations purposes. If the social worker reveals your information for any purpose other than treatment, payment or health care operations purposes, then you must sign a different permission form. However, please note that the social worker may reveal information you have given to the social worker without your written permission if the law requires the social worker to do so or not revealing the information may present a clear and imminent danger to you or others.

· If you provide confidential information to a substance abuse professional, then the substance abuse professional will not reveal that information to anyone, unless you give permission in writing. When you sign a written consent, you are agreeing that a substance abuse professional may share information you have provided to the substance abuse professional when the substance abuse professional discloses this information for treatment, payment and health care operations purposes. If the substance abuse professional reveals your information for any purpose other than treatment, payment or health care operations purposes, then you must sign a different permission form. However, please note that the substance abuse professional may reveal the information without your written permission if there is a clear and imminent danger to you or to others; in a medical emergency, but then only to an appropriate professional or to public authorities; or, when the law requires the substance abuse professional to disclose the information.

· If you provide confidential information to a massage or bodywork therapist, then the massage or bodywork therapist will not reveal that information to anyone, unless you give permission in writing. If the massage or bodywork therapist reveals your information for any purpose then you must sign a permission form. However, the massage or bodywork therapist may reveal the information without your written permission if the law or a court order may require the therapist to do.

· If you are seeking treatment and rehabilitation for drug dependence, Albemarle Hospital shall not reveal your name to law enforcement officers or agencies, unless you provide us with written permission. Albemarle Hospital shall also not reveal your name in any court, grand jury or administrative proceeding without your written permission, unless the law compels Albemarle Hospital to reveal your name.

· For patients of ambulatory surgery facilities, Albemarle Hospital's cardiac rehabilitation program, you have the right to object in writing to Albemarle Hospital's disclosing your individually identifiable health information to the North Carolina Department of Health and Human Services during an inspection.

· If you are an unemancipated minor under North Carolina law, then Albemarle Hospital physicians will not disclose, without your consent, information related to your health status regarding treatment for venereal disease, pregnancy (except in the case of an abortion), abuse of drugs or alcohol or emotional disturbance to a parent, legal guardian, person standing in loco parentis or a legal custodian who has legal authority to provide permission for your medical or psychiatric care. However, the physician may notify these individuals if in the physician's opinion the notification is essential to your life or health. In addition, the physician may give such information if your parent, legal guardian, person standing in loco parentis or legal custodian contacts the physician concerning your treatment.

· For patients receiving mental health, developmentally disabled or substance abuse services:

Except as described in these paragraphs, Albemarle Hospital may only use or disclose your confidential information if you give your written permission or sign an authorization that specifies the name of the persons to whom Albemarle Hospital may disclose the information. Your written permission or authorization must also state the specific time period during which the release is valid.

If a court has adjudicated you incompetent or you are a minor, Albemarle Hospital will not disclose your health information to a person acting as an external client advocate on your behalf, unless both you and your legally responsible person have executed written permission or authorization.

Albemarle Hospital may also disclose your health information, without your permission or authorization, in the following circumstances: (i) to other health care providers treating you, as necessary to meet an emergency, provided that we attempt to obtain your consent after the emergency; (ii) to health oversight agencies for oversight activities (e.g., audits); (iii) to internal client advocates to monitor services that Albemarle Hospital is providing to you and to serve as an advocate; (iv) to provide law enforcement agencies and other persons with information regarding your escape from, breach of condition of release from and/or return to a 24-hour facility, in order to assure your expeditious return and protect the public; (vi) to an attorney upon your request or to your personal representative; (vii) to comply with the provisions of a court order; (viii) to the court, certain attorneys and/or other interested parties in connection with certain legal proceedings (including involuntary commitment, guardianship, criminal cases, and others) where your confidential information is relevant to the proceeding; (ix) in some circumstances, to attorneys representing Albemarle Hospital or its employees; (x) as the law requires, including laws requiring reporting of abuse or neglect; (xi) to a correctional institute to facilitate your treatment; (xii) to avert an imminent and serious threat to the health or safety of yourself or another individual; (xiii) to business associates who perform services for Albemarle Hospital and who have a contract with Albemarle Hospital that prohibits the business associate from further disclosing the information; (xiv) in certain cases, limited information, such as the act of admission or discharge, certain transfers, decision to leave against medical advice, referral and appointment information for treatment after discharge to certain individuals you designate, your next of kin, and/or certain other family members, to provide them with basic information related to your treatment. Albemarle Hospital will not disclose more detailed information about your treatment to these individuals (e.g., diagnosis, prognosis, medications prescribed, dosage, side effects, progress and additional information), unless you have given your consent or authorization. However, please note that Albemarle Hospital can disclose your health information to these individuals only if your health care professional deems the disclosure to be therapeutically beneficial to you.

NOTE: References in this Privacy Notice to health care professionals include only those professionals that Albemarle Hospital employs.

D. MARKETING

We will need your written authorization to use and disclose your PHI for marketing purposes, except if the marketing is a face-to-face communication or if it involves a promotional gift of nominal value. "Marketing" includes a communication about a product or service that encourages you to purchase or use the product or service. It also includes an arrangement whereby Albemarle Hospital discloses your PHI to another entity, in exchange for compensation, and the other entity communicates about its own product or service to encourage purchase or use of that product or service. Marketing does not include our describing a health-related product or service (or payment for such product or service) that we provide. Marketing also does not include our communication for your treatment, or to direct or recommend to you alternative treatments, therapies, health care providers, or settings of care.

E. NO OTHER USES OR DISCLOSURES WITHOUT YOUR WRITTEN AUTHORIZATION

Albemarle Hospital will not make any other uses and disclosures of your individually identifiable health information without your written authorization. Your authorization may be revoked at any time if you provide written notice to Albemarle Hospital.

II. YOUR RIGHTS

Federal and state law protects your rights to keep your individually identifiable health information private.

Your Right to Receive a Confidential Communications and to Request Restrictions.

You may request that you receive communications from Albemarle Hospital regarding individually identifiable health information by alternative means or at alternative locations. You must make your request for confidential communications in writing and must submit this request to the office listed below. Albemarle Hospital reserves the right to condition your request on the receipt of information regarding how you wish Albemarle Hospital to handle payment and/or on the availability of an alternative address or method of contact that you may request. You may request restrictions on certain uses and disclosures of protected health information for purposes of treatment, payment, health care operations; however, the law does not require Albemarle Hospital to agree to the requested restrictions unless the restriction request is a reasonable restriction on communication.

Your Right to Inspect and Copy. You have the right to inspect and obtain a copy of any individually identifiable health information in your medical record unless your attending physician has determined that there is a sound medical reason to deny you access or unless the law restricts Albemarle Hospital from disseminating the information.

Your Right to Amend. You also have the right to amend your individually identifiable health information, unless Albemarle Hospital did not create such information or unless Albemarle Hospital determines that your medical record is accurate and complete in its existing form.

Your Right to an Accounting. You have the right to request and receive an accounting of disclosures of your individually identifiable health information that Albemarle Hospital has made in the six (6) years prior to the request date, or during the period between the request date and the date that federal law required Albemarle Hospital to comply with federal privacy regulations, whichever is more recent. Such an accounting will not include disclosures made to carry out treatment, payment or health care operations, to create an accurate patient directory or notify persons involved in your care, to ensure national security, to comply with the authorized requests of law enforcement, or to inform you of the content of your medical records, or those disclosures which you have previously authorized pursuant to a validly executed authorization form.

If you would like more information on how to exercise these rights, please contact Albemarle Hospital's Chief Privacy Officer at 252-384-4081.

A. The right to Get This Notice by E-Mail. You have the right to get a copy of this notice by e-mail. Even if you have agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice.

III. GRIEVANCES OR FURTHER INQUIRIES

If you believe that Albemarle Hospital has violated your privacy rights with respect to individually identifiable health information, you may file a complaint with Albemarle Hospital and the Department of Health and Human Services. To file a complaint with Albemarle Hospital, please contact the Privacy Officer at 252-384-4081. Albemarle Hospital will not retaliate against you for filing a complaint. You may also contact the above office for a copy of this Privacy Notice or for further information regarding its contents.

IV. AMENDMENTS

Albemarle Hospital reserves the right to amend the terms of this Privacy Notice at any time and to apply the revised Privacy Notice to all individually identifiable health information that it maintains. If Albemarle Hospital amends this Privacy Notice, you will be provided with a revised copy at your next visit to Albemarle Hospital, or upon request. The revised Privacy Notice will also be available on Albemarle Hospital's web site, www.albemarlehosp.org <http://www.albemarlehosp.org>.

V. ORGANIZED HEALTH CARE ARRANGEMENT

Albemarle Hospital, its current credentialed physicians, and its contract physicians, i.e. Albemarle Radiology LTD, Anesthesia Management Solutions LLC, Pathology Associates of Eastern North Carolina PLLC, and Emergency Medicine Physicians LTD, will maintain a joint Notice of Privacy Practices that covers treatment at Albemarle Hospital's facilities and treatment sites only. These covered entities agree to abide by the terms of this Notice. Protected Health Information will be shared between Albemarle Hospital and its current credentialed physicians and its contract physicians. Physicians who treat, diagnose or otherwise care for patients at Albemarle Hospital facilities and treatment sites are not employees or agents of the hospital and therefore Albemarle Hospital is not responsible for the care they render to patients. Physicians provide their services as independent contractors to Albemarle Hospital.

This Privacy Notice is effective on April 14, 2003.