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.

Wuesthoff Health System (Wuesthoff) considers health information to be confidential. We protect the privacy of our patient health information in accordance with federal and state privacy laws, as well as our own privacy policies.

We have prepared this notice of our privacy practices for patients of Wuesthoff Medical Center-Rockledge, Wuesthoff Medical Center-Melbourne and all of our affiliated entities. This notice describes how we may use and disclose information about you in administering your health care, and it explains your legal rights regarding the information.

Wuesthoff, members of its Medical Staff, and other health care providers affiliated with Wuesthoff typically work together in a clinically integrated setting to provide you with health care, and may share information for treatment, payment and health care operations. In such settings the federal Privacy Rule permits the use of a single Notice of Privacy Practices to describe how Wuesthoff, Medical Staff members, and other health care providers affiliated with Wuesthoff will use or disclose your health information. This Notice applies only to the care provided to you within the Wuesthoff Health System and which is reflected in the medical records maintained by the System.

When we use the term "health information" we mean information that identifies you and relates to your medical history (e.g., the health care you receive or the amounts paid for that care).

Uses and Disclosures of Protected Health Information

We use health information about you for treatment, to obtain payment for treatment, and for health care operations.

Treatment: We may disclose health information to doctors, dentists, pharmacies, hospitals and other health care providers who provide care to you. For example, your treating doctors may request medical information from us to supplement their own medical records. We may also send certain information to doctors or for other treatment-related reasons. We may also disclose health information about you for the purpose of treatment alternatives and treatment reminders.

Payment: We may use and disclose your health information in a number of ways, including utilization and medical necessity reviews; coordination of care; determination of eligibility; collection of payment; calculation of cost-sharing amounts; and responding to complaints, grievances and requests for external review. For example, we may use your health information to decide if a particular treatment is medically necessary and how the treatment should be billed. During this process, we may disclose information to your provider.

Health Care Operations: We may use and disclose health information during the normal course of our business. This includes operational activities such as quality assessment and improvement, accreditation by independent organizations, outcomes management, health services research, preventative health, disease management and care coordination. For example, we may use the information to provide information concerning disease management programs for our patients with specific conditions, such as diabetes, asthma or heart failure. Other operational activities requiring the use and disclosure of health information include administration of insurance, underwriting and rating, fraud investigations, facilitation of sale, transfer, merger or consolidation of all or part of Wuesthoff with another entity, and other general administrative activities, including data and information systems management, and customer service (e.g. health related benefits and services).

Other Reasons for Disclosure. We may also disclose such information for the following reasons:

• Research - to researchers, provided measures are taken to protect your privacy.
  
  
• Legal/Regulatory - to various governmental agencies that regulate the provision of health care services, e.g., Agency for Health Care Administration, Centers for Medicare and Medicaid Services, Office of Inspector General, Department of Children and Families and the like. Health information may be released to federal, state or local law enforcement officials or in response to a subpoena, court order or other legal proceeding or for matters of public interest as required or permitted by law (e.g., child abuse and neglect, threats to public health and safety, and national security).
  
  
• Hospital Directories - Unless you object, we will use and disclose in our hospital directory while you are an inpatient your name, the location at which you are receiving care, your condition (in general terms), and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name. Members of clergy will be told your religious affiliation.
  
  If you do not wish for this information to be available in our hospital directory, please indicate your preference on the "Patient Acknowledgment of Receipt of Provider Notice of Privacy Practices". If you elect to "opt out" of the directory, we will not inform your family or friends of your presence in the hospital, which means that you will not receive phone calls, visits or flowers while you are in the hospital. You may choose to disclose your hospital admission (including room number) to those you wish to know of your admission.
  
  If you choose to "opt out" after your admission, please notify our Privacy Officer, in writing, at 110 Longwood Avenue, Mailstop #28, Rockledge, Florida 32955. Your election will be processed within two (2) business days after receipt.
  
  
• Fundraising - Wuesthoff or its affiliates, including Wuesthoff Health System Foundation, may use certain information (name, address, telephone number, dates of service, age, and gender) to contact you in the future to raise money. The money raised will be used to expand and improve the services and programs we provide the community. If you do not wish to be contacted for our fundraising efforts, please notify Wuesthoff Health System Foundation, P.O. Box 565002, Rockledge, Florida 32955, in writing.
  
  
• Wuesthoff may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Wuesthoff may disclose information about your health care to a relative, a friend, any other person identified by you to receive your health information, provided that the information is directly relevant to that person's involvement with your health care.

In any other situation, you will be asked for your written consent or authorization before using or disclosing any protected health information about you. If you choose to sign an authorization, you can later revoke that authorization to stop any future uses or disclosures.

Individual Rights. You have the right to:

• In most cases, look at or get a copy of your information (If you request copies, there is a charge pursuant to Section 395.3025, Florida Statutes).
  
  
• If you are a minor, you may have the right to block parental access to your health information as permitted by Florida law. ¨ Receive a list of those to whom we have disclosed information about you for reasons other than treatment, payment or health care operations.
  
  
• Request that we correct existing information if you believe that information in your record is incorrect or important information is missing.
  
  
• Request, in writing, that we be restricted to the use your protected health information for the purposes of treatment, payment or health care operations unless otherwise specifically authorized by you, when required by law or in emergency circumstances. (Please note that while we will consider your request, we are not required to grant it).
  
  
• Request receipt of confidential communications of protected health information as provided by law.
  
  
• Request a copy of this Notice in paper format.

If you are concerned that we have violated your privacy rights, or you disagree with a decision made regarding access to your information, you may contact our Privacy Officer at 321-637-2831. You may also send a written complaint to the U.S. Department of Health and Human Services. No person will be negatively affected by filing a complaint.

This Notice is Subject to Change

We may change our policies at any time. Before we make a significant change in our policies, we will change this Notice and post it at our registration area(s) or in the waiting area. For more information about our privacy practices, please contact our Privacy Officer.

Our Legal Duty

This Notice is effective as of April 14, 2003. We are required by law to protect the privacy of your health information, provide this Notice about our information practices, and follow the practices described. We are required to follow the terms of the Notice currently in effect.

If you have any questions regarding this Notice, please contact the Director of Health Information Management/Privacy Officer at 321-637-2831, 110 Longwood Avenue, Rockledge, Florida 32955.