Common use of Right to an Accounting of Disclosures Clause in Contracts

Right to an Accounting of Disclosures. You have a right to request and receive a list of certain disclosures we have made of your protected health information. Your written request must state a time period that may not be longer than the six years prior to the date on which the accounting is requested. The accounting will identify the other persons or entities to which we have disclosed your personal health information. Any accounting includes only disclosures, and will not include uses of your information. In addition, we are not required to provide an accounting of the following disclosures:  Disclosures made to carry out treatment, payment and health care operations;  Disclosures we made to you or your personal representative;  Disclosures we made after obtaining your written authorization;  Disclosures made from the patient directory or to persons involved in your care or other notification purposes as provided for under federal law;  Disclosures that were incidental to permissible uses and disclosures of your health information;  Disclosures for purposes of research, public health or our business operations where your protected health information has been partially de-identified so that it does not directly identify you;  Disclosures for national security or intelligence purposes;  Disclosures to correctional institutions or law enforcement officers about individuals in their lawful custody;  Disclosures that are part of a limited data set. To request an accounting of disclosures, please submit a written request to USFPG Clinical Operations Health Information Management at the address listed at the end of this Notice. You have a right to receive one accounting within every 12- month period at no cost. If you request a second accounting within that 12-month period, we may charge you for the cost of compiling the accounting. 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. Ordinarily we will respond to your request for an accounting within 60 days. If we need additional time to prepare the accounting, we will notify you in writing about the reason for the delay and the date when you can expect to receive the accounting. We may delay providing you with an accounting without notifying you if a law enforcement official or government agency asks us to do so. Right to Request Additional Privacy Protections. You have the right to request that we further restrict the way we use and disclose your health information to treat your condition, collect payment for that treatment, or conduct our or another health care entity’s business operations. You may also request that we limit how we disclose information about you to persons involved in your care. To request a restriction, please write to the USFPG Clinical Operations Health Information Management address listed at the end of this Notice. We are not required to agree to your request for a restriction, and in some cases the restriction you request may not be permitted under law. Once we have agreed to a restriction, you have the right to revoke the restriction at any time. Under some circumstances, we will also have the right to revoke the restriction, after notifying you. If we do agree to your requested restriction, we will comply with your request unless the information is needed to provide you with emergency treatment or we are required or permitted by law to disclose. If you have paid out of pocket and the information pertains solely to a health care item or service, you may request that your personal health information not be disclosed to a health plan for purposes of payment or health care operations.

Right to an Accounting of Disclosures. You have a the right to request and receive one free “accounting of disclosures” every 12 months. This is a list of certain disclosures we have made of your protected health medical information. Your written request must state a time period There are several categories of disclosures that may not be longer than the six years prior to the date on which the accounting is requested. The accounting will identify the other persons or entities to which we have disclosed your personal health information. Any accounting includes only disclosures, and will not include uses of your information. In addition, we are not required to provide an accounting list in the accounting. For example, we do not have to keep track of the following disclosures:  Disclosures made to carry out treatment, payment and health care operations;  Disclosures we made to you or your personal representative;  Disclosures we made after obtaining your written authorization;  Disclosures made from the patient directory or to persons involved in your care or other notification purposes as provided for under federal law;  Disclosures that were incidental to permissible uses and disclosures of your health information;  Disclosures for purposes of research, public health or our business operations where your protected health information has been partially de-identified so that it does not directly identify you;  Disclosures for national security or intelligence purposes;  Disclosures to correctional institutions or law enforcement officers about individuals in their lawful custody;  Disclosures that are part of a limited data setauthorized. To Your request an accounting of disclosuresmust stateatimeperiod,whichmaynotbelonger than6yearsandmaynotinclude dates before April 14, please submit a written request to USFPG Clinical Operations Health Information Management at the address listed at the end of this Notice. You have a right to receive one accounting within every 12- month period at no cost2003. If you request more than one accounting in a second accounting within that 12-month period, we may charge you for the cost costs of compiling providing the accountinglist. We will notify you of the cost involved, involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Ordinarily we will respond to In your request for an accounting within 60 days. If we need additional time to prepare the accountingrequest, we will notify you in writing about the reason for the delay must indicate: • The type of restriction you want and the date when information you can expect want restricted; and • Towhom you want the limits to receive the accountingapply, for example, your spouse. We may delay providing you with an accounting without notifying you if a law enforcement official or government agency asks us to do so. Right to Request Additional Privacy Protections. You have Rightto RequestConfidentialCommunications.Youhave the right to request that we further restrict the communicate with you about medical matters in a certain way we use and disclose your health information to treat your condition, collect payment for that treatment, oratacertainlocation. For example,youcanask thatwe only contact youat work or conduct our or another health care entity’s business operations. You may also request that we limit how we disclose information about you to persons involved in your care. To request a restriction, please write to the USFPG Clinical Operations Health Information Management address listed at the end of this Noticeby mail. We are not required will accommodate all reasonable requests. Your request must specify how or where you wish to agree to your request for a restriction, and in some cases the restriction you request may not be permitted under lawcontacted. Once we have agreed to a restriction, you have Right toa PaperCopyof ThisNotice. Youhave the right to revoke the restriction a papercopy of this notice. Copies of this notice always will be available in our medical record department. Can you change this notice? Wereservetherighttochange thisnotice. Wereservetherighttomakethe revisedorchangednoticeeffectiveformedicalinformationwealreadyhave about youaswell asany information we receiveinthe future. Copies ofthe current notice will be posted at any timeNRHS and will be available for you to pick up on each visit to NRHS. Under some circumstances, we will also have the right to revoke the restriction, after notifying you. If we do agree to your requested restriction, we will comply with your request unless the What happens if my medical information is needed used by or disclosed to a person or entity that should not have access to it? Wearerequiredtonotify youofanyacquisition,access, use,or disclosure of your medical information that is inconsistent with the federal law governing the protection of medical information (known has HIPAA). WhatifIhavequestionsorneedtoreportaproblem? Ifyoubelieveyourprivacyrightshavebeenviolated,youmayfileacomplaint with us or with the Office of Civil Rights of the Department of Health and Human Services. To file a complaint with us, or if you would like more information about ourprivacy practices, contact NRHS’sPrivacyOfficerat(405) 307-1405or by mail at 000 X Xxxxxx Xxx, Norman, OK 73071. Tofile a complaint with the Office of Civil Rights of the Department of Health and Human Services, you must submit the complaint within 180 days of when you knew or should have known of the circumstance that led to the complaint. The complaint must be submitted inwriting.InformationonhowtofileacomplaintcanbelocatedontheOffice of Civil Rights website at: xxxx://xxx.xxx.xxx/ocr/privacy/index.html or our Privacy Official can provide you with emergency treatment or we are required or permitted by law to disclosecurrent contact information. If you have paid out of pocket and the information pertains solely to a health care item or service, you may request that your personal health information You will not be disclosed to penalized for filing a health plan for purposes of payment or health care operationscomplaint.

Right to an Accounting of Disclosures. You have a the right to request and receive a list of certain the disclosures we have made of Protected Health Information about you. This list will not include disclosures made for treatment, payment, health care operations, for purposes of national security, made to law enforcement or to corrections personnel, or made pursuant to your protected health informationauthorization or made directly to you. To request this list you must submit your request in writing to the applicable administrator listed above. Your written request must state a the time period that from which you want to receive a list of disclosures. The time period may not be longer than the 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 or electronically). We will respond to your request for an accounting within 60 days after receipt unless we notify you in writing prior to the expiration of the 60-day period why we are unable to respond within that time frame and specify the date on which the accounting is requestedwe will respond, which will not be later than 90 days after receipt of your request. The accounting will identify the other persons or entities to which we have disclosed your personal health information. Any accounting includes only disclosures, and will not include uses of your information. In addition, we are not required to provide an accounting of the following disclosures:  Disclosures made to carry out treatment, payment and health care operations;  Disclosures we made to you or your personal representative;  Disclosures we made after obtaining your written authorization;  Disclosures made from the patient directory or to persons involved in your care or other notification purposes as provided for under federal law;  Disclosures that were incidental to permissible uses and disclosures of your health information;  Disclosures for purposes of research, public health or our business operations where your protected health information has been partially de-identified so that it does not directly identify you;  Disclosures for national security or intelligence purposes;  Disclosures to correctional institutions or law enforcement officers about individuals in their lawful custody;  Disclosures that are part of a limited data set. To request an accounting of disclosures, please submit a written request to USFPG Clinical Operations Health Information Management at the address listed at the end of this Notice. You have a right to receive one accounting within every 12- month period at no cost. If first list you request within a second accounting within that 12-month period, we period will be free. We may charge you for the cost of compiling the accountingresponding to any additional requests. We will notify you of the cost involved, involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Ordinarily we will respond to your request for an accounting within 60 days. If we need additional time to prepare the accounting, we will notify you in writing about the reason for the delay and the date when you can expect to receive the accounting. We may delay providing you with an accounting without notifying you if a law enforcement official or government agency asks us to do so. • Right to Request Additional Privacy ProtectionsRestrictions. You have the right to request a restriction or limitation on Protected Health Information we use of disclose about you for treatment, payment or health care operations, or that we further restrict the way we use and disclose your health information to treat your condition, collect payment for that treatment, or conduct our or another health care entity’s business operations. You someone who may also request that we limit how we disclose information about you to persons be involved in your care or payment for your care, like a family member or friend. To request a restrictionWhile we will consider your request, please write to the USFPG Clinical Operations Health Information Management address listed at the end of this Notice. We we are not required to agree to your request for it in all circumstances, except in the case of a restriction, and in some cases the restriction you request may not be permitted under law. Once we have agreed disclosure restricted to a restriction, you have health plan if the right to revoke disclosure is for the restriction at any time. Under some circumstances, we will also have the right to revoke the restriction, after notifying you. If we do agree to your requested restriction, we will comply with your request unless the information purpose of carrying out payment or health care operations and is needed to provide you with emergency treatment or we are not otherwise required or permitted by law to disclose. If you have paid out of pocket law; and the information Protected Health Information pertains solely to a health care item or serviceservice for which you, or the person other than the health plan on your behalf, has paid the covered entity in full. If we do agree to it, we will comply with your request. To request a restriction, you may must make your request in writing to the applicable administrator listed above. 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 or parent). We will not agree to restrictions on Protected Health Information uses or disclosures that your personal health information not be disclosed are legally required, or which are necessary to a health plan for purposes of payment or health care operationsadminister our business.