NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. This notice becomes effective April 14, 2003.

If you have any questions about this notice, please contact our Privacy Officer listed below:

Kathleen Norwood
Advanced Centre for Plastic Surgery
7300 Sandlake Commons Blvd., Suite 100
Orlando, FL 32819
407.345.8145
kitty@yournewlook.com

Our Pledge Regarding Health Information

As a patient of our practice, we are required to create and maintain a record of the care and services that you receive at our practice, and this includes medical information about you, your health and health status. All information obtained is personal, and we are committed to maintaining the confidentiality of this information as required by law. This notice describes how employees, other office personnel and other healthcare providers providing call coverage for Dr. Matas will handle your private information.

This notice advises you about the ways in which we may use and disclose medical information about you, and describes your rights and our obligations regarding the use and disclosure of that information. We are required to give you this notice by law, as well as to follow the terms described in this notice.

How We May Use and Disclose Health Information About You

We must have your signed consent to use and disclose health information for the following purposes:

Treatment
We may use medical information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurse technicians, office staff or other personnel who are involved in taking care of you and your health. For example, Dr. Matas may be evaluating you for a surgical procedure and may need to know if you have other health problems that could complicate your treatment. He may use your health history to decide what treatment is best for you. He may also tell another doctor about your condition in order to provide the most appropriate treatment for you. Different areas of the practice may also share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and mammograms. We also may disclose to people outside the practice who may be involved in your medical care after you leave our office, such as phoning in prescriptions to your pharmacy or scheduling outpatient testing. Family members or other healthcare providers may be part of your medical care outside this office and may require information about you in order to care for you properly.

Payment
We may use and disclose medical information about you so that the treatment and services that we provide you at our practice, at a hospital, ambulatory surgery center, nursing home or other site may be billed to and payment may be collected from you, your insurance company or a third-party. We may also advise your health insurance plan about a treatment you are going to have in order to obtain prior approval or to determine if your plan will cover the treatment.

Health Care Operations
We may use and disclose health information about you in order to run the office and make sure that you and our other patients receive quality care. For example, we may use your information to evaluate the performance of our staff in caring for you. We may also use information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient or whether certain new treatments are effective.

Appointment Reminders
We may use and disclose medical information in connection with our efforts to remind you that you have an appointment. For example, we may leave a reminder message on your answering machine in which other family members have access to hearing. Please notify us if you do not wish to be contacted for appointment reminders. If you advise us in writing (at the address listed at the top of this notice) that you do not wish to receive such communications, we will comply with your request.

Treatment Alternatives
We may tell you about or recommend alternative treatment options that may be of interest to you. For example, we may use your information to determine if you qualify for a nutritional or weight loss program.

Health-related Benefits and Services
We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

Ambulatory Surgery Center Registry
If your service is performed at an ambulatory surgery center that our practice uses, we may include certain limited information about you while you are a patient at the center. This information may include your name, your general condition and any information needed to register you as a patient at the facility.

Individuals Involved in Your Care or Payment for Your Care
We may release medical information about you to a friend or family member who is involved in your medical care, or to someone who helps pay for your care. For example, we may disclose information to a husband in order to collect for medical services prior to the procedure, or provide him with details of necessary care after your procedure.

Special Situations
Other permitted and required uses and disclosures that may be made without your consent, authorization or opportunity to object are listed below.

Emergencies
We may use or disclose your medical information when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person.

Communication Barriers
We may use and disclose your information if Dr. Matas attempts to obtain consent from you but is unable to do so due to substantial communication barriers and determines, using his professional judgment, that you intend to consent under the circumstances.

Coroners, Medical Examiners and Funeral Directors
We may release medical information to a coroner or medical examiner to identify a deceased person or to determine the cause of death.

Organ and Tissue Donation
If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation to an organ donation bank, as necessary, to facilitate such donation and transplantation.

As Required By Law

Research
We may use or disclose health information about you for research products that are subject to a special approval process. We will ask you for your permission if the researchers will have access to your name, address or other information that reveals who you are.

Military, Veterans, National Security and Intelligence
If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other governmental authorities to release health information about you. We may also release information about foreign military personnel to the appropriate foreign military authority.

Workers Compensation
We may release health information about you for workers' compensation or for application for benefits under the Family Medical Leave Act. These programs provide benefits for work-related injuries or illnesses.

Public Health Risks
We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability; or report birth defects, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications, or problems with products.

Legal Proceedings
If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court order, subpoena, warrant, summons, or similar process, subject to all applicable legal requirements.

Health Oversight Activities
We may disclose health information to a health oversight agency for audits, investigations, inspections or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the healthcare system, government programs and compliance with civil rights laws.

Information Not Personally Identifiable
We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.

Family and Friends
We may disclose health information about you to your family member or friends if we obtain your verbal agreement to do so, or if we give you an opportunity to object to such a disclosure and you do not raise an objection. Or, if we can infer from the circumstances, based on our professional judgment, that you would not object. For example, we may assume that you agree with our disclosure to your spouse when you bring your spouse with you into the exam room or while treatment options and details are discussed.

Other Uses and Disclosures of Health Information
We will not use or disclose your information for any purpose other than those identified in the previous sections without your specific, written Authorization. We must obtain your Authorization separate from any Consent we may have obtained from you. If you give us Authorization to disclose information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses already made with your permission. If we have HIV or substance abuse information about you, we cannot release that information without a special signed, written authorization (different from the Authorization and Consent mentioned above) from you. In order to disclose these types of records for purposes of treatment, payment or healthcare operations, we will have to have both your signed Consent and a special written Authorization that complies with the law governing HIV or substance abuse records.

Your Rights Regarding Medical Information About You

You have the following rights regarding medical information we maintain about you:

Right To Inspect and Copy
You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records and any other records that Dr. Matas and the practice use for making decisions about you. We may deny your request to inspect and copy in certain limited circumstances. Under federal law, you may not inspect or copy (1) psychotherapy notes; (2) information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; (3) medical information that is subject to law that prohibits access to medical information. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to our Privacy Contact. If you request a copy of the information, we may charge a fee as permitted by state law for the costs of copying, mailing or other supplies associated with your request.

Right to Amend
If you feel that medical information we have about you is incorrect or incomplete you have the right to request an amendment for as long as the information is maintained by the practice. Your request must be made in writing to our Privacy Contact and you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. To request an Amendment, complete and submit a Medical Record Amendment/Correction Form to designated Privacy Contact. We may deny your request to amend information that we did not create, unless the person or entity that created the information is no longer available to make the amendment, or it is not part of the health information that we keep.

Right to An Accounting of Disclosures
You have the right to request an "accounting of disclosures". This is a list of the disclosures we made about you for purposes other than treatment, payment and healthcare operations. To obtain this list, you must submit your request in writing to our Privacy Contact. It must state a time period, which may not be longer than (6) years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (paper or electronically). We may charge for the costs or providing the list. We will notify you of any cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend. For example, you could ask that we not use or disclose information about a procedure you had.

We Are Not Required to Agree to Your Request
If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you may complete and submit the Request for Restriction On Use/Disclosure of Medical Information to designated Privacy Contact.

Right to Request Confidential Communications
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you may request that we only contact you at work or by mail. To request confidential communications, you may complete and submit the Request For Restriction On Use/discloser of Medical Information and or Confidential Communication to Privacy Contact. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy. To obtain such a copy, contact the designated Privacy Contact.

Changes to This Notice

We reserve the right to change this notice, and to make revised or changed notice effective for medical information we already have about you a well as any information we receive in the future. We will post a summary of the current notice in the office with its effective date in the top right hand corner. You are entitled to a copy of the notice currently in effect.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact our designated Privacy Contact at the location below. You will not be penalized for filing a complaint.

Kathleen Norwood
Advanced Centre for Plastic Surgery
7300 Sandlake Commons Blvd., Suite 100
Orlando, FL 32819
407.345.8145
kitty@yournewlook.com