Effective: 4/14/03

NOTICE OF PRIVACY PRACTICES

As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability
and Accountability Act of 1996 (HIPAA)

THIS NOTICE DESCRIBES HOW HEALTH
INFORMATION ABOUT YOU AS A PATIENT OF THE PENNSYLVANIA NEUROSURGERY AND NEURO-SCIENCE INSTITUTE, INC. MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR PROTECTED HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

A. OUR COMMITMENT TO YOUR PRIVACY

The Pennsylvania Neurosurgery and Neuroscience Institute, Inc. (PNNI) is dedicated to
maintaining the privacy of your protected health information (PHI). In conducting our business,
we will create records regarding you and the treatment and services we provide to you. We are
required by law to maintain the confidentiality of health information that identifies you. We also
are required by law to provide you with this notice of our legal duties and the privacy practices
that we maintain in our practice concerning your PHI. By federal and state law, we must follow
the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following
important information:
* How we may use and disclose your PHI
* Your privacy rights in your PHI
* Our obligations concerning the use and disclosure of your PHI

The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice of Privacy Practices in our offices in a visible location at all times, and you may request a copy of our most current Notice of Privacy Practices at any time.

B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Pennsylvania Neurosurgery and
Neuroscience Institute, Inc.

4310 Londonderry Road
Harrisburg, PA 17109
Attention: Privacy Officer

C. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your
PHI.

1. Treatment. PNNI may use your protected health information for our treatment purposes as well as the treatment purposes of other health care providers. Treatment includes the provision,
coordination, or management of healthcare services to you by one or more health care providers. Some examples of treatment uses and disclosures include:
* PNNI providers and staff – including, but not limited to, our doctors, physician assistants, medical assistants, practice manager, front office staff– may use and disclose your PHI with each other in order to treat you or to assist in your treatment.
* PNNI may use and disclose your PHI with an outside physician to whom we have referred you for care.
* PNNI may use and disclose your PHI with an outside physician with whom we are consulting regarding your care.
* PNNI may use and disclose your PHI with an outside laboratory, radiology center, or other health care facility where we have referred you for testing.
* PNNI may use and disclose your PHI with an outside home health agency, durable medical equipment agency or other health care provider to whom we have referred you for health cares services and products.
* PNNI may use and disclose your PHI with a hospital or other health care facility where we are admitting or treating you.
* PNNI may use and disclose your PHI with another health care provider who seeks this information for the purpose of treating you.

2. Payment. PNNI may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us or so that you may obtain reimbursement for that care, for example, from your health insurer. Some examples of payment uses and disclosures
include:
* PNNI and/or its billing service may use and disclose your PHI with your health insurer to determine whether you are eligible for coverage or whether proposed treatment is a covered service.
* PNNI and/or its billing service may use and disclose your PHI to submit a claim form to your health insurer.
* PNNI and/or its billing service may provide supplemental information to your health insurer so that your health insurer can obtain reimbursement from another health plan under a coordination of benefits clause in your subscriber agreement.
* PNNI and/or its billing service may use and disclose your PHI demographic information with other health care providers who seek this information to obtain payment for health care services provided to you.
* PNNI and/or its billing service may use and disclose your PHI to mail you bills in
envelopes with our practice name and return address.
* PNNI and/or its billing service may use and disclose your PHI to provide a bill to a family member or other person designated as responsible for payment for services rendered to you.
* PNNI and/or its billing service may use and disclose your PHI to your health insurer to support the medical necessity of a health service.
* PNNI may allow your health insurer access to your PHI for a medical necessity or quality review audit.
* PNNI may use and disclose your PHI to a billing agency, collection agency, or our attorney for purposes of securing payment of a delinquent account
* PNNI may use and disclose your PHI in a legal action for purposes of securing payment of a delinquent account.
* PNNI may use and disclose your PHI for claim payment information with a Human Resources representative from your employer if you have asked he or she to get involved on your behalf.

3. Health Care Operations. PNNI may use and disclose your PHI to operate our business as well as certain health care operation purposes of other health care providers and health plans. Some examples of health care operation purposes include:
* Quality assessment and improvement activities.
* Population based activities relating to improving health or reducing health care costs
* Accreditation, certification, licensing and credentialing activities.
* Health care fraud and abuse detection and compliance programs.
* Conducting other medical review, legal services, and auditing functions.
* Business planning and development activities, such as conducting cost management and planning related analyses.
* Sharing information regarding patients with entities that are interested in purchasing our practice and turning over patient records to entities that have purchased our practice.


D. USES AND DISCLOSURES FOR OTHER PURPOSES

1. Appointment Reminders. PNNI may use and disclose your PHI to contact you and remind
you of an appointment.

2. Treatment Options. PNNI may use and disclose your PHI to inform you of potential treatment options or alternatives.

3. Health-Related Benefits and Services. PNNI may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.

4. Release of Information to Family/Friends/Personal Representatives. PNNI may release your PHI to the extent necessary to obtain help from a family member, friend or other person that you indicate is involved in your care, or the payment for your health care, or who assists in
taking care of you. PNNI may disclose health information to your personal representative. Your
personal representative would be your legal guardian, someone who has power of attorney over
your health care decisions, or your parent if you are an unemancipated minor under the age of

18. A personal representative would also include an executor, or an administrator acting on
behalf of a deceased individual or the estate.

5. Disclosures Required By Law. PNNI will use and disclose your PHI when we are required
to do so by federal, state or local law.


E. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL
CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

1. Public Health Risks. PNNI may disclose your PHI to public health authorities that are
authorized by law to collect information for the purpose of:
* maintaining vital records, such as births and deaths.
* reporting child abuse or neglect,
* preventing or controlling disease, injury or disability.
* notifying a person regarding potential exposure to a communicable disease.
* notifying a person regarding a potential risk for spreading or contracting a disease or condition.
* reporting reactions to drugs or problems with products or devices.
* notifying individuals if a product or device they may be using has been recalled.
* notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
* notifying your employer under limited circumstances related primarily to workplace
injury or illness or medical surveillance.
* notifying appropriate government agency(ies) and authority(ies) regarding information on your medical treatment and response(s) to an investigational treatment or drug that you have received or may receive under a separate form of consent by you.
* OSHA requirements for workplace surveillance and injury reports.

2. Health Oversight Activities. PNNI may disclose your PHI to a health oversight agency for
activities authorized by law. Oversight activities can include, for example, investigations,
inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3. Lawsuits and Similar Proceedings. PNNI may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by
another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

4. Law Enforcement. PNNI may release PHI if asked to do so by a law enforcement official:
* Regarding a crime victim in certain situations, if we are unable to obtain the person’s
agreement.
* Concerning a death we believe has resulted from criminal conduct.
* Regarding criminal conduct at our offices.
* In response to a warrant, summons, court order, subpoena or similar legal process.
* To identify/locate a suspect, material witness, fugitive or missing person.
* In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).
* Comply with legal requirements ie: mandatory reporting of gun shot wounds.
5. Deceased Patients. PNNI may release PHI to a medical examiner or coroner to identify a
deceased individual or to identify the cause of death. If necessary, we also may release
information in order for funeral directors to perform their jobs.

6. Organ and Tissue Donation. PNNI may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

7. Research. PNNI may use and disclose your PHI for research purposes in certain limited
circumstances. We will obtain your written authorization to use your PHI for research purposes except when an IRB or Privacy Board has determined that the waiver of your authorization satisfies the following: (i) the use or disclosure involves no more than a minimal risk to the individual’s privacy based on the following: (A) an adequate plan to protect the identifiers from
improper use and disclosure; (B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the PHI.

8. Serious Threats to Health or Safety. PNNI may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another
individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

9. Military. PNNI may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

10. National Security. PNNI may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations such as medical suitability determinations for the Department of State.

11. Inmates. PNNI may disclose your PHI to correctional institutions or law enforcement
officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you,
(b) for the safety and security of the institution, and/or (c) to protect your health and safety or the
health and safety of other individuals.

12. Workers’ Compensation. PNNI may release your PHI for workers’ compensation and similar programs established by law, that provide benefits for work-related injuries or illness without regard to fault. This would include submitting a claim for payment to your employer’s workers’ compensation carrier if we treat you for a work-related injury.

13. Business Associates. Certain functions of the practice are performed by a business associate
such as a billing company, answering service, or a law firm. PNNI may use and disclose your
PHI to our business associates and allow them to create and receive PHI on our behalf. For example, we may share with our billing company information regarding your care and payment for your care so that the company can file health insurance claims and bill you or another responsible party.

14. Incidental Disclosures. We may disclose your PHI as by-product of an otherwise permitted
use for disclosure. For example, other patients may overhear your name being paged in the
waiting room.

F. YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding the PHI that we maintain about you:

1. Confidential Communications. You have the right to request that PNNI communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must complete a written Request for Confidential Communications form and send or deliver to Pennsylvania Neurosurgery and Neuroscience Institute, Inc., 4310 Londonderry Road, Harrisburg, PA 17109 Attention: Privacy Officer. This will specify the requested method of contact, or the location where you wish to be
contacted. Our practice will accommodate reasonable requests. You do not need to give a
reason for your request.

2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations. Additionally, you have the right to
request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to
agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In
order to request a restriction in our use or disclosure of your PHI, you must complete a written Request for Limitations and Restrictions of Protected Health Information form and send or
deliver to Pennsylvania Neurosurgery and Neuroscience Institute, Inc., 4310 Londonderry Road, Harrisburg, PA 17109 Attention: Privacy Officer. Your request must describe in a clear and
concise fashion:
(a) the information you wish restricted;
(b) whether you are requesting to limit our practice’s use, disclosure or both; and
(c) to whom you want the limits to apply.

3. Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that may
be used to make decisions about you, including patient medical records and billing records. In
order to inspect and/or obtain a copy of your PHI, you must complete a written Request to
Inspect and Copy Protected Health Information form and send or deliver to Pennsylvania
Neurosurgery and Neuroscience Institute, Inc., 4310 Londonderry Road, Harrisburg, PA 17109
Attention: Privacy Officer. PNNI may charge a fee for the costs of copying, mailing, labor and
supplies associated with your request. PNNI may deny your request to inspect and/or copy in
certain limited circumstances and you will receive a Patient Denial Letter to Inspect and Copy
Protected Health Information letter. However, you may request a review of our denial.
Another licensed health care professional chosen by us will conduct reviews.

4. Amendment. You may ask us to amend your health information if you believe it is incorrect
or incomplete, and you may request an amendment for as long as the information is kept by or
for our practice. To request an amendment, you must complete a written Request for
Correction/Amendment of Protected Health Information form and send or deliver to
Pennsylvania Neurosurgery and Neuroscience Institute, Inc., 4310 Londonderry Road,
Harrisburg, PA 17109 Attention: Privacy Officer. You must provide us with a reason that
supports your request for amendment. PNNI will deny your request if you fail to submit your
request (and the reason supporting your request) in writing. Also, we may deny your request if
you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of
the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to
inspect and copy; or (d) not created by our practice, unless the individual or entity that created
the information is not available to amend the information. PNNI will provide a written response
of acceptance or denial to your request.

5. Accounting of Disclosures. All of our patients have the right to request an “accounting of
disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our
practice has made of your PHI for non-treatment or operations purposes. Use of your PHI as part
of the routine patient care in our practice is not required to be documented. For example, the
doctor sharing information with PNNI staff; or the billing department using your information to
file your insurance claim. In order to obtain an accounting of disclosures, you must complete a
written Request for an Accounting of Certain Disclosures of Protected Health Information
for Non-TPO Purposes form and send or deliver to Pennsylvania Neurosurgery and
Neuroscience Institute, Inc., 4310 Londonderry Road, Harrisburg, PA 17109 Attention:
Privacy Officer. All requests for an “accounting of disclosures” must state a time period, which
may not be longer than six (6) years from the date of disclosure and may not include dates before
April 14, 2003. The first list you request within a 12-month period is free of charge, but our
practice may charge you for additional lists within the same 12-month period. Our practice will
notify you of the costs involved with additional requests, and you may withdraw your request
before you incur any costs.

6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our
Notice of Privacy Practices. You may ask us to give you a copy of this notice at any time. To
obtain a paper copy of this notice, contact Pennsylvania Neurosurgery and Neuroscience
Institute, Inc., 4310 Londonderry Road, Harrisburg, PA 17109 Attention: Privacy Officer

7. Right to File a Complaint. If you believe your privacy rights have been violated, you may
file a complaint with our practice or with the Secretary of the Department of Health and Human
Services. To file a complaint with PNNI, you must complete a written Patient Complaint
Form and send or deliver to Pennsylvania Neurosurgery and Neuroscience Institute, Inc., 4310
Londonderry Road, Harrisburg, PA 17109 Attention: Privacy Officer. You will not be
penalized for filing a complaint.

8. Right to Provide an Authorization for Other Uses and Disclosures. PNNI will obtain
your written authorization for uses and disclosures that are not identified by this notice or
permitted by applicable law. Any authorization you provide to us regarding the use and
disclosure of your PHI may be revoked at any time in writing. After you revoke your
authorization, we will no longer use or disclose your PHI for the reasons described in the
authorization. Please note, we are required to retain records of your care.


If you have any questions regarding this notice of our health information privacy policies, please contact:
Pennsylvania Neurosurgery and Neuroscience Institute, Inc.
4310 Londonderry Road
Harrisburg, PA 17109
Attention: Privacy Officer

Telephone (717) 920-PNNI (7664)
Toll Free: 1-888-920-4360