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.

Uses and Disclosures
Without your written authorization, we can use your health information for the following purposes:

• Treatment: Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of therapy evaluations and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.
• Payment: Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
• Health care operations: Your health information may be used to support the day-to-day activities and management of Lawrence Therapy Services LLC as necessary. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
• Law enforcement: Your health information may be disclosed to law enforcement agencies, to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting. This may also include reporting your information to national security or intelligence activities if you are involved with the military or to the proper authorities if you are an inmate in a correctional institution.
• Public health reporting: Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.
• Health Oversight Activities: We may disclose your health information to authorities so that they can monitor, investigate, inspect, or license those who work in the health care system or for government benefit programs.
• Appointment reminders: Your health information may be used by our staff to send you appointment reminders, which may be in the form of a message left over the phone either with an individual or on an answering machine or a written reminder sent through the mail.
• Information about treatments: Your health information may be used to send you information on the treatment and management of your medical condition. We may also send you a newsletter or information describing other health-related products and services that we believe may interest you.
• For workers' compensation:: Your health information may be disclosed to the appropriate persons in order to comply with the laws related to workers' compensation or other similar programs that may provide benefits for work-related injuries or illness.
• To those individuals involved with your care or payment of your care: We may release your health information to anyone helping care for you or helping you pay your medical bills. This may include but is not limited to family members, relatives, or close personal friends. You have the right to object to such disclosure, unless you are unable to function or there is an emergency. You may not; however, object to us giving health care information to your Durable Power of Attorney. In addition, we may release your health information to organizations authorized to handle disaster relief efforts so those who care for you can receive information about your location or health status. You may agree or disagree orally to such release, unless there is an emergency. We will give you enough information so that you can decide whether or not to object to the release of your health information to others involved with your care. Other uses and disclosures require your authorization: Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.

Individual Rights
You have certain rights under the federal privacy standards. These include:

• the right to request restrictions on the use and disclosure of your protected health information
• the right to receive confidential communications concerning your medical condition and treatment
• the right to inspect and copy your protected health information
• the right to amend or submit corrections to your protected health information
• the right to receive an accounting of how and to whom your protected health information has been disclosed
• the right to receive a printed copy of this notice

Lawrence Therapy Services LLC Duties
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices.

We also are required to abide by the privacy policies and practices that are outlined in this notice.

Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recent revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.

Requests to Inspect Protected Health Information
You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Receptionist or the Privacy Officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request. A fee applies if your request involves copying your protected health information.

Complaints
If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:

Lawrence Therapy Services LLC
Attn: Privacy Officer
2200 Harvard Rd, Suite 101
Lawrence, KS 66049
(785) 842-0656

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint.

Contact Person
If you have any further questions or concerns regarding our privacy practices, contact the Privacy Officer at the address listed above.

Effective Date
This Notice is effective on or after April 14, 2003.