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.

If you have any questions, please contact our Privacy Office at the address or phone number at the end of this notice.

Who will follow this notice?
Clinical Radiologists, S.C. (CRSC) provides health care to our patients. We provide these services together with other physicians, professionals and organizations. The information about privacy practices in this notice will be followed by:

• All employees of our organization, including our staff at our affiliate sites with whom we may share medical information.
• All business associates of CRSC with whom we share medical information.

Our pledge to you
We understand that medical information about you is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain, whether created by CRSC physicians and staff, other physicians or other health care professionals. These other physicians and health care professionals may have different policies or notices regarding their use and disclosure of medical information. We are required by law to:

• Keep medical information about you private.
• Give you this notice of our legal duties and privacy practices with respect to medical information about you.
• Follow the terms of the notice that are currently in effect.

Changes to this notice
We may change our policies at any time. Changes will apply to medical information we already hold, as well as medical information obtained after the change. If we make a significant change in our policies, we will change our notice and post the new notice in waiting areas (if applicable) and on our Web site (www.crscweb.com). You may request a copy of the current notice at any time. The effective date is listed just below the title.

How we may use and disclose medical information about you
We may use and disclose medical information about you for treatment (such as sending medical information about you to a health care facility or to another physician involved in your care); to obtain payment for treatment (such as sending billing information to your insurance company or Medicare); and to support our health care operations (such as comparing patient data to improve treatment methods).

We may use or disclose medical information about you without your prior authorization for several other reasons. Subject to certain requirements, we may give out medical information about you without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, research studies, funeral arrangements and organ donation, workers' compensation purposes, and emergencies. We also disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances, or in response to judicial or administrative orders.

We also may contact you for appointment reminders, or to tell you about or recommend possible treatment options, alternatives, health-related benefits or services that may be of interest to you, or to support fundraising or marketing efforts.

We may disclose medical information about you to a friend or family member who is involved in your medical care, or to disaster relief authorities so that your family can be notified of your location and condition. Our workers will use their professional judgment in determining what they disclose, and to whom, based on their evaluation of your best interests.

Other uses of medical information
In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision except to the extent that disclosures have already been made based upon your original authorization.

Your rights regarding medical information about you
In most cases, you have the right to look at or get a copy of medical information that we use to make decisions about your care, when you submit a written request. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.

If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we amend the records, by submitting a request in writing that provides your reason for requesting the amendment. We could deny your request to amend a record if the information was not created by us; if it is not part of the medical information maintained by us; or if we determine that record is accurate. You may appeal, in writing, a decision by us not to amend a record.

You have the right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, health care operations or where you specifically authorized a disclosure, when you submit a written request. The request must state the time period desired for the accounting, which must be less than a 6-year period and starting after April 14, 2003. You may receive the list in paper form. The first disclosure list request in a 12-month period is free; other requests may be subject to a fee. We will inform you of the cost before you incur any costs.

If this notice was sent to you electronically, you have the right to a paper copy of this notice.

You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you. We will accommodate all reasonable requests.

You may request, in writing, that we not use or disclose medical information about you for treatment, payment or health care operations or to persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will consider your request but we are not legally required to accept it. We will inform you of our decision on your request.

All written requests or appeals should be submitted to our Privacy Office listed later in this notice.

Complaints
If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Office (listed below).

Finally, you may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our Privacy Office can provide you the address.

You will not be penalized or retaliated against for filing a complaint.

Clinical Radiologists, S.C.
Privacy Office
701 N. First Street
Springfield, IL 62702
217-222-9302

Thank you for the opportunity to provide for your health care needs.