THIS NOTICE IS EFFECTIVE 01/01/2003 UNTIL FURTHER NOTICE.

RIGHT TO NOTICE As a patient you have the right to adequate notice of the uses and disclosure of your protected information. Under the Health Insurance Portability and Accesibility Act (HIPPA), Dr. Stephen M.Polakoff can use your protected health information for treatment, payment and health care operations. a) Treatment - We may use or disclose your health information to a physician or other healthcare provider providing treatment to you. b) Payment - We may use and disclose your health information to obtain payment for services we provide you. c) Health care operations - We may use and disclose your health information in connection with out healthcare operations. Healthcare operations include quality assessment and improvement activities, reviewing the competiency or qualificdations of healthcare professionals, evaluating provider performance, conducting training programs,acccreditation, certification, licensing or credentialing activities. Your Authorization Most uses and disclosures that do not fall under treatment, payment, health care operations will require your written authorization. Upon signing, you may revoke your authorization (in writing) through our practice at any time. Emergency Situations In the event of your incapacity or an emergency situation , we will disclose health information to a family member, or another person responsible for your care, using our professional judgement. We will only disclose health information that is directly relevant to the person's involvement in your healthcare. Marketing We will not use your health information for marketing communications with out your written authorization. Required by Law We may also use or disclose your health information when we are required to do so by law. Abuse or Neglect We may disclose your health information to apppropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence or a victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your or other people's health or safety. National Security We may disclose the health information of Armed Forces personnel to military authorities under cetaian circumstances. We may disclose health information to authorized federal officials required for lawful intelligence, counterintelligence and other national security activities. We may disclose health information of inmates or patients to the appropriate quthorities under certain circumstances.

Your Rights as a Patient You have the right to restrict the dicslosure of your information (in writing). You have the right to inspect and copy your protected health information. You have the right to receive an accout of disclosures of your protected health information. You have the right to amend your protected health information.

Legal Requirements Dr. Stephen Polakoff is required by law to maintain the privacy of your protected health information. We are required to abide by the terms of this notice as it is currently stated, and reserve the right to change this notice. The policies in any new notice will not be in effect until they are posted to this site, or are avaible within our office.

Complaints If you have any complaints regarding the way your protected health informatin was handled, you may submit complaint in writing to our office. You will not be retaliated against in any manner for a complaint.

Contact Information For further information about Dr. Polakoff's privacy polocies, please contact Dr.Polakoff at 413 S. Camp Meade Road Linticum, Maryland 21090 410-859-3111 410-336-3676 fax:410-859-8222

You have the right to a paper copy of this notice of privacy polocies.