Leonard J. Swinyer, M.D., P.C.
3920 South 1100 East #310
Salt Lake City, UT 84124

NOTICE OF PRIVACY PRACTICES

This Notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Introduction. Leonard J. Swinyer, M.D, P.C. is a private medical practice with a focus on dermatology, which includes diseases of the skin, hair and nails. Our practice involves diagnosis and treatment of all such diseases, including surgery of the skin and minor cosmetic procedures such as the injection of collagen.

When you become a patient of Leonard J. Swinyer, M.D. or his associate practitioners you provide us with information about you and your health which is used to create a medical record. Your medical record is the information that we use to plan your care, provide treatment and receive payment for our services. It is important for you to understand that your health record contains personal health information that is protected by federal and state laws.

Our Responsibilities. Leonard J. Swinyer, M.D., P.C. is required to maintain the privacy of your personal health information and to provide you with a notice about our legal duties and privacy practices with respect to your personal health information. We are also required to accommodate reasonable requests that you make to communicate personal health information by alternative means or at alternative locations. Any time we use or disclose your personal health information, we must follow the terms of this Notice (or other Notices as may be in effect at that time).

How We Use And Disclose Your Protected Health Information.

# Uses and Disclosures for Treatment, Payment and Health Care Operations . After making a good faith effort to provide you with this Notice, we may use your personal health information to provide your treatment, to obtain payment for your treatment, for our internal health care operations, and other reasons as listed. We may use and disclose your personal health information for such purposes in the following ways:

(1) For Treatment. We may use and disclose your personal health information to plan, provide and coordinate your health care services. For example, we may send a letter to your primary care physician or referral doctor regarding your diagnosis and treatment.

(2) For Payment. We may use and disclose your personal health information to obtain payment from you, your insurance company, or other third party. We may also contact your insurance company to verify coverage for your care or notify them of upcoming services that may need prior notice or approval. For example, we may disclose information about the services provided to you to claim and obtain payment from your insurance company.

(3) For Health Care Operations. We may use or disclose your protected health information for our health care operations. For example, we may use or disclose your personal health information to perform risk assessments and other administrative tasks to monitor the quality of care that we provide.

(4) Other Uses of Your Health Information We may also use your health information to:

• Recommend treatment alternatives;
• Tell you about health services and products that may benefit you;
• Share information with family or friends involved in your care or payment for your care, when appropriate;
• Share information with third parties who assist us with treatment, payment, and health care operations. Our business associates must protectyour information by following our privacy practices;
• Remind you of an appointment.

Sharing Your Health Information There are limited situations when we are permitted or required to disclose health information without your signed authorization. These situations are:

• For public health purposes such as reporting communicable diseases, work-related illness, or other diseases and injuries permitted by law; reporting births and deaths; and reporting reactions to drugs and problems with medical devices;
• To protect victims of abuse, neglect, or domestic violence;
• For health oversight activities such as investigations, audits, and inspections;
• For law enforcement purposes;
• For lawsuits and similar proceedings;
• When otherwise required by law;
• When requested by law enforcement as required by law or court order;
• To coroners, medical examiners, and funeral directors;
• For organ and tissue donation;
• For research under strict federal guidelines;
• To reduce or prevent a serious threat to public health and safety;
• For workers’ compensation or similar programs if you are injured and work; and
• For specialized government functions such as intelligence and national security.
   
• All other uses and disclosures not described in this notice require your signed authorization. You may revoke your authorization at any time with a written statement (with limited exceptions as provided by federal regulations.
   
• Your Rights. You have the right to do the following:
   
• # Right to Receive Further Information. You have the right to contact our office if you want additional information about our privacy practices, your privacy rights, or disagree about a decision we made about your personal health information, or if you believe that your privacy rights have been violated.
   
• # Right to Inspect and Copy Your Health Information . Upon written request, you have the right to access and obtain a copy of your health information maintained by us. Fees may apply. Under limited circumstances we may deny you access to a portion of your health information, and you may request a review of this denial.
   
• # Right to Request Amendment Your Health Information . You have the right to request in writing that we amend health information maintained in your health record. We will comply with your request only if we determine the information you wish to amend is false, inaccurate or misleading.
  
• # Right to Request Additional Restrictions on Uses and Disclosures of Your Health Information . You have the right to request in writing that we place additional restrictions on how we use or disclosure your personal health information. While we will consider any request for additional restrictions, we are not required to agree to your request.
   
• # Right to Request an Accounting of Disclosures . You have a right to request in writing a record of whom we have released your personal health information to. The record will include the date the information was released, to whom, and a brief statement of the reason for the disclosure. The accounting does not include disclosures made for treatment, payment, and health care operations, and some disclosures required by law. Your request must state the period of time desired for accounting which must be within the six years prior to your request and exclude dates prior to April 14, 2003. The first accounting is free but a fee will apply if more than one request is made in a 12-month period.
  
• # Right to Request Confidentiality in Certain Communications . You have the right to request to receive your health information by alternative means of communication or at alternative locations. We will accommodate any such reasonable written request made on your behalf.
  
• Right to Request a Paper Copy. You have the right to request a paper copy of this notices even if you have already received it electronically.
  
• # Right to File a Complaint . If you believe your privacy rights have been violated, in addition to filing a complaint with us, you have the right to file a written complaint with the Office of Civil Rights of the United States Department of Health and Human Services. Upon request, the Privacy Officer will provide you with the information needed to file your complaint. Under no circumstances will we retaliate against you for filing a complaint with us or the Office of Civil Rights.
  
• Changes to Notice. We reserve the right to change our privacy practices and to alter this Notice according to those changes. In the event that our Notice changes, we give you a copy of our revised notice at your next office visit.
  
• Privacy Officer. To contact our Privacy Officer, please address all requests to Leonard J. Swinyer, M.D, P.C., 3920 South 1100 East #310, Salt Lake City, UT 84124 ATTN: Privacy Officer. The privacy officer can also be reached by phone at (801) 266-8841 or by email at privacyofficer@lswinyer.com. The privacy officer can assist you with any questions or concerns you may have regarding our privacy practices.
   
• Effective Date of this Notice. This Notice is effective as of February 1, 2005. For new patients after February 1, 2005 the effective date is the first date of service as noted in the medical record.