NOTICE OF PRIVACY PRACTICES

! NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW HEALH CARE INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Intrductin This Ntice f Privacy Practices describes the privacy practices f Beacn Orthpaedics & Sprts Medicine, Ltd. and Beacn Orthpaedics Surgery Center, LLC ( Beacn r we ). This Ntice applies when services are prvided within Beacn s facilities, and/r when Beacn s physicians are acting as part f ne r mre f the jint arrangements described belw. This Ntice als: describes yur rights and ur bligatins fr using yur health infrmatin, infrms yu abut laws that prvide special prtectins, explains hw yur prtected health infrmatin is used and hw, under certain circumstances, it may be disclsed and tells yu hw changes in this Ntice will be made available t yu. We are required by law t prtect the privacy f yur infrmatin, t prvide this Ntice abut ur privacy practices, and t fllw the privacy practices that are described in this Ntice. Prtected Health Infrmatin This Ntice applies t health infrmatin created r received by the physicians and staff at Beacn that identifies yu and that relates t yur past, present r future physical r mental cnditin; the care prvided; r the past, present r future payment fr yur health care. Fr example, yur prtected health infrmatin includes yur symptms, test results, diagnses, treatment, health infrmatin frm ther prviders, and billing and payment infrmatin relating t these services. Use and Disclsure f Yur Prtected Health Infrmatin Withut Yur Authrizatin

Here are sme examples f hw we may use and disclse prtected health infrmatin withut yur authrizatin (a written dcument that gives us permissin t share yur health infrmatin). Treatment. We use and disclse yur health infrmatin t prvide treatment. Fr example: Yur physician uses yur infrmatin t find ut whether certain tests, therapies, and medicines shuld be rdered and whether, and which, surgery shuld be perfrmed. Nurses and ther nn-physician health care prviders (physical therapists, fr example) may need t knw and/r discuss yur health prblems t care fr yu and t understand hw t evaluate yur respnse t treatment. We may disclse yur health infrmatin t anther ne f yur treatment prviders. Physicians and hspitals in the Greater Cincinnati area exchange health infrmatin with ne anther thrugh HealthBridge, a nnprfit rganizatin that serves as a health care clearinghuse, in rder t assure that data cllected abut the patient at a participating hspital r health care prvider is prvided t the patient s treating physician. Payment. We may use and disclse yur health infrmatin fr payment purpses. Fr example: We may use it t prepare claims fr payment f services. If yu have health insurance and we bill yur insurance directly, we will include infrmatin that identifies yu, as well as yur diagnsis, the prcedures perfrmed, and supplies used s that we can be paid fr the treatment prvided. Health Care Operatins. We may use and disclse yur health infrmatin t carry ut health care peratins. Fr example, we use and disclse it t mnitr and imprve ur health services. Als, authrized staff may lk at prtins f yur recrd t perfrm administrative activities. We may als use a sign in sheet at the registratin desk, as well as call yu by name in the waiting rm when yur physician is ready t see yu. Train Staff and Students. We may use and disclse yur infrmatin t teach and train staff and students. One example f this is when teaching physicians review patient health infrmatin with medical and ther health care studies students. Cnduct Research. We may use and disclse yur infrmatin fr research. An Institutinal Review Bard (IRB) may review each request t use r disclse it. The IRB reviews research t make sure that the rights, safety, and welfare f research subjects and their infrmatin are prtected. In sme cases, yur infrmatin might be used r disclsed fr research withut yur cnsent. Fr example, we might lk at medical charts t see if peple wh wear bicycle

helmets get fewer injuries. We might use sme f yur infrmatin t decide if we have enugh patients t cnduct an rthpaedic research study. We might include yur infrmatin in a research database. In these cases, the IRB makes sure that using infrmatin withut yur authrizatin is justified. The IRB makes sure that steps are taken t limit its use. In all ther cases, we must btain yur authrizatin t use r disclse yur infrmatin fr a research prject. We may share infrmatin abut yu used fr research with researchers at ther institutins. Cntact Yu fr Infrmatin. We may cntact yu by mail r telephne fr the purpse f reminding yu abut an appintment, the need t change an appintment, return yur phne call, prvide test results, infrm yu abut treatment ptins r advise yu abut ther health-related benefits and services. We may leave a message at the number yu prvided t us. Jint Activities. Yur health infrmatin may be used and shared by Beacn and ther health care prviders in the Greater Cincinnati area t further their jint activities and with ther individuals r rganizatins that engage in jint treatment, payment r health care peratinal activities with Beacn. Health infrmatin is shared when necessary t prvide clinical care services, secure payment fr clinical care services, and perfrm ther jint health care peratins such as peer review and quality imprvement activities, and accreditatin related activities. Business Assciates. Yur health infrmatin may be used by Beacn and disclsed t individuals r rganizatins that assist Beacn r t cmply with its legal bligatins as described in this Ntice. Fr example, we may disclse infrmatin t cnsultants wh assist us in ur business activities. These business assciates must agree t prtect the cnfidentiality f yur infrmatin. Other Uses and Disclsures. We als use and disclse yur infrmatin t enhance health care services, prtect patient safety, safeguard public health, ensure that ur facilities and staff cmply with gvernment and accreditatin standards, and when therwise allwed by law. Fr example, we prvide r disclse infrmatin: Abut FDA-regulated drugs and devices t the U.S. Fd and Drug Administratin. T gvernment versight agencies with data fr health versight activities such as auditing r licensure. T public health authrities with infrmatin n cmmunicable diseases and vital recrds.

T yur emplyer, findings relating t the medical surveillance f the wrkplace r evaluatin f wrk-related illnesses r injuries. T wrkers cmpensatin agencies and self-insured emplyers fr wrk-related illness r injuries. T apprpriate gvernment agencies when we suspect abuse r neglect. T apprpriate agencies r persns when we believe it necessary t avid a serius threat t health r safety r t prevent serius harm. T rgan prcurement rganizatins t crdinate rgan dnatin activities. T law enfrcement when required r allwed by law. Fr curt rder r lawful subpena. T crners, medical examiners and funeral directrs. T gvernment fficials when required fr specifically identified functins such as natinal security. When therwise required by law, such as t the Secretary f the United States Department f Health and Human Services fr purpses f determining cmpliance with ur bligatins t prtect the privacy f yur health infrmatin. If yu are a member f the armed frces, we may release medical infrmatin abut yu as required by military cmmand authrities. We may als release medical infrmatin abut freign military persnnel t the apprpriate freign military authrity. If yu are an inmate at a crrectinal institutin r under the custdy f a law enfrcement fficial, we may disclse yur PHI t the crrectinal institutin r the law enfrcement fficial. Use and Disclsure When Yu Have the Opprtunity t Object Disclsure t and Ntificatin f Family, Friends r Others. Unless yu bject, yur health care prvider will use his r her prfessinal judgment t prvide relevant prtected health infrmatin t yur family member, friend r anther persn. This persn wuld be smene that yu indicate has an active interest in yur care r the payment fr yur health care r wh may need t ntify thers abut yur lcatin, general cnditin r death. Disclsure fr Disaster Relief Purpses. We may disclse yur lcatin and general cnditin t a public r private entity (such as FEMA r the Red Crss) authrized by law t assist in disaster relief effrts.

Use and Disclsure Requiring Yur Authrizatin Other than the uses and disclsures described abve, we will nt use r disclse yur prtected health infrmatin withut yur written authrizatin. Uses and disclsures f yur infrmatin fr marketing purpses and disclsures that cnstitute a sale f yur infrmatin als require yur authrizatin. If yu prvide us with written authrizatin, yu may revke it at any time unless disclsure is required fr us t btain payment fr services already prvided r the law prhibits revcatin. We cannt take back any uses r disclsures already made with said authrizatin. Additinal Prtectin f Yur Prtected Health Infrmatin Special state and federal laws apply t certain classes f patient health infrmatin. Fr example, additinal prtectins may apply t infrmatin abut sexually transmitted diseases, drug and alchl abuse treatment recrds, mental health recrds, and HIV/AIDS infrmatin. When required by law, we will btain yur authrizatin befre releasing this type f infrmatin. Yur Individual Rights Regarding Prtected Health Infrmatin Yu have rights related t the use and disclsure f yur prtected health infrmatin. T exercise any f the rights listed belw, yu may cntact: Privacy Officer Beacn Orthpaedics & Sprts Medicine, Ltd. 500 E Business Way, Suite A Cincinnati OH 45241 Business Phne: (513) 354-3700 Yur specific rights are listed belw: The right t request restricted use: Yu may request, in writing, that we nt use r disclse yur infrmatin fr treatment, payment, and/r peratinal activities except when authrized by yu, when required by law, r in emergency circumstances. We are nt legally required t agree t yur request. In yur request, yu must tell us what infrmatin yu want t restrict and t whm the restrictins apply. The right t request nndisclsure t health plans abut items r services that are selfpaid: Yu have the right t request, in writing, that health care items r services fr which yu paid ut f pcket in full nt be disclsed t yur health plan. The right t receive cnfidential cmmunicatins: Yu have the right t request that we cmmunicate with yu abut medical matters in a particular way r at a certain lcatin. Fr example, yu can ask that we nly cntact yu at wrk r by mail. T request

cnfidential cmmunicatins, yu must make yur request, in writing, t the address abve. We will cnsider all reasnable requests. Yur request must specify hw r where yu wish t be cntacted. The right t inspect and receive cpies: In mst cases, yu have the right t inspect and receive a cpy f certain health care infrmatin including certain medical and billing recrds. Yu cannt receive yur riginal recrds. If yu request a cpy f the infrmatin, we may charge a fee fr the csts f cpying, mailing r ther supplies assciated with yur request. We may deny yur request in limited circumstances. If yu are denied access t yur prtected health infrmatin, yu may request that denial be reviewed. We have 30 days t prcess yur request nce we receive it. The right t request an amendment t yur recrd: If yu believe that infrmatin in yur recrd is incrrect r that imprtant infrmatin is missing, yu have the right t request, in writing t the address listed abve, that we make a crrectin r add infrmatin. In yur request fr the amendment, yu must give a reasn fr the amendment. We are nt required t agree t the amendment f yur recrd, but a cpy f yur request will be added t yur recrd. Yu will be ntified in writing f the staff s decisin within 60 days f receiving yur request. The right t knw abut disclsures fr reasns ther than treatment, payment, r health care peratins: Yu have the right t receive a list (an accunting) f instances during the three year perid preceding yur request when we have disclsed yur health infrmatin. Certain instances will nt appear n the list, such as disclsures fr treatment, payment, r health care peratins r when yu have authrized the use r disclsure. These instances will appear n the list: Where the disclsure ccurred fr reasns that are nt permitted by the federal HIPAA Privacy Rule and where a frmal ntice t yu f this disclsure is nt therwise required; Fr public health activities (except t reprt child abuse r neglect); Fr judicial and administrative prceedings r law enfrcement; T avert a serius threat t health r safety; Fr military and veterans activities, the Department f State's suitability determinatins, and gvernment prgrams prviding public benefits; and Fr wrkers' cmpensatin. Yu may limit the accunting t a specific time perid, type f disclsure, r recipient. Yur first accunting f disclsures in a calendar year is free f charge. Any additinal

request within the same calendar year requires a prcessing fee. We will prvide yu with the reprt within 60 days f receiving yur request. The right t an access reprt. Beginning in January, 2013 (January, 2014 in certain circumstances), yu may request a reprt that will shw all uses and disclsures f yur electrnic prtected health infrmatin that is stred in recrds we use t make decisins abut yur health care during the three year perid preceding yur request. (Recrds we maintain as part f quality assurance and peer review activities are nt included.) We will prvide the reprt in a frm r frmat yu request, if we can readily prduce that frm r frmat. Yu may limit this access reprt t a specific date, time, perid, r persn. Yur first accunting f disclsures in a calendar year is free f charge. Any additinal request within the same calendar year requires a prcessing fee. We will prvide yu with the reprt within 60 days f receiving yur request. The right t a paper cpy f this Ntice. Yu may ask t receive a cpy f this ntice at any time. Yu may btain a cpy frm ur web site, www.beacnrth.cm, r frm the facility where yu btained treatment. The right t make cmplaints. If yu are cncerned that we have vilated yur privacy, r yu disagree with a decisin we made abut access t yur recrds, yu may file a cmplaint with the Beacn Privacy Officer using the cntact infrmatin we listed abve. We will nt retaliate against anyne fr filing a cmplaint. Yu may als cntact the U.S. Department f Health and Human Services Office fr Civil Rights: U.S. Department f Health & Human Services 200 Independence Avenue, S.W. Rm 509F HHH Building Washingtn, DC 20201 Phne: 1-877-696-6775 www.hhs.gv/cr/privacy/hipaa/cmplaints Uses and Disclsures Incnsistent with Beacn Privacy Practices If yur prtected health infrmatin is used r disclsed in a manner that is nt cnsistent with the practices described in this Ntice, Beacn will ntify yu in writing f this breach. Privacy Ntice Changes We reserve the right t change the privacy practices described in this Ntice. We reserve the right t make the revised r changed Ntice effective fr prtected health infrmatin we already

have as well as any infrmatin we may receive in the future. We will pst a cpy f the current Ntice at ur Beacn facilities. In additin, yu may request a cpy f this Ntice frm the Beacn Privacy Officer. An electrnic versin f the Ntice is psted at http:// www.beacnrth.cm. ATTENTION: If yu speak the fllwing freign languages, language assistance services, free f charge, are available t yu. Call 513-354-3700. Españl (Spanish): ATENCIÓN: Si habla españl, tiene a su dispsición servicis gratuits de asistencia lingüística. Llame al 513-354-3700. 繁體中 文 (Chinese): 注意 : 如果您使 用繁體中 文, 您可以免費獲得語 言援助服務 請致電 513-354-3700. Updated and effective as f March 2016; 11/29/2016