Preferred Medicine Inc. Spine, Sports & Occupational Medicine, P.C.

In the words of our patients....

"I truly believe that starting therapy at Preferred Medicine was one of the best decisions I've ever made regarding my recovery. The genuine care and comfort that each patient receives is incredible."

HIPAA Addendum

1. Definitions. For purposes of this Addendum, the following terms shall have the designated meanings.

(a) "Designated Record Set" shall mean a group of records maintained by or for Patient that is (i) the medical records and billing records about individuals maintained by or for Patient, (ii) the enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or (iii) used, in whole or in part, by or for Patient to make decisions about individuals. As used herein, the term "Record" means any item, collection or grouping of information that includes Protected Health Information and is maintained, collected, used, or disseminated by or for Patient.

(b) "Electronic Media" shall mean the mode of electronic transmissions. It includes the Internet, extranet (using Internet technology to link a business with information only accessible to collaborating parties), leased lines, dial-up lines, private networks, and those transmissions that are physically moved from one location to another using magnetic tape, disk, or compact disc media.

(d) "HIPAA Transaction" shall mean Transactions as defined in 45 C.F.R.§ 160/103 of the Transaction Standards.

(e) "Individually Identifiable Health Information" shall mean information that is a subset of health information, including demographic information collected from an individual, and

(a) is created or received by a health care provider, health plan, employer, or health care clearinghouse; and

(b) relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual; and (a) identifies the individual, or (b) with respect to which there is a reasonable basis to believe the information can be used to identify the individual.

(f) "Privacy Standards" shall mean the Standards for Privacy of Individually Identifiable Health Information, 45 C.F.R. Parts 160 and 164.

(g) "Protected Health Information" shall mean Individually Identifiable Health Information that is (i)transmitted by electronic media; (ii) maintained in any medium constituting electronic media; or (iii) transmitted or maintained in any other form or medium. "Protected Health Information" shall not include education records covered by the Family Educational Right and Privacy Act, as amended, 20 U.S.C. § 1232g, or records described in 20 U.S.C. § 1232g(a)(4)(B)(iv).

(h) "Secretary" shall mean the Secretary of the United States Department of Health and Human Services.

(i) "Security Standards" shall mean the regulations with regard to security standards for health information to be promulgated by the Secretary pursuant to the authority granted by Title II, Subtitle F, Section 263 of HIPAA.

(j) "Transaction Standards" shall mean the Standards for Electronic Transactions, 45 C.F.R. 160 and 162.

2. Use of Protected Health Information. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall not, and shall ensure that its directors, officers, employees, contractors and agents do not use Protected Health Information received from the Patient in any manner that would constitute a violation of the Privacy Standards if used by the Patient, except that Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. may use Protected Health Information (i) for Preferred Medicine and Spine, Sports & Occupational Medicine's proper management and administrative services, or (ii) to carry out the legal responsibilities of Preferred Medicine and Spine, Sports & Occupational Medicine, P.C.

3. Disclosure of Protected Health Information. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall not, and shall ensure that its directors, officers, employees, contractors, and agents do not disclose Protected Health Information received from the Patient in any manner that would constitute a violation of the Privacy Standards if disclosed by the Patient, except that Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. may disclose Protected Health Information in a manner permitted pursuant to the Agreement or as required by law. To the extent Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. discloses Protected Health Information to a third party, Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. must obtain, prior to making any such disclosure: (i) reasonable assurances from such third party that such Protected Health Information will be held confidential as provided pursuant to the Agreement, and will be disclosed only as required by law or for the purposes for which it was disclosed to such third party; and (ii) an agreement from such third party to immediately notify Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. of any breaches of the confidentiality of the Protected Health Information, to the extent it has obtained knowledge of such breach.

4. Safeguards Against Misuse of Information. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. agrees that it will implement all appropriate safeguards to prevent the use of disclosure of Protected Health Information other than pursuant to the terms and conditions of the Agreement.

5. Reporting of Disclosures of Protected Health Information. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall, within five (5) days of becoming aware of a disclosure of Protected Health Information in violation of the Agreement by Preferred Medicine and Spine, Sports & Occupational Medicine, P.C., its officers, directors, employees, contractors, or agents, or by a third party to which Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. disclosed Protected Health Information pursuant to subsection (c) of this Section, report any such disclosure to the Patient.

6. Agreements by Third Parties. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall enter into an agreement with any agent or subcontractor that will have access to Protected Health Information that is received from, or is created or received by Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. on behalf of, the Patient pursuant to which such agent or subcontractor agrees to be bound by the same restrictions, terms, and conditions that apply to Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. pursuant to his Addendum with respect to such Protected Health Information.

7. Access to Information. Within five (5) days of a request by Patient for access to Protected Health Information about an individual contained in a Designated Record Set, Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall make available to the Patient such Protected Health Information for so long as such information is maintained in the Designated Record Set. In the event any individual requests access to Protected Health Information directly from Preferred Medicine and Spine, Sports & Occupational Medicine, P.C., Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall within two (2) days forward such request to the Patient. Any denials of access to the Protected Health Information requested shall be the responsibility of the Patient.

8. Availability of Protected Health Information for Amendment. Within ten (10) days of receipt of a request form the Patient for the amendment of an individual's Protected Health Information or a record regarding an individual contained in a Designated Record Set (for so long as the Protected Health Information is maintained in the Designated Record Set), Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall provide such information to the Patient for amendment and incorporate any such amendments in the Protected Health Information as required by 45 C.F.R. § 164.526.

9. Accounting Disclosures. Within ten (10) days of notice by the Patient to Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. that it has received a request for an accounting of disclosures of Protected Health Information regarding an individual during the six (6) years prior to the date on which the accounting was requested, Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall make available to the Patient such information as is in Company's possession and is required for the Patient to make the accounting required by 45 C.F.R. § 164.528. At a minimum, Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall provide the Patient with the following information: (i) the date of the disclosure; (ii) the name of the entity or person who received the Protected Health Information, and if known, the address of such entity or person, (iii) a brief description of the Protected Health Information disclosed; and (iv) a brief statement of the purpose of such disclosure which includes an explanation of the basis for such disclosure. In the event the request for an accounting is delivered directly to Preferred Medicine and Spine, Sports & Occupational Medicine, P.C., Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall within two (2) days forward such request to the Patient. It shall be the Patient's responsibility to prepare and deliver any such accounting requested. Preferred Medicine and Spine, Sports, & Occupational Medicine, P.C. hereby agrees to implement an appropriate record-keeping process to enable it to comply with the requirements of this Section.

10. Availability of Books and Records. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. hereby agrees to make its internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. on behalf of, the Patient available to the Secretary for purposes of determining Patient's and Preferred Medicine and Spine, Sports & Occupational Medicine's compliance with the Privacy Standards.

11. Effect of Termination. Upon the termination of the Agreement for any reason, Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. will return to Patient, or, at Patient's direction, destroy, all Protected Health Information received from Patient that Preferred Medicine and Spine, Sports & Occupational Medicine maintains in any form, recorded on any medium, or stored in any storage system, unless said information has been de-identified and is no longer Protected Health Information. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall remain bound by the provisions of this Addendum, even after termination of the Agreement, until such time as all Protected Health Information has been returned, de-identified or otherwise destroyed as provided in this Section.

12. Breach of Contract. In addition to any other rights Patient may have in the Agreement, this Addendum or by operation of law or in equity, Patient may (i) terminate the Agreement if Patient determines that Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. has violated a material term of this Addendum, and (ii) at its option, cure or end any such violation. Patient's cure of a breach of this Addendum shall not be construed as a waiver of any other rights Patient has in the Agreement, this Addendum or by operation of law or in equity.

13. Third Party Rights. The terms of this Addendum are not intended, nor should they be construed, to grant any rights to any parties other than Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. and Patient.

14. Electronic Transactions. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. hereby represents and warrants that to the extent it is transmitting any of the HIPAA Transactions for Patient, the format and structure of such transmissions shall be in compliance with the Transaction Standards, provided, it is Patient's responsibility to ensure that appropriate Code Sets are used in the coding of services and supplies.

15. Data Security. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. hereby represents and warrants that it will utilize commercially reasonable efforts to implement administrative, technical and physical safeguards and policies and procedures to comply with the Privacy Standards and Security Standards.
16. Injunctive Relief. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. acknowledges and stipulates that its unauthorized use or disclosure of Protected Health Information while performing services pursuant to the Agreement or this Addendum would cause irreparable harm to Patient, and in such event, Patient shall be entitled, if he/she so elects, to institute and prosecute proceedings in any court of competent jurisdiction, either in law or in equity, to obtain damages and injunctive relief, together with the right to recover from Preferred Medicine and Spine, Sports & Occupational Medicine's costs, including reasonable attorney's fees, for any such breach of the terms and conditions of the Agreement or Addendum.

17. Owner of Protected Health Information. Under no circumstances shall Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. be deemed in any respect to be the owner of any Protected Health Information used or disclosed by or to Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. pursuant to the terms of the Agreement.

IN WITNESS WHEREOF, the parties have executed this Addendum the day and year first above written.

PREFERRED MEDICINE AND PATIENT:
SPINE, SPORTS & OCCUPATIONAL
MEDICINE, P.C.

_________________________________ _________________________
Signed Signed

_________________________________ _________________________
Printed Printed

_________________________________ _________________________
Date Date

ACKNOWLEDGMENT OF RECEIPT OF PRIVACY NOTICE

By signing below, I acknowledge that I have received COVERED ENTITY'S Notice of Privacy Practices ("Notice").

______________________________________ Date: ______________
Signature (Patient or Authorized Representative)

______________________________________
Printed (Patient or Authorized Representative)

NOTICE OF PRIVACY PRACTICES

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.

Our Responsibilities

Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. takes the privacy of your health information seriously. We are required by law to maintain that privacy and to provide you with this Notice of Privacy Practices. This Notice is provided to tell you about our duties and practices with respect to your information. We are required to abide by the terms of this Notice that is currently in effect.

How We May Use and Disclose Your Health Information

The following categories describe different ways that we use and disclose your health information without your authorization. For each category we explain what we mean and give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

o For Treatment. We may use health information about you to provide you with treatment, health care or other related services. We may disclose your health information to doctors, nurses, aids, technicians or other Covered Entity employees who are involved in taking care of you. Additionally, we may use or disclose your health information to manage or coordinate your treatment, health care or other related services. Example: If we send you for a consultation with an orthopedic specialist, we may forward your MRI or X-ray results to the orthopedic specialist.)

o For Payment. We may use and disclose your health information to bill and collect for the treatment and services we provide to you. We may send your health information to an insurance company or other third party for the payment purposes. Example: Treatment notes will be sent with bill or office visit notes to insurance company for reimbursement.)

o For Health Care Operations. We may use and disclose your health information for health care operations. These uses and disclosures are necessary to run the Covered Entity, to make sure you receive competent, quality health care, and to maintain and improve the quality of health care we provide. Example: Tracking of specific diagnosis of patients and the treatment results:

o As Required by Law. We will disclose your health information when required to do so by federal, state, or local law.

o For Public Health Purposes. We may disclose your health information for public health activities. While there may be others, public health activities generally include the following:

o Preventing or controlling disease, injury or disability.
o Reporting births and deaths.
o Reporting defective medical devices or problems with medications.
o Notifying people of recalls of products they may be using.
o Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.

o About Victims of Abuse. We may disclose your health information to notify the appropriate government authority if we believe you have been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

o Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities might include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws.

o Judicial Purposes. We may disclose your health information in response to a court or administrative order. We may also disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in a dispute, but only if efforts have been made to tell you about the request, in which you were given an opportunity to object to the request, or to obtain an order protecting the information requested.

o Law Enforcement. We may release health information if asked to do so by a law enforcement official, if such disclosure is :

o Required by law.
o In response to a court order, subpoena, warrant, summons or similar process.
o To identify or locate a suspect, fugitive, material witness, or missing person.
o About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement.
o About a death we believe may be the result of criminal conduct.
o About criminal conduct at the Covered Entity.
o In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location or the person who committed the crime.

o Coroners, Medical Examiners and Funeral Directors. In certain
circumstances, we may disclose health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about individuals to funeral directors as necessary to carry out their duties.

o Organ and Tissue Donation. We may disclose your health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

o Research. Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all individuals who received one medication to those who received another. All research projects, however, are subject to a special approval process. This process includes evaluating a proposed research project and its use of health information, trying to balance the research needs with your need for privacy of your health information. Before we use or disclose health information for research, the project will have been approved through this research approval process. Additionally, when it is necessary for research purposes and so long as the health information does not leave the Covered Entity, we may disclose your health information to researchers preparing to conduct a research project, for example, to help the researchers look for individuals with specific health needs. Lastly, if certain criteria are met, we may disclose your health information to researchers after your death when it is necessary for research purposes. To Avert a Serious Threat to Health or Safety. We may use and disclose your health information when we believe it is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat or to law enforcement authorities in particular circumstances.

o Military and Veterans. If you are a member of the armed forces, we may release your health information as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.

o National Security and Intelligence Activities. We may release your health information to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities authorized by law.

o Protective Services for the President and Others. We may disclose your health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations.

o Custodial Situations. If a correctional institution or law enforcement authority makes certain representations, we may disclose your health information to a correctional institution or law enforcement official.

o Workers' Compensation. We may disclose your health information as authorized by and to the extent necessary to comply with workers' compensation laws or laws relating to similar programs.

o Treatment Alternatives, Appointment Reminders, and Health-Related Benefits. We may use and disclose your health information to tell you about or recommend possible treatment alternatives or health-related benefits or services that may be of interest to you. Additionally, we may use and disclose your health information to provide appointment reminders. If you do not wish the Covered Entity to contact you about treatment alternatives, health-related benefits or appointment reminders, you must notify in writing, and state which of those activities you wish to be excluded from, the person listed on the last page of this Notice.

o Individuals Involved in Your Care or Payment for Your Care. We may release health information about you to a family member, other relative, or any other person identified by you who is involved in your health care. We may also give information to someone who helps pay for your care. We may also tell your family, friends, personal representative or other person responsible for your health care your condition and that you are at the Covered Entity.

OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose your health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization. We will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made under the authorization, and that we are required to retain our records of the care that we provided to you.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.

You have the following rights regarding health information we maintain about you:

o Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care.

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to Nancy, Medical Records Dept. at 15636 Southfield Road, Allen Park, MI 48101. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.

o Right to Request Confidential Communications. Typically, we communicate with you regarding your health care either through your home phone or through the mail at your home address. You have the right to request that we communicate with you or your responsible party about your health care in an alternative way or at a certain location.

To request confidential communications, you must make your request in writing to Nancy, Medical Records Dept., 15636 Southfield Road, Allen Park, MI 48101. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

o Right to Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your care.

To inspect and copy health information that may be used to make decisions about you, you can submit your request in writing or orally to Nancy, Medical Records Dept., 15636 Southfield Road, Allen Park, MI 48101. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

o Right to Amend. You have the right to ask us to amend your health and/or billing information for as long as the information is kept by the Covered Entity.

To request an amendment, your request must be made in writing and submitted to Nancy, Medical Records Dept., 15636 Southfield Road, Allen Park, MI 48101. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

o Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.

o Is not part of the health information kept by or for the Covered Entity.

o Is not part of the information which you would be permitted to inspect and copy.

o Is accurate and complete.

o Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures that we have made of your health information.

To request this list of disclosures, you must submit your request in writing to Nancy, Medical Records Dept., 15636 Southfield Road, Allen Park, MI 48101. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, during such 12-month period, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

o Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.

You may obtain a copy of this Notice at our web site at www.PreferredMedicine.com.

To obtain a paper copy of this Notice, contact Nancy, Medical Records Dept., 15636 Southfield Road, Allen Park, MI 48101.

WHO THIS NOTICE APPLIES TO.

This Notice describes the Covered Entity's practices and those of:

o Any health care professional authorized to enter information into or consult your medical record.

o All departments and units of the Covered Entity.

o Any member of a volunteer group we allow to help you.

o All employees, staff and other Covered Entity personnel.

CHANGES TO THIS NOTICE.

We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in a clear and prominent location to which you have access. The Notice is also available to you upon request. The Notice will contain on the first page, in the top right-hand corner, the effective date. In addition, if we revise the Notice, and you are still with the Covered Entity, we will offer you a copy of the current Notice in effect.

COMPLAINTS.

If you believe your privacy rights have been violated, you may file a complaint with the Covered Entity or with the Secretary of the Department of Health and Human Services. To file a complaint with the Covered Entity, contact Faye Chehab. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

If you have any questions about this Notice, please contact:

Faye Chehab
Preferred Medicine and
Spine, Sports & Occupational Medicine, P.C.
15636 Southfield Road
Allen Park, MI 48101
(313) 928-0700 Fax: (313) 928-0701

CHECKLIST FOR NOTICE OF PRIVACY PRACTICES

To determine whether a Covered Entity has met all of the requirements of the Regulations in drafting and providing its Notice to Patients and the public, the Covered Entity must ask the following questions in relation to the contemplated Notice. A negative answer to any of the following may indicate that the Covered Entity must receive its Notice and/or the manner in which the Notice is being provided to Patients and the public.

? Has the Covered Entity prepared a Notice that includes:

(1) A header as follows: '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."

(2) A description, including at least one example, of the types of Uses and Disclosures that the Covered Entity is permitted to make for Treatment, Payment, and Health Care Operations.

(3) A description of each of the other purposes for which the Covered Entity is permitted or required to use or disclose Protected Health Information without the Patient's consent or authorization.

(4) A statement that other Uses or Disclosures will only be made with the Patient's authorization and that the Patient may revoke such authorization in writing, except to the extent that the Covered Entity has taken action in reliance thereon?

? If the Covered Entity plans to engage in the following activities, has the Covered Entity included a separate statement in its Notice, as applicable, that:

(1) The Covered Entity may contact the Patient to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the Patient.

(2) The Covered Entity may contact the Patient to raise funds for the Covered Entity?

? Does the Notice include a statement of the Patient's rights with respect to Protected Health Information and a brief description of how the Patient may exercise those rights including the following:

o The right to request restrictions on Uses or Disclosures.
o The right to request and receive communications of Protected Health information from the Covered Entity by alternative means or at alternative locations.
o The right to inspect and copy Protected Health Information.
o The right to amend Protected Health Information.
o The right to receive an accounting of Disclosures of Protected Health Information.
o The right of a Patient, including a Patient who has agreed to receive the Notice electronically, to obtain a paper copy of the Notice upon request?

? Does the Notice include sufficient detail to place the Patient on notice of the Uses and Disclosures that are permitted or required by the Regulations or other applicable law?

? Does the Notice include a statement that:

(1) The Covered Entity is Required by Law to maintain the privacy of Protected Health Information and to provide Patients with notice of its legal duties and privacy practices with respect to Protected Health Information.

(2) The Covered Entity is required to abide by the terms of the Notice currently in effect.

(3) For the Covered Entity to apply a change in a privacy practice that is described in the Notice to Protected Health Information it created or received prior to issuing a revised Notice, a statement that the Covered Entity reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all Protected Health Information that it maintains.

(4) Describes how the Covered Entity will provide Patients with a revised Notice?

? Does the Notice state that Patients may complain to the Covered Entity and the Secretary if they believe their privacy rights have been violated; briefly describe how to file a complaint; and state that the Patient will not be retaliated against for filing a complaint?

? Does the Notice contain the name and/or title, and telephone number of a person or office to contact for further information regarding filing complaints or other information provided in the Notice?

? Does the Notice contain the date on which the Notice is first in effect, which may not be earlier than the date on which the Notice is printed or otherwise published?

? If the Covered Entity elects to limit the Uses or Disclosures that it is permitted to make, does the Notice describe its more limited Uses or Disclosures? (Note: A Covered Entity may not limit Disclosures Required by Law).

? If the Covered Entity materially changes its Uses or Disclosures, the Patient's rights, legal duties or other privacy practices stated in the Notice, has the Covered Entity promptly revised and redistributed the Notice? (Note: A material change may not be implemented prior to the effective date of the Notice in which such material change is reflected).

? Has the Covered Entity made the Notice available upon request to any person, including Patients in compliance with the following:

(1) If a Direct Treatment Relationship exists with an Individual, the Covered Entity must provide the Notice no later than the date of the first service delivery, including service delivered electronically; have the Notice available at the service delivery site for the Individual to request and take with them; and post the Notice in a clear and prominent location where it is reasonable to expect Patients seeking service to be able to read the Notice; and whenever the Notice is revised, make the revised Notice likewise available as described herein.

(2) If the Covered Entity maintains a website, the Notice must be prominently posted and made available on the website.

(3) If the Covered Entity provides Notice via e-mail, the Patient has agreed to electronic Notice; and if the Covered Entity knows that the e-mail transmission has failed, Covered Entity must provide a paper copy of the Notice.

(4) If the first service delivery is delivered electronically, the Covered Entity must provide electronic Notice automatically and contemporaneously in response to the Patient's first request for service?

? If the Covered Entity participates in an Organized Health Care Arrangement and has created a joint Notice, has the Covered Entity complied with the following:

(1) The Covered Entities participating in the Organized Health Care Arrangement must agree to abide by the terms of the Notice.

(2) The Notice must include a statement that it covers more than one Covered Entity; must describe the Covered Entities, or class of Covered Entities, with reasonable specificity; must describe with reasonable specificity the service delivery sites, or classes of delivery sites; and, if applicable, state that the Covered Entities will share Protected Health Information as necessary to carry out Treatment, Payment, and Health Care Operations relating to the Organized Health Care Arrangement? (Note: Provision of a joint Notice to a Patient by any one of the Covered Entities included in the joint Notice, will satisfy the Notice requirements of the remaining Covered Entities).

? Has the Covered Entity documented compliance with the Notice requirements by retaining a copy of each Notice issued by the Covered Entity for a period of six (6) years from the date each Notice was created, or the date each Notice was last in effect, whichever is later?
PREFERRED MEDICINE AND
SPINE, SPORTS & OCCUPATIONAL MEDICINE, P.C.

Department: Page 1 of 1
Policy Name: Investigation of Complaints Policy No.:
By Secretary; Requirements
Approved Date: Replaces Policies Dated:
Effective Date:

PURPOSE: To ensure compliance with federal regulations regarding the investigation of complaints filed under HIPAA regulations.

DEFINITIONS:
"Person" or "Patients" means any person who has testified, assisted, or participated in an investigation, compliance review, proceeding or hearing with respect to carrying out the purpose and intent o the HIPAA Privacy Regulations.
"Secretary" means the Secretary of Health and Human Services or any other officer or employee of HHS to whom the authority involved has been delegated.

POLICY: It is the policy of Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. to cooperate with the Secretary, as necessary, in the investigation of complaints filed against Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. including allowing a review of policies, procedures, practices and circumstances regarding alleged acts or omissions.

It is the policy of Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. to refrain from taking from any action that may intimidate, threaten, coerce, or discriminate against any Patient or Individual who acts in good faith in filing a complaint against Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. or with the Secretary regarding Preferred Medicine and Spine, Sports & Occupational Medicine's privacy policies or practices.

Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall not require any Patient to waive his or her right to file a complaint with the Secretary as a condition of providing treatment.

PROCEDURE:

Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall retain all such documents that may be necessary to support or defend the propriety of its privacy policies and procedures.

In the event any member of Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. receives notice from the Secretary of an investigation of a complaint against Preferred Medicine and Spine, Sports & Occupational Medicine, P.C., the member shall immediately notify the Privacy Official or designee.

Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. must permit access by the Secretary during normal business hours to its facilities, books, records, accounts and other sources of information that are pertinent to ascertaining compliance with the Privacy Regulations. It the Secretary requires documents or information that is in the exclusive possession of another office, agency, institution or person, and Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. cannot obtain such information, Preferred Medicine and Spine, Sports, & Occupational Medicine, P.C. must certify to the Secretary this fact, including the efforts made to obtain the information.

REFERENCES:

Privacy Standards Manual Section 1.3
HIPAA Privacy Brief - Administrative Requirements
45 CFR §§ 160.300 through 160.306, 160.310, 160.312, and 164.530

Additional Optional Provisions for Business Associate Contracts

1. Indemnification. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall indemnify Patient for any and all claims, inquiries, costs or damages, including but not limited to any monetary penalties, incurred by Patient arising from a violation by Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. of its obligations hereunder.

2. Errors and Omissions Policy. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. hereby agrees to maintain at all times during the term of the Agreement a policy insuring against errors and omissions, such policy to be for such amounts as is standard in the industry. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall provide Patient with a copy of the certificate of insurance evidencing the policy upon the anniversary date of each term of the Agreement.

3. Exclusion from Limitation of Liability. To the extent that Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. has limited its liability under the terms of the Agreement, whether with a maximum recovery for direct damages or a disclaimer against any consequential, indirect or punitive damages, or other such limitations, all limitations shall exclude all damages to Patient arising from Preferred Medicine and Spine, Sports & Occupational Medicine's breach of its obligations relating to the use and disclosure of Protected Health Information.

4. Minimum Necessary Representations. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. hereby represents and warrants that, for all Protected Health Information that Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. requests from Patient for the purposes of providing services under the Agreement, it shall request only that amount of information that is minimally necessary to perform such services. In addition, for all uses and disclosures of Protected Health Information by Preferred Medicine and Spine, Sports & Occupational Medicine, P.C., Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. represents and warrants that it shall institute and implement policies and practices to limit such uses and disclosures to that which is minimally necessary to perform its services under the Agreement.

5. Judicial and Administrative Proceedings. In the event Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. receives a subpoena, court or administrative order or other discovery request or mandate for release of Protected Health Information, Patient shall have the right to control Preferred Medicine and Spine, Sports & Occupational Medicine's response to such request. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall notify Patient of the request as soon as reasonably practicable, but in any event within 48 business hours of receipt of such request.

6. Evidence of Safeguards. (To be used in place of the Safeguards Against Misuse of Information Section in primary Addendum).
Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. hereby represents and warrants that it has implemented all appropriate safeguards to prevent the use or disclosure of Protected Health Information that are not permitted by the terms of the Agreement or this Addendum. Specifically, Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. represents that it has undertaken and will continue to execute the following safeguards: ______________________________________________. In the event Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. determines it is no longer necessary or feasible to conduct a stated safeguard, it shall notify Patient in writing of its intent to discontinue such safeguard. Patient shall have the option of terminating the Agreement with no penalty if it determines the termination of such safeguards renders the Protected Health Information vulnerable to improper use or disclosure.

7. Procedure for Marketing/Fundraising Activities. If Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. performs marketing or fundraising services on behalf of Patient and uses or discloses Protected Health Information in furtherance of those services, Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall adopt and implement a policy and procedure for removing the names of all individuals who have expressly opted out of receiving future marketing or fundraising materials from Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. on Patient's behalf. If Patient receives information of an individual's request to opt out of future mailings, Patient agrees to notify Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. of such request out as soon as reasonably practicable after receipt of the request.

8. Electronic Transactions. (To be used in place of paragraph 14 of standard agreement for situations in which business associates will conduct standard transactions on behalf of Patient.)
Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. hereby represents and warrants that, to the extent it is transmitting any of the HIPAA Transactions for Patient, the format and structure of such transmissions shall be in compliance with the Transaction Standards; provided, however, it is Patient's responsibility to ensure that appropriate Code Sets are used in the coding of services and supplies. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. shall indemnify and hold harmless Patient from any monetary penalties assessed against Patient arising from a breach of the representations and warranties contained in this Section 14, including reimbursing Patient for any cost incurred by Patient as a result of an audit or investigation by the Secretary, which may include, without limitation, attorney's fees.

9. Additional Agreements. Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. and Patient agree that, if applicable, they will enter into Trading Partner and Chain of Trust Agreements, as those agreements are described in the Transactions Standards and Security Standards. The parties agree that they will enter into the agreements at such time as to comply with the compliance dates of the Standards.

10. Breach of Contract. (To be used in place of paragraph 12 of standard agreement for situations in which the Company is a software Company).
In addition to any other rights Patient may have in the Agreement, this Addendum or by operation of law, if Patient determines that Preferred Medicine and Spine, Sports & Occupational Medicine, P.C. has violated a material term of this Addendum, Patient may (i) terminate the Agreement; (ii) amend the source code escrow agreement to provide for the release of the source code to Patient; and (iii) seek all other remedies in law or in equity available to Patient; provided, however, that in the event of such violation, Patient shall have the right, at his/her sole option, to cure or end the violation without affecting any rights provided herein.

15636 Southfield Road Allen Park, Michigan 48101 Tel: 313.928.0700