Privacy Disclaimer / Patient Bill of Rights

NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

LifeWatch is dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. LifeWatch is required by law to abide by the terms of this Notice.

HOW YOUR MEDICAL INFORMATION WILL BE USED AND DISCLOSED:
We will use your medical information as part of rendering diagnostic services. For example, your medical information may be used by the doctor or nurse treating you, by the business office to process your payment for the services rendered and by administrative personnel reviewing the quality of the care you receive.
We may also use and/or disclose your information in accordance with federal and state laws for the following purposes:

• Treatment Information We may contact you with information about the use of LifeWatch diagnostic services or the devices you used in the course of our providing cardiac diagnostic services.
• Disclosure to Department of Health and Human Services We may disclose medical information when required by the United States Department of Health and Human Services as part of an investigation or determination of our compliance with relevant laws.
• Family and Friends Unless you object, we may disclose your medical information to immediate family members when the medical information is directly relevant to that person's involvement with your care and when the LifeWatch needs to reach you about our diagnostic services or equipment.
• Disaster Relief We may disclose your medical information to a public or private entity, such as the American Red Cross, for the purpose of coordinating with that entity to assist in disaster relief efforts. This provision applies to patients deemed to be at risk at the time a disaster occurs, and only when the disaster impacts the patient's locality.
• Abuse or Neglect We may disclose your medical information when it concerns abuse, neglect or violence to you in accordance with federal and state law.
• Legal Proceedings We may disclose your medical information in the course of certain judicial or administrative proceedings.
• Law Enforcement We may disclose your medical information for law enforcement purposes or other specialized governmental functions.
• Coroners, Medical Examiners and Funeral Directors We may disclose your medical information to a coroner, medical examiner or a funeral director.
• Public Safety & Emergency Care We may use or disclose your medical information to prevent or lessen a serious threat to the health or safety of the patient when requested by a treating public safety agency (emergency medical personnel) or a physician rendering emergency care.
• Workers' Compensation We may disclose your medical information as authorized by laws relating to workers' compensation or similar programs when applicable and only when requested by your carrier.
• Business Associates We may disclose your health information to a business associate with whom we contract to provide services on our behalf. To protect your health information, we require our business associates to appropriately safeguard the health information of our patients.
  

AUTHORIZATIONS:
We will not use or disclose your medical information for any other purpose without your written authorization. Once given, you may revoke your authorization in writing at any time. To request a Revocation of Authorization form, you may contact:

Compliance Officer

LifeWatch, Corp.

O’Hare International Center II

10255 West Higgins Road Suite 100

Rosemont IL 60018

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:
You have the following rights with respect to your medical information:

• You may ask us to restrict certain uses and disclosures of your medical information. We are not required to agree to your request, but if we do, we will honor it.
• You have the right to receive communications from us in a confidential manner.
• Generally, you may inspect and copy your medical information. This right is subject to certain specific exceptions, and you may be charged a reasonable fee for any copies of your records.
• You may ask us to amend your medical information. We may deny your request for certain specific reasons. If we deny your request, we will provide you with a written explanation for the denial and information regarding further rights you may have at that point.
• You have the right to receive an accounting of the disclosures of your medical information made by LifeWatch during the last six years (or following April 14, 2003), except for disclosures for treatment, payment or healthcare operations, disclosures which you authorized and certain other specific disclosure types.
• You may request a paper copy of this Notice of Privacy Practices for Protected Health Information.
• You have the right to complain to us and/or to the United States Department of Health and Human Services if you believe that we have violated your privacy rights. If you choose to file a complaint, you will not be retaliated against in any way.

To file a complaint, please contact us in writing:

Compliance Officer

LifeWatch, Corp.

O’Hare International Center II

10255 W. Higgins Road, Suite 100
Rosemont IL 60018

THIS NOTICE IS EFFECTIVE AS OF April 14, 2003

REVISION OF NOTICE OF PRIVACY PRACTICES
We reserve the right to change the terms of this Notice, making any revision applicable to all the protected health information we maintain. If we revise the terms of this Notice, we will post a revised notice at LifeWatch and will make paper copies of the revised Notice of Privacy Practices available upon request.

PATIENT BILL OF RIGHTS

Your rights as a patient:

• You have a right to equitable, considerate, respectful care that includes consideration of your psychosocial, spiritual, cultural and personal values and beliefs.
• You have the right to know the identity and specialty of individuals involved in your care.
• You have a right to refuse to be served by any member of staff without jeopardizing your access to medical care.
• You have a right to prompt response to all reasonable requests.
• You have a right to confidentiality of all records and communications concerning your medical history and treatment to the extent provided by law.
• You have a right to participate or have your designated representative participate in the consideration of ethical issues, which arise in your care.
• You have a right to receive competent interpreter services when seeking care at LifeWatch.
• You have a right to report safety concerns.
• You have a right to obtain a copy of any rules and regulations of LifeWatch, which apply to your conduct as a patient, such as the No Smoking Policy.
• You have a right to file a complaint or grievance both internally and externally. Internally, you may file a complaint by contacting the LifeWatch Compliance Department at 847.720.2100, extension 4258. Externally, you may file a complaint with the Joint Commission on Accreditation of Healthcare Organizations at 800.994.6610.
  

Your responsibilities as a patient:

• To provide accurate and complete information about your present symptoms and other matters relating to your health as applicable to your cardiac care.
• To report unexpected changes in your condition to those responsible for your care.
• To tell us if you do not understand the proposed plan of care and what is expected of you.
• To follow the treatment plan recommended by the practitioner primarily responsible for your care.
• Accept responsibility for your actions if you refuse treatment or do not follow your practitioner’s instructions.
• To assure the financial obligations of your health care are fulfilled as promptly as possible; to give the LifeWatch all necessary information we will need about the payment of your care.
• To follow LifeWatch rules and regulations affecting patient care and conduct.
• To respect the property of LifeWatch.