Notice of Privacy Statement

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.

This Notice of Privacy Practices is adopted to ensure that ORTHOPEDIC SURGERY CENTER, L.L.C., “the Surgery Center”, fully complies with all federal and state privacy protection laws and regulations, in particular the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Protection of patient privacy is of utmost importance to the Surgery Center. The Surgery Center is required by law to maintain the privacy of its patients protected health information and to abide by its Notice of Privacy Practices. The Surgery Center must provide its patients with a copy of its Notice of Privacy Practices outlining its legal duties and privacy practices with respect to protected health information. Violations of any of these provisions will result in disciplinary action which may include termination of employment and possible referral for criminal prosecution.

This Notice of Privacy Practices shall become effective as of February 3, 2005, the date of organization of the Surgery Center and shall remain in effect until it is either amended or cancelled.

As a patient of the Surgery Center, you have a right to receive a paper copy of this Notice of Privacy Practices. If you have any questions or comments concerning this notice, you should contact the Chief Privacy Officer, Orthopedic Surgery Center, L.L.C., 7301 Hennessy Blvd., Suite 100, Baton Rouge, Louisiana 70808, by mail or by telephone at 225- 763-6011, Fax No. 225-763-6163.

DEFINITIONS:

For the purposes of this Notice of Privacy Practices, the following defined terms shall have the following definitions.

a. “HHS” shall mean the United States Department of Health and Human Services.

b. “Health Information” or “Protected Health Information” shall mean certain Individually Identifiable Health Information, as defined in 45 C.F.R. § 164.501 of the Privacy Standards.

I. Information Collected

In the ordinary course of business the Surgery Center may receive personal information such as:

Patient’s name, address, and telephone number;

Information relating to treatment, diagnosis, or other medical information concerning a patient;

Patient’s insurance information and coverage. In addition, other information will be gathered about a patient and we will create a record of the care and/or services provided to the patient by the Surgery Center. Some of the information also may be provided to us by other individuals or organizations that are part of the patient’s “circle of care” – such as referring doctors, their health plan and family members, hospitals or other health care providers.

II. How The Surgery Center May Use or Disclose Your Protected Health Information

The Surgery Center collects protected health information from you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of the Surgery Center, but the information in the medical record belongs to you. The Surgery Center protects the privacy of your protected health information. It is the policy of the Surgery Center that all protected health information may not be used or disclosed unless it meets one of the following conditions:

1. The patient, who is the subject of the information, has consented to the use or disclosure and the use or disclosure is for the treatment, payment or health care operations.

a. Treatment. The Surgery Center collects information from you regarding your past medical history, present medical problems and/or complaints, as well as any diagnosis and/or medical treatment at the Surgery Center. This information may be transmitted to various departments within our organization, your referring physician and any other entities associated with or involved in your treatment. This information may also be disclosed to your physicians or your primary care physician in association with your treatment including any physical therapy or home health entities.

b. Payment. The Surgery Center will collect billing information from you such as your present address, social security number, date of birth, health insurance carrier, policy number, and any other related billing information. The Surgery Center may disclose to your health insurance provider, Medicare and Medicaid, or any other payor of health care claims the minimum amount necessary of your patient health care information in order to process your health insurance claim.

c. Regular Health Care Operations. The Surgery Center will disclose your healthcare information to our physicians, nurses, radiology personnel, billing clerks, administrative staff and other employees involved in your healthcare treatment.

2. The patient, who is the subject of the information, through a written authorization has authorized the use or disclosure of the information. This authorization may be revoked by the patient submitting a written revocation to the Surgery Center, or

3. The patient, who is the subject of the information, does not object to the disclosure and the disclosure is to persons involved in the health care of the individual or for facility directory purposes.

a. Notification and communication with family. We may disclose your protected health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition, or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.

4. Voice Mail Message. It is the policy of the Surgery Center that a voice mail or answering machine message may be left at a patient’s home or other number the patient provides to the Surgery Center regarding appointments, billing or payment issues, or other PHI, related to treatment, payment or health care operations.

5. Facility Directories. It is the policy of the Surgery Center that unless you object, we will use and disclose in our facility directory your name, your condition (in general terms) and your religious affiliation. All of this information, except religious affiliation will be disclosed to people who ask for you by name. Members of the clergy will be told of your religious affiliation.

6. As Required by Law. It is the policy of the Surgery Center that we may use and disclose your protected health information as required by law.

a. Public health. As required by law, we may disclose your protected health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.

b. Health oversight activities. We may disclose your protected health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.

c. Judicial and administrative proceedings. We may disclose your protected health information in the course of any administrative or judicial proceeding.

d. Law enforcement. We may disclose your protected health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and/or for other law enforcement purposes.

e. Deceased person information. We may disclose your protected health information to coroners, medical examiners and funeral directors.

f. Organ donation. We may disclose your protected health information to organizations involved in procuring, banking or transplanting organs and tissues.

g. Research. We may disclose your protected health information to researchers conducting research that has been approved by an Institutional Review Board or the Surgery Center’s Board of Managers.

h. Public safety. We may disclose your protected health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

i. Specialized government functions. We may disclose your protected health information for military, national security, prisoner purposes.

j. Worker’s compensation. We may disclose your protected health information as necessary to comply with worker’s compensation laws.

k. Marketing. We may contact you to provide appointment reminders or to give you information about other treatments or health-related benefits and services that may be of interest to you.

l. Change of Ownership. In the event that the Surgery Center is sold or merges with another organization, your protected health information / record will become the property of the new owner.

III. Other Policies, Uses and Disclosures

1. Notice of Privacy Practices. It is the policy of the Surgery Center that privacy practices must be published and that all uses and disclosures of protected health information are done in accordance with the Surgery Center’s privacy policy.

2. Deceased Individuals. It is the policy of the Surgery Center that privacy protections extend to information concerning deceased individuals.

3. Restriction Requests. It is the policy of the Surgery Center that serious consideration must be given to all requests for restrictions on uses and disclosures of protected health information as published in the privacy policy. You have the right to request restrictions on certain uses and disclosures of your protected health information. The Surgery Center is not required to agree to the restriction that you requested. If a particular restriction is agreed to, the Surgery Center is bound by that restriction.

4. Minimum Necessary Disclosure. It is the policy of the Surgery Center that it shall make reasonable efforts to limit the disclosure to the minimum amount of information needed to accomplish the purpose of the disclosure. It is also the policy of the Surgery Center that all requests for protected health information must be limited to the minimum amount of information needed to accomplish the purpose of the request.

5. Access to Information. It is the policy of the Surgery Center that you have the right to inspect and copy your protected health information. It is the Surgery Center’s policy that access to protected health information must be granted to a patient when such access is requested. Such request shall be submitted in writing by completing the Surgery Center’s request form entitled “Request for Inspection and/or Copy of Protected Health Information”. Costs associated with the copying of any protected health information shall be in accordance with applicable state and federal law.

6. Designation of Personal Representative. It is the policy of the Surgery Center that access to protected health information must be granted to your designated personal representative as specified by you when such access is requested. This designation of a personal representative must be made in writing by completing the Surgery Center’s form entitled “Designation of Personal Representative”.

7. Confidential Communications Channels. It is the policy of the Surgery Center that you have the right to receive your protected health information through a reasonable alternative means or at an alternative location. Confidential communication channels can be used within the reasonable capability of the Surgery Center, (i.e. do not call me at work, call me at home) as requested by you. Such request shall be made in writing by completing the Surgery Center’s form entitled “Confidential Channel Communication Request”.

8. Amendment of Incomplete or Incorrect Protected Health Information. It is the policy of the Surgery Center that you have a right to request that the Surgery Center amend your protected health information that is incorrect or incomplete. The Surgery Center is not required to change your protected health information and will provide you with information about the Surgery Center’s denial and how you can disagree with the denial. A request to amend your protected health information shall be made in writing by completing the Surgery Center’s form entitled “Request for Amendment of Health Information”.

9. Accounting of Disclosures. It is the policy of the Surgery Center that an accounting of disclosures of protected health information made by the Surgery Center is given to you whenever such an accounting is requested in writing. You have a right to receive an accounting of disclosures of your protected health information made by the Surgery Center, except that the Surgery Center does not have to account for the disclosures described in Section II (1) (a)(b)(c), of this Notice of Privacy Practices. Such written request for an accounting shall be made by completing the Surgery Center’s form entitled “Request for Accounting of Disclosures”.

10. Complaints. It is the policy of the Surgery Center that all complaints by employees, patients, providers or other entities relating to protected health information be investigated and resolved in a timely fashion. Complaints about this Notice of Privacy Practices or how the Surgery Center handles your protected health information should be directed to: Chief Privacy Officer Orthopedic Surgery Center, L.L.C. 7301 Hennessy Blvd., Suite 100 Baton Rouge, Louisiana 70808 Telephone No. 225-763-6011 • Fax No. 225-763-6163 If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to: Department of Health and Human Services Office of Civil Rights Hubert H. Humphrey Bldg. 200 Independence Avenue, S.W. Room 509F HHH Building Washington, DC 20201

11. Prohibited Activities. It is the policy of the Surgery Center that no employee may engage in any intimidating or retaliatory acts against any person who files a complaint or otherwise exercises their rights under HIPAA regulations. It is also the policy of the Surgery Center that no disclosure of protected health care information will be withheld as a condition for payment for services from the patient or from an entity.

12. Responsibility. It is the policy of the Surgery Center that the responsibility for designing and implementing procedures related to this policy lies with the Chief Privacy Officer.

13. Mitigation. It is the policy of the Surgery Center that the effects of any unauthorized use or disclosure of protected health information be mitigated (to decrease the damage caused by the action) to the extent possible.

14. Business Associates. It is the policy of the Surgery Center that business associates must be contractually bound to protect your protected health information to the same degree as set forth in this policy.

15. Preemption of State Law. It is the policy of the Surgery Center that the federal privacy regulations are the minimum standard to be used regarding the privacy of a patient’s protected health care information. If the laws of the State of Louisiana are more stringent in certain areas, the state laws in these areas shall prevail. In all other areas, the federal privacy regulations shall prevail.

16. Cooperation with Privacy Oversight Authorities. It is the policy of the Surgery Center that oversight agencies such as the Office for Civil Rights of the Department of Health and Human Services be given full support and cooperation in their efforts to ensure the protection of protected health information within the organization. It is also the policy of the Surgery Center that all personnel cooperate fully with all privacy compliance review and investigations.

If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact the Chief Privacy Officer of the Surgery Center.

IV. Changes to this Notice of Privacy Practices.

The Surgery Center reserves the right to amend this Notice of Privacy Practices at any time in the future and will provide a copy of such amendment to you upon request or upon your next visit. Until such amendment is made, the Surgery Center is required by law to comply with this Notice.