Effective Date: October 1, 2008

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.

Who Will Follow This Notice
Memorial Health Services, through its affiliate hospital entities listed above (Memorial Health Services and its affiliated hospitals are referred to collectively in this notice as “MemorialCare”) and the employees and staff of the MemorialCare entities, provide health care to patients, together with other health care providers and other organizations. This notice applies to the following persons and entities, who have agreed to be bound by this notice; provided that each person and entity is solely and separately responsible and liable for complying with this notice and applicable law (and the MemorialCare entities are only liable for their own violations):

• Each MemorialCare entity, as well as all MemorialCare employees, staff and other personnel, who may need to access your information to perform their job functions.
• Members of the medical staffs of MemorialCare hospitals, as well as the other physicians and other health care professionals who provide health care services at a MemorialCare hospital.
• Any member of a volunteer group we allow to help you while you are being cared for.

This notice applies to all of the records related to your health care provided to you in a MemorialCare hospital and generated by the applicable MemorialCare entity, whether made by MemorialCare personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created or maintained in the doctor’s office or clinic. You should review your doctor’s notice for information on how your doctor will handle your medical information outside of MemorialCare hospitals.

Our Pledge Regarding Medical Information:
We understand that medical information about you and your health is personal. Protecting medical information about you is important. We create a record of the care and services you receive while in our care. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways in which we may use and disclose medical information about you. This notice also describes your rights, and certain obligations we have regarding the use and disclosure of your medical information.

We are required by law to:

• Keep medical information that identifies you private;
• Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
• Follow the terms of the notice that is currently in effect.

How We May Use And Disclose Medical Information About You
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to 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.

• For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different healthcare professionals within MemorialCare hospitals also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you outside the MemorialCare hospital that treated you to people who may be involved in your medical care after you leave the hospital or that provide services that are part of your care.
  
  
• For Payment. We may use and disclose medical information about you so that the treatment and services you receive may be billed to, and payment may be collected from, you, an insurance company or a third party. For example, we may need to give your health plan information about surgery you received at a MemorialCare hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your insurance will cover the treatment.
  
  
• For Health Care Operations. We may use and disclose medical information about you for our health care operations. These uses and disclosures are necessary to make sure that all of our patients receive quality care and to run our facilities. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes. We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are. We may disclose your medical information to another health care professional that you have seen so they may improve their quality or costs of care.
  
  
• Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at a MemorialCare hospital.
  
  
• Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
  
  
• Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you. The Memorial Information and Access (MIAC) card is an example of a MemorialCare health-related service and benefit.
  
  
• Facility Directory. We may include certain limited information about you in the facility directory of a MemorialCare hospital while you are a patient at that hospital. This information may include your name, location in the hospital and your general condition (e.g., fair, good, etc). Unless there is a specific written request from you to the contrary, this directory information may also be released to people who ask for you by name. This information is released so your family and friends can visit you in the hospital and generally know how you are doing. If you wish to "opt out" of the facility directory, please contact the Admitting Department at the MemorialCare hospital where you are being treated and request that your information not be included in the facility directory.
  
  
• Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. Unless there is a specific written request from you to the contrary, we may also tell your family or friends about your condition and that you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
• Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave our site. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the hospital.
  
  
• Business Associates There are some services provided in or for our organization through contacts with business associates. Examples include billing services to submit your claim to the insurance company for payment, transcription services to transcribe dictated reports from the health professionals caring for you in the hospital and copy services for making copies of your health record. When these services are contracted, we may disclose your information to our business associates so they can perform the job we have asked them to do.
  
  
• As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law.
  
  
• To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you when 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 the threat.
  
• Fundraising Activities. We may use certain information about you (demographic & dates of service) to contact you in the future in an effort to raise money for our hospitals. We may also disclose this same information to our hospital-affiliated foundation for the same purpose. The money raised will be used to expand and improve the services and programs we provide to the community. If you do not wish to be contacted for our fundraising efforts, you must notify the Foundation Director in writing at the MemorialCare hospital where you were treated.

Special Situations

• Organ and Tissue Donation. We may release medical 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.
  
  
• Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities.
  
  
• Workers’ Compensation. We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
  
  
• Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
  
  
• Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested.
  
  
• Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following:
• to prevent or control disease, injury or disability;
• to report births and deaths;
• to report the abuse or neglect of children, elders and dependent adults;
• to report reactions to medications or problems with products;
• to notify people of recalls of products they may be using;
• to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
• to notify the appropriate government authority if we believe a patient has 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.
• Law Enforcement. If permitted by applicable law, we may release medical information if asked to do so by a law enforcement official:
  
  • In response to a court order, subpoena, warrant, summons or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
  • About a death we believe may be the result of criminal conduct;
  • About criminal conduct at the hospital; and
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
• Coroners, Medical Examiners and Funeral Directors. We may release medical 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 medical information about patients to funeral directors as necessary to carry out their duties.
  
  
• Protective Services for the President, National Security and Intelligence Activities. We may release medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations, or for intelligence, counterintelligence, and other national security activities authorized by law.
  
  
• Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Note on Other Restrictions
Please be aware that certain federal or state laws may have more strict requirements on how we use and disclose your medical information. If there are stricter requirements, even for the purposes listed above, we will not disclose your medical information without your written permission, or as otherwise permitted or required by such laws. For example, we will not disclose your HIV test results without obtaining your written permission, except as permitted by state law. We may also be restricted by law to obtain your written permission to use and disclose your information related to treatment for certain conditions such as mental illness, or alcohol or drug abuse.

Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you:

• Right to Inspect and Copy. You have the right to inspect and copy the information that we have about you that may be used to make decisions about you and your care, including your medical and billing records, but may not include some mental health information. We may deny your request to inspect and copy in certain very limited circumstances.

  To inspect and copy your information that may be used to make decisions about you, you must submit your request in writing to the Medical Records Department at the MemorialCare hospital where you received health care services. 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.

• Right to Amend. If you feel that information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the MemorialCare hospital where you were treated.
  
  To request an amendment, your request must be made in writing and submitted to the Medical Records Department of the MemorialCare hospital where you were treated. 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:

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the medical information kept by or for the MemorialCare hospital where you were treated;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Is accurate and complete.
  You also may have the right to ask us to add an addendum to your records, which can be up to 250 words for each item you believe to be incorrect or incomplete. Please submit your request for an addendum to the Medical Records Department of the MemorialCare hospital where you were treated.

• Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you other than disclosures for certain purposes, such as for treatment, payment and health care operations purposes, as those functions are described above, or any disclosures that have been specifically authorized by you.
  
  To request this list or accounting of disclosures, you must submit your request in writing to the Medical Records Department of the MemorialCare hospital where you were treated. Your request must state a time period, which may not be longer than six (6) years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, 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.
  
  
• Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations purposes. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.
  
  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 the Medical Records Department of the MemorialCare hospital where you were treated. 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.
  
  
• Right to Request Confidential Communications. You have the right to request that we communicate with you in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
  
  To request confidential communications, you must make your request in writing to the Medical Records Department at the MemorialCare hospital where you seek treatment. 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.
  
  
• Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. 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 website, www.memorialcare.org
  
  A paper copy of this notice is also available in the Admitting Departments of all MemorialCare hospitals.

Changes To This Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical 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 each MemorialCare hospital, as well as our website identified above. The notice will contain on the first page, in the top right-hand corner, the effective date.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with us and with the Secretary of the United States Department of Health and Human Services. To file a complaint with us, contact the Memorial Health Services Risk Management Department at (562) 933-1730 for information on how to file your complaint. All complaints must be submitted in writing. We will take no action against you and you will not be penalized for filing a complaint.

Other Uses of Medical Information
Other uses and disclosures of medical 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 your authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical 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 with your authorization, and that we are required to retain our records of the care that we provided to you.

Privacy Officer:
Lynn H. Grieves
Chief Compliance Officer/Privacy Officer
Memorial Health Services
17360 Brookhurst Street, 1st Floor
Fountain Valley, CA 92708
(714) 377-3206