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 CLOSELY.

Uses & Disclosures

Treatment. Your health information may be used by staff members or disclosed to other health
care professions for the purpose of evaluating your health, diagnosing medical conditions and
providing treatment. For example, results of laboratory tests and procedures will be available
in your medical record to all health professionals who may provide treatment or who may be
consulted by staff members.

Payment. Your health information may be used to seek payment from your health plan, from
other sources of coverage such as an automobile insurer or from credit card companies that you
may use to pay for services. For example, your health plan may request and receive information
on dates of services, the services provided and the medical condition being treated.

Healthcare Operations. Your health information may be used as necessary to support the dayto-
day activities and management of Vero Orthopaedics/Vero Neurology. For example,
information on the services you received may be used to support budgeting and financial
reporting, and activities to evaluate and promote quality.

Law Enforcement. Your health information may be disclosed to law enforcement agencies
without your permission, to support government audits and inspections, to facilitate lawenforcement
investigations, and to comply with government mandated reporting.

Public Health Reporting. Your health information may be disclosed to public health agencies
as required by law. For example, we are required to report certain communicable diseases to
the state’s public health department.

Other Uses & Disclosures Require Your Authorization. Disclosure of your health information
or its use for any purpose other than those listed-above requires your specific written
authorization. If you change your mind after authorizing a use or disclosure of your information
you may submit a written revocation of the authorization. However, your decision to revoke the
authorization will not affect or undo any use or disclosure of information that occurred before
you notified us of your decision.

Additional Uses of Information

Appointment Reminders. Your health information will be used by our staff to send you
appointment reminders.

Information about Treatment. Your health information may be used to send you information
on the treatment and management of your medical condition that we may find to be of interest.
We may also send you information describing other health-related goods and service that we
believe may interest you.

Individual Rights. You have certain rights under federal privacy standards. These include:

the right to request restrictions on the use and disclosure
the right to receive confidential communications
the right to inspect and copy your protected health
the right to amend or submit corrections to your protected
the right to receive an accounting of how and whom disclosed
the right to receive a printed copy of this Notice

Vero Orthopaedics/Vero Neurology Duties. We are required by law to maintain the privacy
of your protected health information and to provide you with this Notice of Privacy Practices.

We are also required to abide by the privacy policies and practices that are outlined in this notice.

Right to Revise Privacy Practices. As permitted by law, we reserve the right to amend or
modify our privacy policies and practices. These changes in our policies and practices may be
required by changes in federal and state laws and regulations. The revised policies and practices
will be applied to all protected health information that we maintain.

Requests to Inspect Protected Health Information. As permitted by federal regulation, we
require that requests to inspect or copy protected health information be submitted in writing. You
may obtain a form to request access to your records by contacting our Privacy Officer. There
may be a charge for this service.

Complaints. If you would like to submit a comment or complaint about our privacy practices,
you can do so by sending a letter outlining your concerns to:

Privacy Officer
Vero Orthopaedics/Vero Neurology
1155 35th Lane, Suite 100
Vero Beach, Florida 32960

If you believe that your privacy rights have been violated, you should call the matter to our
attention by sending a letter describing the cause of your concern to the same address. You will
not be penalized or otherwise retaliated against for filing a complaint.

Contact Person. The name and address of the person you can contact for further information
concerning our privacy practice is as-noted above, or telephone numbers is (772) 569-2330.

Effective Date. This Notice is effective on or after January 13, 2003