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.

Shannon Medical Center, Shannon Clinic, and Shannon Business Services (collectively, "Shannon") are required by law to protect the privacy of your individual health information ("Protected Health Information" or "PHI") and to provide you with notice of our legal duties and privacy practices with respect to PHI. Shannon Medical Center may dispose of your medical records on or after the 10th anniversary on which you were last treated in the hospital.

Uses and Disclosures of Protected Health Information.

Shannon may use and disclose your PHI without your authorization for treatment, payment, and health care operations purposes either within Shannon, with health care providers, health plans, and those that process health care claims, benefits and related information. Your PHI may be exchanged electronically.

Treatment. Shannon may use and disclose your PHI for the purpose of providing, coordinating, or managing the delivery of healthcare services to you by one or more healthcare providers who are involved in taking care of you. For example, your primary care physician may consult with us regarding your condition or treatment. Shannon do not limit the use or disclosure of your PHI for purposes of your care or treatment. Otherwise, we limit use and disclosure of PHI to that which is reasonably necessary for a permitted purpose.

Payment. Shannon may use and disclose your PHI to obtain payment or reimbursement for providing healthcare services, such as when we request payment from your insurer, health plan, or a government benefit program.

Healthcare Operations. Shannon may use and disclose your PHI internally in a number of ways, including for quality assessment and improvement, for planning and development, management, and administration. Your information could be used, for example, to assist in the evaluation of the quality of services that you were provided. Healthcare operations also includes conducting training programs in which students, trainees or practitioners in areas of health care learn under supervision to practice or improve their skills.

In addition, we may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you, and we may contact you to raise funds for Shannon.

Opportunity to Object. Unless you object, Shannon may also disclose:

• Your name, location at Shannon Medical Center, and your condition, to persons who ask for you by name, and (along with your religious affiliation) to members of the clergy.
• PHI that is directly relevant their involvement with your care or payment related to your care to a member of your family or other relative, a close personal friend, or to any other person identified by you.
• PHI to notify, identify, or locate a member of your family, your personal representative, another person responsible for your care, or certain disaster relief agencies of your location, general condition, or death. If you are incapacitated, there is an emergency, or you otherwise do not have the opportunity to object to this use or disclosure, we will do what in our judgment is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person's involvement with your healthcare.
• PHI for the purpose of fundraising communications from Shannon.

Shannon will also use our judgment and experience regarding your best interest in allowing people to pick up filled prescriptions, medical supplies, test results or other similar actions involving disclosure of PHI. If you object to one of the disclosures listed above, please contact one the Privacy Officer listed below.

Authorized by Law. Shannon is also permitted to share your PHI, without your authorization, as required by law and in the following instances authorized by law.

• To public health authorities for the purposes of preventing or controlling disease or other public health purposes;
• To appropriate government authorities to report about victims of suspected abuse, neglect, or domestic violence;
• To the Food and Drug Administration to report quality, safety, or effectiveness of the FDA-regulated products or activities;
• In certain limited circumstances to an employer such as if we are asked to evaluate or treat a work-related illness or injury;
• To qualified health authorities for purposes of conducting health oversight activities;
• In response to subpoenas, discovery requests, or other lawful legal processes in the course of a judicial or administrative proceeding;
• To law enforcement authorities as required or permitted by law, such as to report a death, to report a crime on our premises, or if it appears necessary to alert law enforcement to respond to an emergency;
• In certain instances, for research purposes;
• To persons involved with respect to matters pertaining to a decedent, or relating to cadaveric organ, eye or tissue donation;
• If we believe, in good faith, that it is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public; or
• For certain specialized government functions, including to Armed Forces Authorities with reference to military personnel or for national security purposes.

Authorization. Other uses and disclosures will be made only with your written authorization, including use and disclosure of PHI for marketing purposes as well as disclosures that constitute a sale of PHI. Written authorization will generally always be required for the release of psychotherapy notes. You may revoke your authorization by notifying us by contacting our Privacy Officer as described below.

Your Privacy Rights

You may ask us to restrict uses and disclosures of your PHI to carry out treatment, payment, or healthcare operations or to restrict uses and disclosures to family members, relatives, friends, or other persons identified by you who are involved in your care or payment for your care. Shannon is not required to agree to these restrictions, except restrictions on disclosures to a health plan for payment or health care operations purposes where the disclosure pertains solely to a health care item or service for which you paid out-of-pocket. If you wish to make such a request you must advise our Privacy Officer in writing.

You may request to receive communications of PHI by alternative means or at alternative locations. Shannon will accommodate the request, if reasonable.

You have the following rights with respect to your PHI: (i) to inspect and copy this information, including an electronic health record; (ii) to request to amend this information; (iii) to receive an accounting of the disclosures of this information by us, including disclosures made using an electronic health record; and (iv) to receive a paper copy of this notice upon request.

You have the right to be notified if there has been a breach of confidentiality with respect to your unsecured PHI.

If you wish to exercise any of the above rights, you must notify our Privacy Officer, identified below, in writing.

Shannon is required to abide by the terms of the Privacy Notice that is currently in effect. Shannon reserves the right to change the terms of this notice and to make the new notice provisions effective for all PHI we maintain, including PHI that is created or received prior to issuing the revised notice. Shannon will promptly revise and distribute a new Privacy Notice wherever there is a material change to the uses or disclosures, your rights, our legal duties, or other privacy practices stated in this Notice. If we revise this Notice, the revision date will be the effective date of the Notice, and we will post the revised notice on our website: www.shannonhealth.com

If you believe your privacy rights have been violated you have the right to file a complaint with us by contacting the Privacy Officer identified below and/or to the Department of Health and Human Services by contacting its website (http://www.hhs.gov/ocr/privacyhowtofile.com) or calling them toll-free at 1-800-368-1019. Shannon will not retaliate against you in any way for the filing of a complaint.

For further information concerning our privacy policy, your privacy rights, or the complaint procedure, please contact our Privacy Officer at:

Shannon Notice of Privacy Practices/April 11, 2018