ACTION MEDICAL STAFFING, INC. HIPAA PRIVACY NOTICE
EMPLOYEE

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.

INTRODUCTION: Protected health information is individually identifiable information maintained or transmitted through any medium. It relates to an individual’s past, present, or future physical or mental health or healthcare. Health information is individually identifiable if it identifies you, a client or a coworker by name and must be protected. Other identifiable information that must be protected include address, Social Security number, dates of service, telephone number, e-mail address or vehicle identification number.
This Notice of Privacy Practices describes how we maintain the confidentiality of protected health information and informs you about the possible uses and disclosures of such information. It also informs you about your rights with respect to your protected health information.

OUR RESPONSIBILITIES: We are required by federal and state law to maintain the privacy of your protected health information. We are also required by law to provide you with this Notice of Privacy Practices that describes our legal duties and privacy practices with respect to your protected health information. We will abide by the terms of this Notice of Privacy Practices. We reserve the right to change this or any future Notice of Privacy Practices and to make the new notice provisions effective for all protected health information that we maintain, including protected health information already in our possession. If we change our Notice of Privacy Practices, we will personally deliver or mail a revised notice to you at your current address. In addition, the notice will be posted in a clear and prominent place in the Action Medical Staffing, Inc. office and on the company’s website (www.actionmedicalstaffing.com).

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION

Licensing and Accreditation: We may disclose your protected health information to any government or private agency, such as to the federal centers for Medicare and Medicaid services, responsible for licensing or accrediting Action Medical Staffing, Inc., so that the agency can carry out its oversight activities. These oversight activities include audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight.

Disaster Relief: We may disclose your protected health information to a public or private entity authorized to assist in disaster relief efforts.

Business Associates: We may contract with certain individuals or entities to provide services on our behalf. Examples include data processing, quality assurance, legal, or accounting services. We may disclose your protected health information to a business associate, as necessary, to allow the business associate to perform its functions on our behalf. We will have a contract with our business associates that obligate the business associates to maintain the confidentiality of your protected health information.

Public Health Activities: We may disclose your protected health information to any public health authority that is authorized by law to collect it for purposes of preventing or controlling injury or disability. We will immediately disclose protected health information to the Florida Department of Health where we diagnose or suspect the existence of a disease of public health significance.

Coroner, Medical Examiner, or Funeral Director: We may disclose protected health information to a coroner, medical examiner, or funeral director to allow them to carry out their duties.

Court Order; Order of Administrative Tribunal: We will disclose protected health information in accordance with an order of a court or of an administrative tribunal of a government agency.

Subpoena: We will disclose protected health information in accordance with a valid subpoena issued by a party to adjudication before a court, an administrative tribunal, or a private arbitrator. Reasonable efforts will be made to notify you of the subpoena, or of efforts to obtain an order or agreement protecting your protected health information. Law Enforcement Agencies: We will disclose protected health information to law enforcement agencies in accordance with a search warrant, a court order or court-ordered subpoena, or an investigative subpoena or summons.

Other Disclosures Required by Law: We will disclose protected health information about an employee when otherwise required by law.

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION

You have the following rights with respect to your protected health information. To exercise these rights, contact us at the following address:
Action Medical Staffing, Inc., 500 South Florida Ave Suite 402, Lakeland, Florida 33801, c/o Administrator.

Right to Request Access: You have the right to inspect and copy your health records maintained by us. This includes the right to have electronic records made available in electronic format to you or to someone whom you designate. In certain limited circumstances, we may deny your request as permitted by law. However, you may be given an opportunity to have such denial reviewed by an independent licensed health care professional.

Right to Request Amendment: You have the right to request an amendment to your health records maintained by us. If your request for an amendment is denied, you will receive a written denial, including the reasons for such denial, and an opportunity to submit a written statement disagreeing with the denial.

Right to Request Special Privacy Protections: You have the right to request restrictions on the use and disclosure of your protected health information for treatment, payment, or health care operations, or providing notifications regarding your identity and status to persons inquiring about or involved in your care. We are generally not required to grant your request, but if we do, we will comply with your request, except in an emergency situation or until the restriction is terminated by you or us. You also have the right to request that we communicate protected health information to the recipient by alternative means or at alternative locations.

Right to an Accounting: You have the right to receive an accounting of disclosures of your protected health information created and maintained by us over the six years prior to the date of your request or for a lesser period. We are not required to provide an accounting of certain routine disclosures or of disclosures of which you are already aware.

Right to Receive a Copy of the Notice of Privacy Practices: You have the right to request and receive a copy of our Notice of Privacy Practices far Protected Health Information in written or electronic form. If you have received this Notice of Privacy Practices in electronic form, you also have a right to receive a copy in written form upon request.

NOTICE OF SECURITY BREACHES: We will provide you with written notification in the event of a security breach involving your Protected Health Information. The notification will describe what happened, the types of information involved, the steps that we are taking to deal with the situation, what you should do to protect yourself against any harmful consequences, and contacts for obtaining further information.

COMPLAINTS: If you believe that your privacy rights have been violated, you may file a complaint with us at the following address: Action Medical Staffing, Inc., 500 South Florida Ave Suite 402, Lakeland, Florida 33801, or call (863) 616-3421 and ask for the Administrator. You also have the right to submit a complaint to the Secretary of the U.S. Department of Health and Human Services, Atlanta Federal Center, Suite 3B70, 61 Forsyth Street, S.W., Atlanta, GA 30303-8909, Attention OCR Regional Manager. We will not retaliate against you if you file a complaint.

YOUR RESPONSIBILITIES: During your employment, you may come in contact with the PHI of coworkers and/or clients. Agency policy restricts information access to those having a legitimate business need, and requires all who have access to such information acknowledge that:

• Information entrusted to or maintained by Action Medical Staffing, Inc. will be accessed for legitimate business reasons only and on an as-needed basis.

• Information entrusted to or maintained by Action Medical Staffing, Inc. will not be disclosed to any individual, group, organization, and/or office beyond the boundaries of the “need to know” in order to accomplish legitimate agency business.

• A deliberate breach of the above stated confidentiality requirements may be grounds for immediate termination.

FURTHER INFORMATION: If you have questions about this Notice of Privacy Practices or would like further information about your privacy rights, contact us at the following address: Action Medical Staffing, Inc., 500 South Florida Ave Suite 402, Lakeland, FL 33801, c/o Administrator,
or call (863) 616-3421.