Page 3 (Notice of Privacy Policies)

Right To Receive An Accounting Of Disclosures Of Your Personal Health Information (continued from page 2)
We reserve our right to temporarily suspend your right to receive an accounting of disclosures to health oversight agencies or law enforcement officials, as required by law. We will provide the first accounting to you in any twelve (12) month period without charge, but will impose a reasonable cost-based fee for responding to each subsequent request for accounting within that same twelve (12) month period. All requests for an accounting shall be sent to:

Complaints
You may file a complaint with us and with the Secretary of DHHS if you believe that your privacy rights have been violated. You may submit your complaint in writing by mail or electronically to our privacy officer, Roberta Fleischman, at the office mailing address, or to the office email address provided in our WebSite, www.mcmicken.com. A complaint must name the entity that is the subject of the complaint and describe the acts or omissions believed to be in violation of the applicable requirements of HIPAA or this Privacy Policy. A complaint must be received by us or filed with the Secretary of DHHS within 180 days of when you knew or should have known that the act or omission complained of occurred. You may file your complaint directly with the Secretary of DHHS at email address ocrprivacy@os.dhhs.gov or call 202-619-0257. You will not be retaliated against for filing any complaint.

Amendments to this Privacy Policy
We reserve the right to revise or amend this Privacy Policy at any time. These revisions or amendments may be made effective for all personal health information we maintain even if created or received prior to the effective date of the revision or amendment. We will post a summary of the current notice in the office with its effective date at the top. You are entitled to a copy of the notice currently in effect. This notice will also be posted on our WebSite, www.mcmicken.com, within 60 days of the effective date of such revision, amendment, or change.

On-going Access to Privacy Policy
We will provide you with a copy of the most recent version of this Privacy Policy at any time upon your written request sent to:

or at the following email address: whmcmicken@aol.com. For any other requests or for further information regarding the privacy of your personal health information, and for information regarding the filing of a complaint with us, please contact our privacy officer Roberta Fleischman at the address, telephone number 215-947-6470, or e-mail address listed above.

William H. McMicken

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