Duraline Medical Products, Inc.
NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003

THIS NOTICE DESCRIBES HOW MEDICAL AND HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

USE AND DISCLOSURE OF HEALTH INFORMATION

We have limited rights to use and/or disclose your Protected Health Information (PHI) for the purposes of providing you treatment, obtaining payment for your care and conducting health care operations. We have established policies to guard against unnecessary disclosure of your health information.

The following is a summary of when and why your health information may be used and disclosed:

1. To Provide Treatment.For example, we may release health information about you to health care providers such as doctors, nurses, therapists, and social workers who take care of you.
2. To Obtain Payment. For example, we may contact your insurance facility, health plan, or another third party to obtain payment for products we provided to you.
3. To Conduct Health Care Operations. For example, for auditing, care planning, treatment, and review purposes. Also, when legally required to do so by Federal, State or local law.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION

For uses and disclosures of your protected health information beyond treatment, payment and operation purposes, we are required to have your written authorization, except as permitted by law. If you or your representative authorizes us to use or disclose your health information, you may revoke that authorization in writing at any time.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION

You have the following rights concerning the use or disclosure of your protected health information that we create or that we may maintain on our premises:

1. Right to request restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on our disclosure of your health information to someone who is involved in your care or the payment of your care. However, we are not required to agree to your request, but will make reasonable efforts to do so.
2. Right to receive confidential communications. You have the right to request that we communicate with you in a certain way. For example, you may request that we not send any health information about you to a family member’s address. We will not request that you provide any reasons for your request and will attempt to honor your reasonable request for confidential communications.
3. Right to inspect and copy your health information. You have the right to request that we provide you with a listing of when, to whom, for what purpose, and what content of your protected health information we have released over a specific period of time. This accounting will not include any information we have made for the purposes of treatment, payment, or health care operations. If you request a copy of your health information, we may charge a reasonable fee for copying and assembling costs associated with your request.
4. Right to amend health care information.You have the right to request we amend your records, if you believe that your health information is incorrect or incomplete. That request may be made as long as the information is maintained by us. The request must be made in writing and include a reason for amendment. In certain cases, we may deny your request for an amendment. For example, if the records were not created by us, if the records you are requesting are not part of our records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, in our opinion, the records containing your health information are accurate and complete.
5. Right to know what disclosures have been made. You or your representative have the right to request an accounting of disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. The request must be made in writing, and should specify the time period for the accounting starting on or after April 14, 2003. We may charge a reasonable fee for copying and assembling costs associated with your request.
6. Right to a paper copy of this notice. You or your representative has a right to a separate paper copy of this Notice at any time even if you or your representative has received this Notice previously.

We are required by law to maintain the privacy of your health information and to provide to you and your representative with this Notice of its duties and privacy practices. We are required to abide by the terms of this Notice as may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains. If we change this Notice, we will provide a copy of the revised Notice to you or your appointed representative.

WHERE TO FILE A COMPLAINT

You have the right to express complaints to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. Any complaints to us should be made in writing to Kathy Peck, HIPAA Compliance Officer, at 324 Werner St. PO Box 67, Leipsic, OH 45856, or call (800) 654-3376 ext. 260. for further information. You will not be retaliated against in any way for filing a complaint. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave. S.W., Washington, D.C., or call (877) 696-6775.

EFFECTIVE DATE
This Notice is effective April 14, 2003.