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

Uses and Disclosures
Advanced Patient Advocacy's ("APA's") goal is to assist you in determining eligibility for government-sponsored programs and then to get you enrolled if eligible. To do this we must collect a certain amount of information about you. The type of information collected may vary, but in general we will be seeking information about your name, birth date, social security number, employment history, health history, current financial situation, and dependents. In most cases, you are the primary source of this information.

Occasionally, we may also collect or verify information by contacting others, such as medical professionals, banks, state/county records offices, insurance companies, or members of your family. Our goal is to collect no more information than is absolutely necessary to process your application. APA may collect information by letter, by telephone, or by personal contact.

APA will sometimes need to disclose personal information (including financial and medical information) and/or privileged information about you to third parties who will be either assisting with or processing your eligibility application. Additionally, all information provided to us may be shared with the healthcare provider where your recent medical treatment occurred. Information about your eligibility application will be used by your healthcare provider to secure payment on your outstanding medical bills. Examples of organizations to which we may disclose your information include: banks, medical professionals, healthcare facilities, state health departments, service support organizations, law enforcement and regulatory officials.

While working with us, you will be asked to sign an authorization that says we have your permission to collect and disclose your personal information as described above. You have the right to revoke this authorization at any time. Revoking your authorization may impede the eligibility and enrollment process of benefit programs and may result in your inability to obtain benefits. A request to revoke the authorization must be submitted in writing to the Privacy Officer at the following address:
Advanced Patient Advocacy, LLC, 1025 Boulders Parkway Suite 400, Richmond, VA 23225

APA is dedicated to protecting your personal information and has instituted a number of policies and practices to help ensure the security of this information. Paper files are stored in secure locked storage areas and electronic information is protected by firewalls, passwords and encryption. Employees are trained and provided with written policies and procedures designed to limit access to your personal information. We understand how important it is to protect your privacy, and will continue to make this a top priority. We will never disclose your information for the purpose of marketing.

Your Rights
You may request to restrict us from using or disclosing any of the information we collect. However, we may deny your request if the restriction impedes the eligibility or enrollment process. If you have requested confidential communication from your healthcare provider, we will abide by that request.

It is your right to inspect and copy any of the information we collect. However, in compliance with restrictions placed on our clients by the Health Insurance Portability and Accountability Act, Advanced Patient Advocacy is unable to release copies of your medical records directly to you. A copy can be requested from the healthcare provider. Additionally, any requests to amend your health information can be made to your healthcare provider.

You are entitled to an accounting of any use or disclosure of any information we have collected. It is also your right to receive a copy of this notice in both paper and electronic formats.

Our Responsibilities
We are required by law to maintain the privacy of your protected health information and to provide you with information outlining our legal responsibilities and practices regarding the privacy of your health information. It is our responsibility to abide by the terms of this notice as it is written. We reserve the right to change this policy as necessary but will inform you of any such changes during your next visit.

Complaints
If you have questions and would like additional information, you may contact the Privacy Officer at 804-272-6001x17 or 877-272-6001 (toll free). If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.