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.

Core Services, Inc. is required by law to maintain the privacy of your health information and to provide you
with notice of its legal duties and privacy practices with respect to your health information. If you have
questions about any part of this notice or if you want more information about the privacy practices at Core Services, INC. please contact: Molly Mebruer, Business Manager Core Services, INC., (314) 647-4880

Effective Date of This Notice: APRIL 15, 2003

I. How Core Services, INC. may Use or Disclose Your Health Information
Core Services collects health information from you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of CORE SERVICES, INC, but the information in the medical record belongs to you. CORE SERVICES, INC protects the privacy of your health information. The law permits CORE SERVICES, INC to use or disclose your health information for the following purposes:

1. Treatment. Treatment means the provision, coordination, or management of health care and related services by one or more healthcare providers, including the coordination or management of health care by a healthcare provider with a third party; consultation between healthcare providers relating to a patient. An example of this would be a consultation and/or a discussion with your physician regarding your plan of care, progress, or status.

2. Payment. Payment means reimbursement for the provision of health care; determinations of eligibility or coverage; billing;, claims management; collection activities, justification of charges; protected health information relating to the collection of reimbursements (only certain information may be disclosed). An example of this would be submitting your bill for health care services to your insurance company.

3. Regular Health Care Operations. Health care operations are any activity related to covered functions in which we participate in the function of our office, such as conducting quality assessment activities; protocol development; case management and care coordination; auditing functions; business management and general administrative activities, including implementation of this regulation; customer service evaluations; resolution of grievances; and marketing for which an authorization is not required. An example of this would be an evaluation of customer service given to patients.

4. Information provided to you.

5. Notification and communication with family. We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.

6. Required by law/ Law Enforcement. As required by law, we may use and disclose your health information,i.e.: to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.

7. Public health. As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.

8. Health oversight activities. We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.

9. Judicial and administrative proceedings. We may disclose your health information in the course of any administrative or judicial proceeding.

10. Worker’s compensation. We may disclose your health information as necessary to comply with worker’s compensation laws.

II. When Core Services May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, Core Services will not use or disclose your health information without your written authorization. If you do authorize Core Services to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.

III. Your Health Information Rights
1. You have the right to request restrictions on certain uses and disclosures of your health information. Core Services is not required to agree to the restriction that you requested.

2. You have the right to receive your health information through a reasonable alternative means or at an alternative location.

3. You have the right to inspect and copy your health information.

4. You have a right to request that Core Services amend your health information that is incorrect or incomplete. Core Services is not required to change your health information and will provide you with information about Core Services denial and how you can disagree with the denial.

5. You have a right to receive an accounting of disclosures of your health information made by Core Services, except that Core Services does not have to account for the disclosures described in parts 1 (treatment), 2 (payment), 3 (health care operations), 4 (information provided to you), 5 (directory listings) and 16 (certain government functions) of section I of this Notice of Privacy Practices.

6. You have a right to a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact Molly Mebruer, Business Manager, Core Services at (314) 647-4880.

IV. Changes to this Notice of Privacy Practices
Core Services reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment. Until such amendment is made, Core Services is required by law to comply with this Notice. Revised notices will be given at any time requested.

V. Complaints
Complaints about this Notice of Privacy Practices or how Core Services handles your health information should be directed to: Molly Mebruer, Business Manager, Core Services at (314)647-4880. If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your compliant to one of the regional Offices for Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.