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NOTICE OF PRIVACY PRACTICES

YORK PAIN CONSULTANTS, LLC, PA
519 US Route 1, York, ME 03909
207-363-4114

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.

If you have any questions about this Notice please contact
our Privacy Officer who is Christopher J. Delorie, DO

This Notice of Privacy Practices describes how we may use and disclose your
protected health information to carry out treatment, payment or health care operations
and for other purposes that are permitted or required by law. It also describes your
rights to access and control your protected health information. “Protected health
information” is information about you, including demographic information, that may
identify you and that relates to your past, present or future physical or mental health or
condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices. We may
change the terms of our notice, at any time. The new notice will be effective for all
protected health information that we maintain at that time. Upon your request, we will
provide you with any revised Notice of Privacy Practices. You may request a revised
version by accessing our website, or calling the office and requesting that a revised
copy be sent to you in the mail or asking for one at the time of your next appointment.

1.        USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Your protected health information may be used and disclosed by your physician, our
office staff and others outside of our office who are involved in your care and treatment
for the purpose of providing health care services to you. Your protected health
information may also be used and disclosed to pay your health care bills and to
support the operation of your physician’s practice.

Following are examples of the types of uses and disclosures of your protected health
information that your physician’s office is permitted to make. These examples are not
meant to be exhaustive, but to describe the types of uses and disclosures that may be
made by our office.

Treatment: We will use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services. This includes the
coordination or management of your health care with another provider. For example,
we would disclose your protected health information, as necessary, to a home health
agency that provides care to you. We will also disclose protected health information to
other physicians who may be treating you. For example, your protected health
information may be provided to a physician to whom you have been referred to ensure
that the physician has the necessary information to diagnose or treat you. In addition,
we may disclose your protected health information from time-to-time to another
physician or health care provider (e.g., a specialist or laboratory) who, at the request of
your physician, becomes involved in your care by providing assistance with your health
care diagnosis or treatment to your physician.

Payment: Your protected health information will be used and disclosed, as needed, to
obtain payment for your health care services provided by us or by another provider.
This may include certain activities that your health insurance plan may undertake
before it approves or pays for the health care services we recommend for you such as:
making a determination of eligibility or coverage for insurance benefits, reviewing
services provided to you for medical necessity, and undertaking utilization review
activities. For example, obtaining approval for a hospital stay may require that your
relevant protected health information be disclosed to the health plan to obtain approval
for the hospital admission.

Health Care Operations: We may use or disclose, as needed, your protected health
information in order to support the business activities of your physician’s practice.
These activities include, but are not limited to, quality assessment activities, employee
review activities, training of medical students, licensing, fundraising activities, and
conducting or arranging for other business activities.

We will share your protected health information with third party “business associates”
that perform various activities (for example, billing or transcription services) for our
practice. Whenever an arrangement between our office and a business associate
involves the use or disclosure of your protected health information, we will have a
written contract that contains terms that will protect the privacy of your protected health
information.

We may use or disclose your protected health information, as necessary, to provide
you with information about treatment alternatives or other health-related benefits and
services that may be of interest to you. You may contact our Privacy Officer to request
that these materials not be sent to you.

We may use or disclose your demographic information and the dates that you received
treatment from your physician, as necessary, in order to contact you for fundraising
activities supported by our office. If you do not want to receive these materials, please
contact our Privacy Officer and request that these fundraising materials not be sent to
you.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your
Authorization or Opportunity to Agree or Object

We may use or disclose your protected health information in the following situations
without your authorization or providing you the opportunity to agree or object. These
situations include:

Required By Law: We may use or disclose your protected health information to the
extent that the use or disclosure is required by law. The use or disclosure will be
made in compliance with the law and will be limited to the relevant requirements of the
law. You will be notified, if required by law, of any such uses or disclosures.

Public Health: We may disclose your protected health information for public health
activities and purposes to a public health authority that is permitted by law to collect or
receive the information. For example, a disclosure may be made for the purpose of
preventing or controlling disease, injury or disability.

Communicable Diseases: We may disclose your protected health information, if
authorized by law, to a person who may have been exposed to a communicable
disease or may otherwise be at risk of contracting or spreading the disease or
condition.

Health Oversight: We may disclose protected health information to a health oversight
agency for activities authorized by law, such as audits, investigations, and inspections.
Oversight agencies seeking this information include government agencies that
oversee the health care system, government benefit programs, other government
regulatory programs and civil rights laws.

Abuse or Neglect: We may disclose your protected health information to a public
health authority that is authorized by law to receive reports of child abuse or neglect. In
addition, we may disclose your protected health information if we believe that you have
been a victim of abuse, neglect or domestic violence to the governmental entity or
agency authorized to receive such information. In this case, the disclosure will be
made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration: We may disclose your protected health information to a
person or company required by the Food and Drug Administration for the purpose of
quality, safety, or effectiveness of FDA-regulated products or activities including, to
report adverse events, product defects or problems, biologic product deviations, to
track products; to enable product recalls; to make repairs or replacements, or to
conduct post marketing surveillance, as required.

Legal Proceedings: We may disclose protected health information in the course of any
judicial or administrative proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure is expressly authorized), or in
certain conditions in response to a subpoena, discovery request or other lawful
process.

Law Enforcement: We may also disclose protected health information, so long as
applicable legal requirements are met, for law enforcement purposes. These law
enforcement purposes include (1) legal processes and otherwise required by law, (2)
limited information requests for identification and location purposes, (3) pertaining to
victims of a crime, (4) suspicion that death has occurred as a result of criminal
conduct, (5) in the event that a crime occurs on the premises of our practice, and (6)
medical emergency (not on our practice’s premises) and it is likely that a crime has
occurred.

Coroners, Funeral Directors, and Organ Donation: We may disclose protected health
information to a coroner or medical examiner for identification purposes, determining
cause of death or for the coroner or medical examiner to perform other duties
authorized by law. We may also disclose protected health information to a funeral
director, as authorized by law, in order to permit the funeral director to carry out their
duties. We may disclose such information in reasonable anticipation of death.
Protected health information may be used and disclosed for cadaveric organ, eye or
tissue donation purposes.

Research: We may disclose your protected health information to researchers when
their research has been approved by an institutional review board that has reviewed
the research proposal and established protocols to ensure the privacy of your
protected health information.

Criminal Activity: Consistent with applicable federal and state laws, we may disclose
your protected health information, if we believe that the use or disclosure is necessary
to prevent or lessen a serious and imminent threat to the health or safety of a person
or the public. We may also disclose protected health information if it is necessary for
law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security: When the appropriate conditions apply, we may
use or disclose protected health information of individuals who are Armed Forces
personnel (1) for activities deemed necessary by appropriate military command
authorities; (2) for the purpose of a determination by the Department of Veterans Affairs
of your eligibility for benefits, or (3) to foreign military authority if you are a member of
that foreign military services. We may also disclose your protected health information
to authorized federal officials for conducting national security and intelligence activities,
including for the provision of protective services to the President or others legally
authorized.

Workers’ Compensation: We may disclose your protected health information as
authorized to comply with workers’ compensation laws and other similar legally-
established programs.

Inmates: We may use or disclose your protected health information if you are an
inmate of a correctional facility and your physician created or received your protected
health information in the course of providing care to you.

Uses and Disclosures of Protected Health Information Based upon Your Written
Authorization

Other uses and disclosures of your protected health information will be made only with
your written authorization, unless otherwise permitted or required by law as described
below. You may revoke this authorization in writing at any time. If you revoke your
authorization, we will no longer use or disclose your protected health information for
the reasons covered by your written authorization. Please understand that we are
unable to take back any disclosures already made with your authorization.

Other Permitted and Required Uses and Disclosures That Require Providing You the
Opportunity to Agree or Object

We may use and disclose your protected health information in the following instances.
You have the opportunity to agree or object to the use or disclosure of all or part of your
protected health information. If you are not present or able to agree or object to the use
or disclosure of the protected health information, then your physician may, using
professional judgement, determine whether the disclosure is in your best interest.

Facility Directories: Unless you object, we will use and disclose in our facility directory
your name, the location at which you are receiving care, your general condition (such
as fair or stable), and your religious affiliation. All of this information, except religious
affiliation, will be disclosed to people that ask for you by name. Your religious affiliation
will be only given to a member of the clergy, such as a priest or rabbi.

Others Involved in Your Health Care or Payment for your Care: Unless you object, we
may disclose to a member of your family, a relative, a close friend or any other person
you identify, your protected health information that directly relates to that person’s
involvement in your health care. If you are unable to agree or object to such a
disclosure, we may disclose such information as necessary if we determine that it is in
your best interest based on our professional judgment. We may use or disclose
protected health information to notify or assist in notifying a family member, personal
representative or any other person that is responsible for your care of your location,
general condition or death. Finally, we may use or disclose your protected health
information to an authorized public or private entity to assist in disaster relief efforts
and to coordinate uses and disclosures to family or other individuals involved in your
health care.

2.        YOUR RIGHTS

Following is a statement of your rights with respect to your protected health information
and a brief description of how you may exercise these rights.

You have the right to inspect and copy your protected health information. This means
you may inspect and obtain a copy of protected health information about you for so long
as we maintain the protected health information. You may obtain your medical record
that contains medical and billing records and any other records that your physician and
the practice uses for making decisions about you. As permitted by federal or state law,
we may charge you a reasonable copy fee for a copy of your records.

Under federal law, however, you may not inspect or copy the following records:
psychotherapy notes; information compiled in reasonable anticipation of, or use in, a
civil, criminal, or administrative action or proceeding; and laboratory results that are
subject to law that prohibits access to protected health information. Depending on the
circumstances, a decision to deny access may be reviewable. In some
circumstances, you may have a right to have this decision reviewed. Please contact
our Privacy Officer if you have questions about access to your medical record.

You have the right to request a restriction of your protected health information. This
means you may ask us not to use or disclose any part of your protected health
information for the purposes of treatment, payment or health care operations. You may
also request that any part of your protected health information not be disclosed to
family members or friends who may be involved in your care or for notification
purposes as described in this Notice of Privacy Practices. Your request must state the
specific restriction requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request. If your
physician does agree to the requested restriction, we may not use or disclose your
protected health information in violation of that restriction unless it is needed to provide
emergency treatment. With this in mind, please discuss any restriction you wish to
request with your physician. You may request a restriction by submitting it to our
Privacy Officer (in writing).

You have the right to request to receive confidential communications from us by
alternative means or at an alternative location. We will accommodate reasonable
requests. We may also condition this accommodation by asking you for information as
to how payment will be handled or specification of an alternative address or other
method of contact. We will not request an explanation from you as to the basis for the
request. Please make this request in writing to our Privacy Officer.

You may have the right to have your physician amend your protected health
information.   This means you may request an amendment of protected health
information about you in a designated record set for so long as we maintain this
information. In certain cases, we may deny your request for an amendment. If we deny
your request for amendment, you have the right to file a statement of disagreement
with us and we may prepare a rebuttal to your statement and will provide you with a
copy of any such rebuttal. Please contact our Privacy Officer if you have questions
about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any,
of your protected health information. This right applies to disclosures for purposes
other than treatment, payment or health care operations as described in this Notice of
Privacy Practices. It excludes disclosures we may have made to you if you authorized
us to make the disclosure, for a facility directory, to family members or friends involved
in your care, or for notification purposes, for national security or intelligence, to law
enforcement (as provided in the privacy rule) or correctional facilities, as part of a
limited data set disclosure. You have the right to receive specific information regarding
these disclosures that occur after April 14, 2003. The right to receive this information is
subject to certain exceptions, restrictions and limitations.

You have the right to obtain a paper copy of this notice from us, upon request, even if
you have agreed to accept this notice electronically.

3.        COMPLAINTS

You may complain to us or to the Secretary of Health and Human Services if you
believe your privacy rights have been violated by us. You may file a complaint with us
by notifying our Privacy Officer of your complaint. We will not retaliate against you for
filing a complaint.

You may contact our Privacy Officer, Christopher J. Delorie, DO, at (207) 363-4114 for
further information about the complaint process.

This notice was published and becomes effective on June 7, 2005.