Arkansas Urology – Notice of Privacy Practices

Effective: October 3, 2025

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.

At Arkansas Urology, P.A, we are committed to treating and using protected health information (“PHI”) about you responsibly. This Notice of Privacy Practices (“Notice”) describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your PHI. This Notice has been updated in accordance with the HIPAA Omnibus Rule. It applies to all PHI as defined by federal regulations.

Arkansas Urology participates in an Organized Health Care Arrangement (“OHCA”) with local hospitals and with Centerview Surgery Center. An OHCA is an arrangement or relationship, recognized in the HIPAA privacy rules, that allows two or more Covered Entities who participate in joint activities to share the PHI about their patients in order to manage and benefit their joint operations. Arkansas Urology, PA will share PHI with participants in the OHCA for treatment, payment and health care operations of the OHCA.

Understanding Your Health Record/Information

Each time you visit Arkansas Urology, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information may be used or disclosed to:

· Plan your care and treatment,

· Communicate with other providers who contribute to your care

· Serve as a legal document

· Receive payment from you, your plan, or your health insurer

· Assess and continually work to improve the care we render and the outcomes we achieve

•  Comply with state and federal laws that require us to disclose your PHI 

 

Your Health Information Rights

Although your health record is the physical property of Arkansas Urology, PA, the information belongs to you. These are 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 access, inspect and copy your health record. You have the right to inspect and/or request a paper copy of your medical record. If the Arkansas Urology, PA office where you receive services maintains an electronic medical record (“EMR”), you have the right to access your health record in a machine-readable electronic format. You have the right to request an electronic copy of your medical record be given to you or transmitted to another individual or entity. Arkansas Urology, PA may charge you a reasonable, cost- based fee for the labor and supplies associated with copying or transmitting the electronic PHI.

· You have the right to amend your health record which you believe is not correct or complete. Arkansas Urology, PA is not required to agree to the amendment if you ask us to amend information that is in our opinion: (i) accurate and complete; (ii) not part of the PHI kept by or for Arkansas Urology, PA; (iii) not part of the PHI which you would be permitted to inspect and copy; or (iv) not created by Arkansas Urology, PA unless the individual or entity that created the information is not available to amend the information. If we deny your request, you may submit a written statement of disagreement of reasonable length. Your statement of disagreement will be included in your medical record, but we may also include a rebuttal statement.

· You have the right to obtain a written accounting of certain non-routine disclosures of your PHI. We are not required to list certain disclosures, including (i) disclosures made for treatment, payment, and health care operations purposes, (ii) disclosures made with your authorization, (iii) disclosures made to create a limited data set, and (iv) disclosures longer than six (6) years prior to the date of your request. If the Arkansas Urology, PA office where you receive services maintains your medical records in an EMR system, you may request that the accounting include disclosures for treatment, payment and health care operations for the three (3) years prior to the date of such request. You must submit your request in writing to the Privacy Officer. The first list you request within a 12-month period is free of charge, but Arkansas Urology, PA may charge you for additional lists within the same 12-month period. Arkansas Urology, PA will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

· You have the right to request communications of your PHI by alternative means (e.g. e-mail) or at alternative locations (e.g. post-office box).

· You have the right to place a restriction to certain uses and disclosures of your information. In most cases Arkansas Urology, PA is not required to agree to these additional restrictions, but if Arkansas Urology, PA does, Arkansas Urology, PA will abide by the agreement (except in certain circumstances where disclosure is required or

permitted, such as an emergency, for public health activities, or when disclosure is required by law). Arkansas Urology, PA must comply with a request to restrict the disclosure of PHI to a health plan for purposes of carrying out payment or health care operations if the PHI pertains solely to a health care item or service for which we have been paid out of pocket in full.

· You have the right to revoke your authorization to use or disclose PHI except to the extent that action has already occurred.