GULF COAST ENDOSCOPY CENTER, INC.
FORT MYERS, FLORIDA

Treatment: We will use and disclose your health information to provide you with medical treatment or services. For example, nurses, physicians, and other members of your treatment team will record information in your record and use it to determine the most appropriate course of care. We may also disclose the information to other health care providers who are participating in your treatment, to pharmacists who are filling your prescriptions, and to family members who are helping with your care. Payment: We will use and disclose your health information for payment purposes. For example, we may need to obtain authorization from your insurance company before providing certain types of treatment or disclose your information to payors to determine whether you are enrolled or eligible for benefits. We will submit bills and maintain records of payments from your health plan. We may be required or permitted to use or disclose the information even without your permission as described below: Public Health Activities: We may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities. Business Associates: We may disclose your health information to business associates (individuals or entities that perform functions on our behalf) provided they agree to safeguard the information. Messages: We may contact you to provide appointment reminders or for billing or collections and may leave messages on your answering machine, voicemail or through other methods. In any other situation, we will ask for your written authorization before using or disclosing identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures. Subject to compliance with limited exceptions, we will not use or disclose psychotherapy notes, use or disclose your health information for marketing purposes or sell your health information, unless you have signed an authorization. You may request restrictions on certain uses and disclosures. We are not required to agree to a requested restriction, except for requests to limit disclosures to your health plan for purposes of payment or health care operations when you have paid in full, out-of-pocket for the item or service covered by the request and when the uses or disclosures are not required by law. We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect. We are required to notify affected individuals in the event of a breach involving unsecured protected health information. If you are concerned that we have violated your privacy rights, you may contact the Center Leader. You also may send a written complaint to the U.S. Department of Health and Human Services. The Center Leader will provide you with the appropriate address upon request. You will not be penalized in any way for filing a complaint. Welcome to Gulf Coast Endoscopy Center We are located in South Fort Myers, Florida. The Center is majority owned and operated by AmSurg Corporation and minority owned by local gastroenterologists. The Center provides a choice for patients who previously were required to go to the hospital for their endoscopic procedures. This choice is endorsed by most commercial insurances and Medicare as an excellent opportunity to reduce the cost of health care while maintaining the highest standards. This choice provides for the diagnosis and treatment of digestive complaints in a painless, safe, cost effective manner. Please take a moment to browse the web site and learn more about our center. There are many excellent reasons to choose Gulf Coast Endoscopy Center over our competitors. We provide advanced medical care to patients through the comprehensive evaluation, diagnosis and treatment of gastrointestinal disorders and liver disease. Our It will not go to a physician and is only monitored during normal business hours.