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.

Protecting your privacy
Protecting your privacy and your medical information is at the core of our business. We
recognize our obligation to keep your information secure and confidential whether on
paper or the Internet. At Signature Healthcare Foundation, Inc. (hereinafter referred to as
“Signature”), privacy is one of our highest priorities.

Keeping your information
Keeping the medical and health information we have about you secure is one of our
most important responsibilities. We value your trust and will handle your information with
care. Our employees access information about you only when necessary to provide
treatment, verify eligibility, obtain authorization, process claims and otherwise meet your
needs. We may also access information about you when considering a request from you
or when exercising our rights under the law or any agreement with you.
We safeguard information during all business practices according to established security
standards and procedures, and we continually assess new technology for protecting
information. Our employees are trained to understand and comply with these information
principles.

Working to meet your needs through information
In the course of doing business, we collect and use various types of information, like
name and address and claims information. We use this information to provide service to
you, to process your claims and to bring you health information that might be of interest
to you.

Keeping information accurate
Keeping your health information accurate and up-to-date is very important. If you believe
the health information we have about you is incomplete, inaccurate or not current,
please call or write us at the telephone numbers or addresses listed below. We take
appropriate action to correct any erroneous information as quickly as possible through a
standard set of practices and procedures.

How – and why – information is shared
We limit who receives information and what type of information is shared.

Sharing information within Signature
We share information within our company to deliver you the health care services and the related information and education programs specified in your plan.

Sharing information with companies that work for us
To help us offer you our services, we may share information with companies that work for us, such as claim processing and mailing companies and companies that deliver health
education and information directly to you. These companies act on our behalf
and are obligated contractually to keep the information that we provide them
confidential.

Other
Patient-specific personally identifiable data is released only when required
to provide a service for you and only to those with a need to know, or with your
consent. Data is released with the condition that the person receiving the data
will not release it further, unless you give permission.

If we receive a subpoena or similar legal process demanding release of information
about you, we will attempt to notify you (unless we are prohibited from doing so.) Except
as required by law or as described above, we do not share information with other
parties, including government agencies. Signature does not share any customer information with third-party marketers who offer their products and services to our patients.

Count on our commitment to your privacy
You can count on us to keep you informed about how we protect your privacy and limit
the sharing of information you provide to us – whether it’s at our office, over the phone or
through the Internet.

Signature Healthcare Foundation, Inc.
12639 Old Tesson Road
St. Louis, MO 63128
(314)849-0311