Ø Disclosure to Relatives, Close Friends and other Caregivers. We may use or disclose your PHI to a family member, other relative, a close personal friend or any other person identified by you when you are present for, or otherwise available prior to, the disclosure, if we:

· Obtain your agreement;

· Provide you with the opportunity to object to the disclosure and you do not object; or

· Reasonably infer that you do not object to the disclosure

If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of your incapacity or an emergency circumstance, we may exercise our professional judgment to determine whether a disclosure is in your best interests. If we disclose information to a family member, other relative or a close personal friend, we would disclose only information that we believe is directly relevant to the person’s involvement with your health care or payment related to your health care. When relatives, close friends and other caregivers request disclosure of your PHI via a distant means (e.g., telephone, Internet, etc.), we will comply with our information security and privacy policies concerning distant inquiries. We may also disclose your PHI in order to notify (or assist in notifying) such persons of your location, general condition or death.

Ø Public Health Activities. We may disclose your PHI for the following public health activities:

· To report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability;

· To report child abuse or neglect to public health authorities or other government authorities authorized by law to receive such reports;

· To report information about products or services under the jurisdiction of the U.S. Food and Drug Administration;

· To alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and

· To report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.

Ø Victims of Abuse, Neglect or Domestic Violence. If we reasonable believe you are a victim of abuse, neglect or domestic violence, we may disclose your PHI to a governmental authority, including a social service or protective services agencies, authorized by law to receive reports of such abuse, neglect, or domestic violence.

Ø Health Oversight Activities. We may disclose your PHI to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs, such as Medicare or Medicaid.

Ø Judicial and Administrative Proceedings. We may disclose your PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process, such as, under Virginia State law, the request of a person (or his/her insurance carrier) against whom you have commenced a lawsuit for compensation or damages for your personal injuries.

Ø Law Enforcement Officials. We may disclose your PHI to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena.

Ø Decedents. We may disclose your PHI to a coroner or medical examiner as authorized by law. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about our patients to a funeral director, as necessary, to carry out their duties.

Ø Organ and Tissue Procurement. If you are or become an organ donor, we may disclose your PHI to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.

Ø Research. We may use or disclose your PHI without your consent or authorization if our Committee for the Protection of Human Subjects in Research approves a waiver of authorization for disclosure.

Ø Health or Safety. We may use or disclose your PHI to prevent or lessen a threat of imminent, serious physical violence against you or another readily identifiable individual or if there is a threat to the general public.

Ø Specialized Government Functions. We may use or disclose your PHI to units of the government with special functions, such as the U.S. military or the U.S. Department of State under certain circumstances.