Notice of Privacy Practices
Effective April
1, 2003
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.
Overview
Our office uses health information about you for treatment,
to obtain payment for treatment, for administrative purposes,
and to evaluate the quality of care that you receive. Your
health information is contained in a medical record that is
the physical property of our practice.
The law requires us to maintain the privacy of your protected
health information ("PHI") in accordance with this Notice of
Privacy Practices ("Notice"), as long as this Notice remains
in effect. We are also required to provide you with a copy
of this Notice, which contains our privacy practices, our legal
duties, and your rights concerning your PHI.
From time to time, we may revise our privacy practices and
the terms of our Notice at any time, as permitted or required
by applicable law. We reserve the right to apply a change in
our policies to previously received PHI . We will promptly
revise and distribute our Notice whenever there is a material
change to the uses or disclosures, your individual rights,
our legal duties, or other privacy practices stated in this
Notice. We will mail a copy of the revised Notice to the address
of record.
Our Privacy Practices
Use and Disclosure. We may use or disclose your PHI for treatment, payment,
or health care operations. For your convenience, we have provided the following
examples of such potential uses or disclosures:
Treatment. Your PHI may be used to provide you with
medical treatment for services. For example, information obtained
by a health care provider, such as a physician, nurse, or other
person providing health care services to you, will record information
in your record that is related to your treatment. This information
is necessary for health care providers to determine what treatment
you should receive.
Payment. Your PHI may be used or disclosed in order
to collect payment for the medical services provided to you.
For example, a bill may be sent to you or a third-party payor,
such as an insurance company or health plan. The information
on the bill may contain information that identifies you, your
diagnosis, and treatment or supplies used in the course of
treatment.
Health Care Operations . Your PHI may be used or
disclosed as part of our internal health care operations. Such
health care operations may include, among other things, quality
of care audits of our staff and affiliates, conducting training
programs, accreditation, certification, licensing, or credentialing
activities.
Authorizations. We will not use or disclose your medical information
for any reason except those described in this Notice, unless
you provide us with a written authorization to do so. We may
request such an authorization to use or disclose your PHI for
any purpose, but you are not required to give us such authorization
as a condition of your treatment. Any written authorization
from you may be revoked by you in writing at any time, but
such revocation will not affect any prior authorized uses or
disclosures.
Patient Access. We will provide you with access to your PHI,
as described below in the Individual Rights section of this
Notice. With your permission, or in some emergencies, we may
disclose your PHI to your family members, friends, or other
people to aid in your treatment or the collection of payment.
A disclosure of your PHI may also be made if we determine it
is reasonably necessary or in your best interests for such
purposes as allowing a person acting on your behalf to receive
filled prescriptions, medical supplies, X rays, etc.
Locating Responsible Parties. Your PHI may be disclosed in
order to locate, identify or notify a family member, your personal
representative, or other person responsible for your care.
If we determine in our reasonable professional judgment that
you are capable of doing so, you will be given the opportunity
to consent to or to prohibit or restrict the extent or recipients
of such disclosure. If we determine that you are unable to
provide such consent, we will limit the PHI disclosed to the
minimum necessary.
Disasters. We may use or disclose your PHI to any public or
private entity authorized by law or by its charter to assist
in disaster relief efforts.
Required by Law. We may use or disclose your medical information
when we are required to do so by law. For example, your PHI
may be released when required by privacy laws, work-related
injuries or illness, public health laws, court or administrative
orders, subpoenas, certain discovery requests, or other laws,
regulations or legal processes. Under certain circumstances,
we may make limited disclosures of PHI directly to law enforcement
officials or correctional institutions regarding an inmate,
lawful detainee, suspect, fugitive, material witness, missing
person, or a victim or suspected victim of abuse, neglect,
domestic violence or other crimes. We may disclose your PHI
to the extent reasonably necessary to avert a serious threat
to your health or safety or the health or safety of others.
We may disclose your PHI when necessary to assist law enforcement
officials to capture a third party who has admitted to a crime
against you or who has escaped from lawful custody.
Deceased Persons. After your death, we may disclose your PHI
to a coroner, medical examiner, funeral director, or organ
procurement organization in limited circumstances.
Research. Your PHI may also be used or disclosed for research
purposes only in those limited circumstances not requiring
your written authorization, such as those that have been approved
by an institutional review board that has established procedures
for ensuring the privacy of your PHI.
Military and National Security. We may disclose to military
authorities the medical information of Armed Forces personnel
under certain circumstances. When required by law, we may disclose
your PHI for intelligence, counterintelligence, and other national
security activities.
Appointments . We may contact you to provide appointment reminders
or information about treatment alternatives or other health-related
benefits and services that may be of interest to you.
Your Individual Rights
Access and Copies. In most cases, you have the right to review or to purchase
copies of your PHI by requesting access or copies in writing to our Privacy
Officer. Please contact our Privacy Officer regarding our copying fees.
Disclosure Accounting. You have the right to receive an accounting
of the instances, if any, in which your PHI was disclosed for
purposes other than those described in the following sections
above: Use and Disclosures, Patient Access, and Locating Responsible
Parties. For each 12-month period, you have the right to receive
one free copy of an accounting certain details surrounding
such disclosures that occurred after April 13, 2003. If you
request a disclosure accounting more than once in a 12-month
period, we will charge you a reasonable, cost-based fee for
each additional request. Please contact our Privacy Officer
regarding these fees.
Additional Restrictions. You have the right to request that
we place additional restrictions on our use or disclosure of
your PHI, but we are not required to honor such a request.
We will be bound by such restrictions only if we agree to do
so in writing signed by our Privacy Officer.
Alternate Communications. You have the right to request that
we communicate with you about your PHI by alternative means
or in alternative locations. We will accommodate any reasonable
request if it specifies in writing the alternative means or
location, and provides a satisfactory explanation of how future
payments will be handled.
Amendments to PHI. You have the right to request that we amend
your PHI. Any such request must be in writing and contain a
detailed explanation for the requested amendment. Under certain
circumstances, we may deny your request but will provide you
a written explanation of the denial. You have the right to
send us a statement of disagreement to which we may prepare
a rebuttal, a copy of which will be provided to you at no cost.
Please contact our Privacy Officer with any further questions
about amending your medical record.
Copy of Notice of Privacy Practices. Should you obtain a copy
of this Notice electronically, you may request a paper copy
of this Notice. Please contact our Privacy Officer and a copy
will be made available to you at no cost.
Our Obligations
We are required to:
- maintain the privacy of protected health information;
- provide
you with this Notice of our legal duties and privacy practices
with respect to your health information;
- abide by the terms
of this Notice;
- notify you if we are unable to agree to
a requested restriction on how your information is used
or disclosed;
- accommodate reasonable requests you may make
to communicate health information by alternative means
or at alternative locations; and
- obtain your written authorization
to use or disclose your health information for reasons
other than those listed above and permitted under law.
Complaints
If you believe we have violated your privacy rights, you may
complain to us or to the Secretary of the U.S. Department of
Health and Human Services. You may file a complaint with us
by notifying our Privacy Officer.
We support your right to protect the privacy of your medical
information. We will not retaliate in any way if you choose
to file a complaint with us or with the U.S. Department of
Health and Human Services.
Contacting Us
If you have any questions or complaints, please contact:
HIPAA Privacy Officer
Frank Schatz , CEO
1700 Whitehorse-Hamilton
Square Rd.
Suite A-1
Hamilton Square, NJ 08690
Phone: 609-587-2020
Fax: 609-588-9545
