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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.
(This
notice is governed by the Health Insurance Portability and Accountability
Act (HIPPA) of 1996.)
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WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION
(PHI).
We are legally required
to protect the privacy of your health information.
We call this information “protected health information” or
“PHI” for short and it includes information that can be used to
identify you that we’ve created or received about your past, present, or
future health condition, the provision of health care to you, or the
payment for this health care. We must provide you with this notice about our privacy
practices that explains how, when, and why we use and disclose your PHI.
With some exceptions, we may not use or disclose any more of your
PHI than is necessary to accomplish the purpose of the use or disclosure.
We are required by law to:
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Make sure that medical information that identifies you is kept
private.
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Provide you with this notice of our legal duties and privacy
practices with respect to medical information about you.
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Follow the terms described in this notice.
However, we reserve the
right to change the terms of this notice and our privacy policies at any
time. Any changes will apply
to the PHI we already have. Before
we make an important change to our policies, we will promptly change this
notice and post a new notice in our waiting room.
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HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION.
We use and disclose
health information for many different reasons.
For some of these uses or disclosures, we need your specific
authorization. Below, we describe the different categories of uses and
disclosures.
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Uses and Disclosures That Do Not Require Your Authorization.
We may use and disclose your PHI without your
authorization for the following reasons:
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For
treatment.
We may disclose your PHI to hospitals, physicians, nurses,
or other health care personnel who provide you with health care
services or are involved in your care.
For example, if you’re being treated for a knee injury,
we may need to coordinate your care with an x-ray technician in
order to coordinate your care.
This includes pharmacists who may be provided information
on other drugs you have been prescribed to identify potential
interactions.
In emergencies, we will use and disclose you PHI to provide
the treatment you require.
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To
obtain payment for treatment.
We may use and disclose
your PHI in order to bill and collect payment for the treatment
and services provided to you.
For example, we may provide portions of your PHI to our
billing department and your health plan to get paid for the health
care services we provided to you.
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For
health care operations. We
may disclose your PHI in order to operate this practice.
For example, we may use your PHI in order to evaluate the
quality of health care services that you received or to evaluate
the performance of the health care professionals who provided
health care services to you.
We may also provide your PHI to our accountants, attorneys,
consultants, billing agency and other Business Associates in order
to make sure we’re complying with the laws that affect us.
These Business Associates will also be required to protect
your PHI. We may use
and disclose your PHI, as necessary, to contact you.
It is the policy of this office to contact patients via
telephone (at the telephone number(s) provided) to confirm the
next day’s appointment. We
will leave limited information on an answering machine, voicemail,
or with party taking a message by identifying the name of the
office and confirming the date/time of the appointment.
We may also need to contact you regarding the scheduling of
surgery, changing of appointments, reminders, etc., via telephone
at the numbers you provide to us, or via mail to your home
address. We may call you by name in the waiting room when we are
ready to see you.
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When
a disclosure is required by federal, state or local law, judicial
or administrative proceedings, or law enforcement.
For
example, we make disclosures when a law requires that we report
information to government agencies and law enforcement personnel
about victims of abuse, neglect, or domestic violence when dealing
with gunshot or other wounds, or when ordered in a judicial or
administrative proceeding.
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For
public health activities. For
example, we report information about births, deaths, and various
diseases to government officials in charge of collecting that
information, and we provide coroners, medical examiners, and
funeral directors necessary information relating to an
individual’s death.
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For
health oversight activities.
For
example, we will provide information to assist the government when
it conducts an investigation or inspection of a health care
provider or organization. We
may disclose your PHI to a person or company required by the Food
and Drug Administration (FDA) to do the following:
report adverse events, product defects, or problems and
biologic product deviations; track products; enable product
recalls; make repairs or replacements; conduct post-marketing
surveillance as required. An
example would be patients who agree to enroll in the
Silicone-Filled Breast Implant Study.
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For
purposes or organ donation. We
may notify organ procurement organizations to assist them in
organ, eye, or tissue donation and transplants.
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For
research purposes.
In certain circumstances, we may provide PHI in order to
conduct medical research.
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To
avoid harm. In
order to avoid a serious threat to the health or safety of a
person or the public, we may provide PHI to law enforcement
personnel or persons able to prevent or lessen such harm.
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For
specific government functions.
We may disclose PHI of
military personnel and veterans in certain situations.
And we may disclose PHI for national security purposes,
such as protecting the president of the United States or
conducting intelligence operations.
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For
workers’ compensation purposes.
We
may provide PHI in order to comply with workers’ compensation
laws.
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Appointment
reminders and health-related benefits or services.
We
may use PHI to provide appointment reminders or give you
information about treatment alternatives, or other health care
services or benefits we offer.
See number 3 health care operations above for
details.
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Use and Disclosure Where You Have the Opportunity to Object:
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Disclosures to family, friends, or others.
We may provide
your PHI to a family member, friend, or other person that you indicate is
involved in your care or the payment for your health care, unless you
object in whole or in part.
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All Other Uses and Disclosures Require Your Prior Written
Authorization.
In any other situation not described above, we will ask for your
written authorization before using or disclosing any of your PHI.
If you choose to sign an authorization to disclose your PHI, you
can later revoke that authorization in writing to stop any future uses and
disclosures (to the extent that we haven’t taken any action relying on
the authorization).
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Incidental Uses and Disclosures.
Incidental uses and
disclosures of information may occur.
An incidental use or disclosure is a secondary use or disclosure
that cannot reasonably be prevented, is limited in nature, and that occurs
as a by-product of an otherwise permitted use or disclosure.
However, such incidental uses or disclosure are permitted only to
the extent that we have applied reasonable safeguards and do not disclose
any more of your PHI than is necessary to accomplish the permitted use or
disclosure. For example,
disclosures about a patient at a nursing station that might be overheard
by personnel not involved in the patient’s care would be permitted.
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WHAT RIGHTS YOU HAVE REGARDING YOUR PHI
You have the following
rights with respect to your PHI:
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The
right to Request Limits on Uses and Disclosures of your PHI.
You have the right to ask that we limit how we use and disclose
your PHI. We will consider your request but are not legally required to
accept it. If we
accept your request, we will put any limits in writing and abide
by them except in emergency situations.
You may not limit the uses and disclosures that we are
legally required or allowed to make.
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The
Right to Choose Who We Send PHI to You.
You have the right to ask that we send information to you
to an alternate address (for example, sending information to your
work address rather than your home address) or by alternate means
(for example, e-mail instead of regular mail).
We must agree to your request so long as we can easily
provide it in the format you request.
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The
Right to See and Get Copies of your PHI.
In most cases, you have the right to look at or get copies
of your PHI that we have, but you must make the request in
writing. If we
don’t have your PHI but we know who does, we will tell you how
to get it. We will respond to you within 30 days after receiving your
written request. In
certain situations, we may deny your request.
If we do, we will tell you, in writing, our reasons for the
denial and explain your right to have the denial reviewed.
If you request copies of your PHI, we will charge you $1.00
for each page. Instead
of providing the PHI you requested, we may provide you with a
summary of explanation of the PHI as long as you agree to that and
to the cost in advance. Any
inspection of your PHI provided in this office will be performed
under direct supervision.
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The
Right to Get a List of the Disclosures We Have Made.
You
have the right to get a list of instances in which we have
disclosed your PHI. The
list will not include uses or disclosures that you have already
consented to, such as those made for treatment, payment, or health
care operations (TPO), directly to you, to your family, or in our
facility directory. The list also won’t include uses and disclosures made for
national security purposes, to corrections or law enforcement
personnel, or before 4/14/03.
We will respond within 60 days of receiving your request.
The list we will give you will include disclosures made in
the last 6 years unless you request a shorter time.
The list will include the date of the disclosure, to whom
PHI was disclosed (including their address, if known), a
description of the information disclosed, and the reason for the
disclosure. We will
provide the list to you at no charge, but if you make more than
one request in the same year, we will charge you $1.00 per page
for each additional request.
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The
Right To Correct or Update Your PHI.
If you believe that there is a mistake in your PHI or that
a piece of important information is missing, you have the right to
request that we correct the existing information or add the
missing information. We
will respond within 60 days of receiving your request in writing.
You must provide the request and your reason for the
request in writing. We
may deny your request in writing if the PHI is (I) correct and
complete, (II) not created by us, (III) not allowed to be
disclosed, or (IV) not part of our records.
Our written denial will state the reasons for the denial
and explain your right to file a written statement or disagreement
with the denial. If
you don’t file one, you have the right to request that your
request and our denial be attached to all future disclosures of
your PHI. If we approve your request, we will make the change to your
PHI, tell you that we have done it, and tell others that need to
know about the change to your PHI.
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The
Right to Get This Notice by E-Mail.
You have the right to get a copy of this notice by e-mail.
Even if you have agreed to receive notice via e-mail, you
also have the right to request a paper copy of this notice.
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HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES.
If you think that we
may have violated your privacy rights, or you disagree with a decision we
made about access to your PHI, you may file a complaint with the person
listed in Section VI below. You
may also send a written complaint to the Secretary of the Department of
Health and Human Services at 200 Independence Avenue, S.W., Room 615F,
Washington, D.C. 20201. We will take no retaliatory action against you if you file a
complaint about our privacy practices.
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PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN
ABOUT OUR
PRIVACY PRACTICES.
If you have any
questions about this notice or any complaints about our privacy practices,
or would like to know how to file a complaint with the Secretary of the
Department of Health and Human Services, please contact:
Privacy Officer, c/o Beverly Friedlander, M.D., 636 Morris
Turnpike, Suite 2G, Short Hills, N.J.
07078, 973-912-9120, 973-912-8070 via fax, e-mail: doctorbev@aol.com.
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