Privacy Policy
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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT
TO US.
Our Legal Duty
This notice of our Privacy Policy is provided to you as a requirement of the
Health Insurance Portability & Accountability Act (HIPAA). We are required by
applicable federal and state laws to maintain the privacy of your protected
health information. We are also required to give you this notice about our
privacy practices, our legal duties, and your rights concerning your protected
health information. It describes how we may use or disclose your protected
health information, with whom that information may be shared, and the safeguards
we have in place to protect it. This notice also describes your rights to access
and amend your protected health information. You have the right to approve or
refuse the release of specific information outside of our Practice except when
the release is required or authorized by law or regulation. We must follow the privacy practices that are
described in this notice while it is in effect. This notice takes effect
April 14, 2003, and will remain in effect until we replace it.
You will be asked to provide a signed acknowledgement of receipt of this Notice.
Our intent is to make you aware of the possible uses and disclosures of your
protected health information and your privacy rights. The delivery of your
health care services will in no way be conditioned upon your signed
acknowledgement. if you decline to provide a signed acknowledgement, we will
continue to provide your treatment, and will use and disclose your protected
health information in accordance with law.
You may request a copy of our notice (or any subsequent revised notice) at any
time. For more information about our privacy practices, or for additional copies
of this notice, please contact us using the information listed at the end of
this notice.
Our Duties To You Regarding Protected Health Information
"Protected health information" is individually identifiable health information
and includes demographic information (for example, age, address, etc.) and
relates to your past, or future physical or mental health or condition and
related health care services. Our Practice is required by law to do the
following:
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Keep your protected health information private
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Present to you this Notice of our legal duties and privacy practices related to
the use and disclosure of your protected health information
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Follow the terms of the Notice currently in effect
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Communicate to you any changes we may make in the Notice
We reserve the right to change our privacy practices and the terms of this
notice at any time, provided that such changes are permitted by applicable law.
We reserve the right to make the changes in our privacy practices and the new
terms of our notice effective for all protected health information that we
maintain, including medical information we created or received before we made
the changes. The effective date of this notice is at the top of the first
page and at the bottom of the last page.
Uses and Disclosures of Protected Health Information
We will use and disclose your protected health information about you for
treatment, payment, and health care operations. Following are examples of the
types of uses and disclosures of your protected health care information that may
occur. These examples are not meant to be exhaustive, but to describe the types
of uses and disclosures that may be made by our office.
Required Uses and Disclosures: By law, we must disclose your health
information to you unless it has been determined by a health care professional
that would be harmful to you. Even in such cases, we may disclose a summary of
your health information to certain of your authorized representatives specified
by you or bylaw. We must also disclose health information to the Secretary of
the U.S. Department of Health and Human Services (HHS) for investigations or
determinations of our compliance with laws on the protection of your health
information.
Treatment: We will use and disclose your protected health information to
provide, coordinate or manage your health care and any related services. This
includes the coordination or management of your health care with a third party.
For example, we would disclose your protected health information, as necessary,
to a home health agency that provides care to you. We will also disclose
protected health information to other physicians who may be treating you. Your protected health information may be provided to a physician to
whom you have been referred to ensure that the physician has the necessary
information to diagnose or treat you. We may disclose your protected health information from time to time
to another physician or health care provider (e.g., a specialist or laboratory)
who, at the request of your physician, becomes involved in your care by
providing assistance with your health care diagnosis or treatment to your
physician.
This also 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 protected health information to provide the treatment you
require.
Payment: Your protected health information will be used, as needed, to
obtain payment for your health care services. This may include certain
activities that your health insurance plan may undertake before it approves or
pays for the health care services we recommend for you, such as: making a
determination of eligibility or coverage for insurance benefits, reviewing
services provided to you for protected health necessity, and undertaking
utilization review activities. For example, obtaining approval for a hospital
stay may require that your relevant protected health information be disclosed to
the health plan to obtain approval for the hospital admission.
Health Care Operations: We may use or disclose, as needed, your protected
health information in order to conduct certain business and operational
activities. These activities include, but are not limited to, quality assessment
activities, employee review activities, training of students, licensing, and
conducting or arranging for other business activities.
For example, we may use a sign-in sheet at the registration desk where you will
be asked to sign your name. We may also call you by name in the waiting room
when your doctor is ready to see you. We may use or disclose your protected
health information, as necessary, to contact you by telephone or mail to remind
you of your appointment.
We will share your protected health information with third party "business
associates" that perform various activities (e.g., billing, transcription
services) for the practice. Whenever an arrangement between our office and a
business associate involves the use or disclosure of your protected health
information, we will have a written contract that contains terms that will
protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to
provide you with information about treatment alternatives or other
health-related benefits and services that may be of interest to you. We may also
use and disclose your protected health information for other marketing
activities. For example, your name and address may be used to send you a
newsletter about our practice and the services we offer. We may also send you
information about products or services that we believe may be beneficial to you.
You may contact us to request that these materials not be sent to you.
Communicable Disease: We may disclose your protected health information,
if authorized by law, to a person who might have been exposed to a communicable
disease or might otherwise be at risk for contracting or spreading the disease
condition.
Threat to Health or Safety: Under applicable Federal and State laws, we
may disclose your protected health information to law enforcement or another
health care professional if we believe in good faith that its use or disclosure
is necessary to prevent or lessen a serious and imminent threat to the health or
safety or a person or the public. We may also disclose protected health
information if it is necessary for law enforcement authorities to identify or
apprehend an individual.
Public Health: We may disclose your protected health information to a
government agency authorized to oversee the health care system or government
programs or its contractors, and to public health authorities for public health
purposes. We may disclose your protected health information to a
public health authority who is permitted by law to collect or receive the
information. For example, the disclosure may be necessary to prevent or control
disease, injury or disability; report births and death; or report reactions to
medications or problems with products.
Military Activity and National Security: When the appropriate conditions
apply, we may use or disclose protected health information or individuals who
are Armed Forces personnel for activities believed necessary by appropriate
military command authorities to ensure the proper execution of the military
mission, including determination of fitness for duty; or to a foreign military
authority if you are a member of that foreign military authority if you are a
member of that foreign military service. We may also disclose your protected
health information, under specific conditions, to authorized Federal officials
for conducting national security and intelligence activities including
protective services to the President or others.
Workers’ Compensation: We may disclose your protected health information
to comply with workers’ compensation laws and other similar legally established
programs.
Inmates: We may use or disclose your protected health information, under
certain circumstances, if you are an inmate or a correctional facility.
Parental Access: State laws concerning minors permit or require certain
disclosure or protected health information to parents, guardians, and persons
acting in a similar legal status. We will act consistently with the laws of this
State (or, if you are treated by us in another state, the laws of the state) and
will make disclosures following such laws.
Marketing: We may use your protected health information to contact you
with information about treatment alternatives that may be of interest to you. We
may disclose your protected health information to a business associate to assist
us in these activities. Unless the information is provided to you by a general
newsletter or in person or is for products or services of nominal value, you may
opt out of receiving further such information by telling us using the contact
information listed at the end of this notice.
Coroners, Funeral Directors, and Organ Donations: We may disclose
protected health information to coroners or medical examiners for identification
to determine the cause of death or for the performance or other duties
authorized by law. We may also disclose protected health information to funeral
directors as authorized by law. Protected health information may be used and
disclosed for cadaveric organ, eye or tissue donations.
Research: We may disclose protected health information to researchers
when authorized by law, for example, if their research has been approved by an
institutional review board that has reviewed the research proposal and
established protocols to ensure the privacy of your protected health
information.
Health Oversight: We may disclose protected health information to a
health oversight agency for activities authorized by law, such as audits,
investigations, and inspections. These health oversight agencies might include
government agencies that oversee the health care system, government benefit
programs, other regulatory programs or civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a
public health authority that is authorized by law to receive reports of child
abuse or neglect. In addition, we may disclose your protected health information
if we believe that you have been a victim of abuse, neglect or domestic violence
to the governmental entity or agency authorized to receive such information. In
this case, the disclosure will be made consistent with the requirements of
applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health
information to a person or company required by the Food and Drug Administration
to report adverse events, product defects or problems, biologic product
deviations; to track products; to enable product recalls; to make repairs or
replacements; or to conduct post marketing surveillance, as required.
Criminal Activity: Consistent with applicable federal and state laws, we
may disclose your protected health information, if we believe that the use or
disclosure is necessary to prevent or lessen a serious and imminent threat to
the health or safety of a person or the public. We may also disclose protected
health information if it is necessary for law enforcement authorities to
identify or apprehend an individual.
Required by Law: We may use or disclose your protected health information
when we are required to do so by law. For example, we must disclose your
protected health information to the U.S. Department of Health and Human Services
upon request for purposes of determining whether we are in compliance with
federal privacy laws. We may disclose your protected health information when
authorized by workers' compensation or similar laws.
Process and Proceedings: We may disclose your protected health
information during any judicial or administrative proceeding, in response to a court or administrative order, subpoena, discovery
request or other lawful process, under certain circumstances. Under limited
circumstances, such as a court order, warrant or grand jury subpoena, we may
disclose your protected health information to law enforcement officials.
Law Enforcement: We may disclose limited information to a law enforcement
official concerning the protected health information of a suspect, fugitive,
material witness, crime victim or missing person. We may disclose the protected
health information of an inmate or other person in lawful custody to a law
enforcement official or correctional institution under certain circumstances. We
may disclose protected health information where necessary to assist law
enforcement officials to capture an individual who has admitted to participation
in a crime or has escaped from lawful custody.
Uses and Disclosures Based On Your Written Authorization
Other uses and
disclosures of your protected health information will be made only with your
authorization, unless otherwise permitted or required by law as described below.
You may give us written authorization to use your protected health information
or to disclose it to anyone for any purpose. If you give us an authorization,
you may revoke it in writing at any time. Your revocation will not affect any
use or disclosures permitted by your authorization while it was in effect.
Without your written authorization, we will not disclose your health care
information except as described in this notice.
Others Involved in Your Health Care: Unless you object, we may disclose
to a member of your family, a relative, a close friend or any other person you
identify, your protected health information that directly relates to that
person's involvement in your health care. If you are unable to agree or object
to such a disclosure, we may disclose such information as necessary if we
determine that it is in your best interest based on our professional judgment.
We may use or disclose protected health information to notify or assist in
notifying a family member, personal representative or any other person that is
responsible for your care of your location, general condition or death. We may
also give information to someone who helps pay for your care. Finally, we may
use or disclose your protected health information to an authorized public or
private entity to assist in disaster relief efforts and coordinate uses and
disclosures to family or other individuals involved in your health care.
Patient Rights
Access: You have the right to look at or get copies of your protected
health information, with limited exceptions. This right does not include
inspection and copying of the following records: psychotherapy notes;
information complied in reasonable anticipation of, or use in, a civil, criminal
or administrative action or proceeding; and protected health information that is
subject to a law that prohibits access to protected health information. You must make a request in writing
to the contact person listed herein to obtain access to your protected health
information. You may also request access by sending us a letter to the address
at the end of this notice. If you request a copy of your protected health
information, we may charge you a reasonable fee for the copying, postage, labor,
and supplies used in meeting your request. If you prefer, we will prepare a
summary or an explanation of your protected health information for a fee.
Contact us using the information listed at the end of this notice for a full
explanation of our fee structure.
Accounting of Disclosures: You have the right to receive a list of
instances in which we or our business associates disclosed your protected health
information for purposes other than treatment, payment, health care operations
and certain other activities after April 14, 2003. After April 14, 2009, the
accounting will be provided for the past six (6) years. We will provide you with
the date on which we made the disclosure, the name of the person or entity to
whom we disclosed your protected health information, a description of the
protected health information we disclosed, the reason for the disclosure, and
certain other information. If you request this list more than once in a 12-month
period, we may charge you a reasonable, cost-based fee for responding to these
additional requests. Contact us using the information listed at the end of this
notice for a full explanation of our fee structure.
Restriction Requests: You have the right to request that we place
additional restrictions on our use or disclosure of your protected health
information. We are not required to agree to these additional restrictions, but
if we do, we will abide by our agreement (except in an emergency). Your request
must be made in writing to our Privacy Officer. In your request, you must tell
us:
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what information you want restricted
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whether you want to restrict our use or disclosure, or both
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to whom you want the restriction to apply, for example, disclosures to your
spouse
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an expiration date.
If we believe that the restriction is not in the best interest of either party,
or that we cannot reasonably accommodate the request, we are not required to
agree to your request. If the restriction is mutually agreed upon, we will not
use or disclose your protected health information in violation of that
restriction, unless it is needed to provide emergency treatment. You may revoke
a previously agreed upon restriction, at any time, in writing.
Confidential Communication: You have the right to request that we
communicate with you in confidence about your protected health information by
alternative means or to an alternative location. You must make your request in
writing. We must accommodate your request if it is reasonable, specifies the
alternative means or location, and continues to permit us to bill and collect
payment from you.
Amendment: You have the right to request that we amend your protected
health information. Your request must be in writing, and it must explain why the
information should be amended. We may deny your request if we did not create the
information you want amended or for certain other reasons. If we deny your
request, we will provide you a written explanation. You may respond with a
statement of disagreement to be appended to the information you wanted amended.
If we accept your request to amend the information, we will make reasonable
efforts to inform others, including people or entities you name, of the
amendment and to include the changes in any future disclosures of that
information.
Electronic Notice: If you receive this notice on our website or by
electronic mail (e-mail), you are entitled to receive this notice in written
form. Please contact us using the information listed at the end of this notice
to obtain this notice in written form.
Special Protections: This Notice is provided to you as a requirement of
HIPAA. There are several other privacy laws that also apply to HI V-related
information, mental health information, and substance abuse information. These
laws have not been superseded and have been taken into consideration in
developing our policies and this Notice.
Questions and Complaints
If you want more information about our privacy practices or have questions or
concerns, please contact us using the information below. If you believe that we
may have violated your privacy rights, or you disagree with a decision we made
about access to your protected health information or in response to a request
you made, you may complain to us using the contact information below. You also
may submit a written complaint to the U.S. Department of Health and Human
Services. We will provide you with the address to file your complaint with the
U.S. Department of Health and Human Services upon request.
We support your right to protect the privacy of your protected health
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
Name of Contact Person: Off Office Manager
New Jersey Office
3219 Route 46 East, Suite 210
Parsippany, NJ 07054
(973) 917-3785 |