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By law, we are required to provide you with our Notice of Privacy Practices
(NPP). This Notice describes how your medical information may be used and
disclosed by us. It also tells you how you can obtain access to this information.
Please review it carefully.
As a patient, you have the following rights:
The right to inspect and copy your information;
The right to request corrections to your information;
The right to request that your information be restricted;
The right to request confidential communication;
The right to a report of disclosures of your information; and
The right to a paper copy of this notice.
We want to assure you that your medical/protected
health information is secure with us. This Notice contains information
about how we will insure that your information remains private.
If you have any questions about this Notice, you can contact Women’s Health
Services at (617) 277-0009 and someone will assist you.
At our organization, we are required to protect the privacy of medical/health
information about you and that can be identified with you. This is called
"protected health information" or "PHI" for short.
We respect the privacy and confidentiality of your protected health information.
This Notice of Privacy Practices ("Notice") describes the ways in which
we may use and disclose your medical/protected health information and how
you can get access to this information. Your health information is contained
in your medical and billing records maintained by this organization. It
includes demographic information and information that relates to your present,
past or future physical or mental health and related healthcare services.
This Notice applies to uses and disclosures that we may make of all of
your protected health information, whether created by us in our organization
or received by us from another healthcare provider.
A. OUR LEGAL DUTY TO PROTECT YOUR HEALTH INFORMATION
Federal law requires us to:
Maintain the privacy of your protected health information that we have
created in our organization or received from another healthcare provider
whether it is about your past, present, or future healthcare condition;
Maintain the privacy of your protected health information regarding payment
for your healthcare;
Notify you about how we protect your protected
health information;
Explain how, when and why we use and disclose protected health information
about you;
Abide by the terms of this Notice, as currently in effect;
Notify you if we are unable to agree to a requested restriction on how
your protected health information is used or disclosed;
Accommodate reasonable requests that you
make to communicate health information by alternative means or at alternative
locations; and
Obtain your written authorization to use or disclose your protected health
information for reasons other than those listed below and permitted by
law.
We know that your protected health information is personal. We are committed
to protecting your information. So as to provide you with good care and
to insure that we follow all legal requirements, we document (in medical
and financial records) the care and services that we provide to you. This
Notice applies to those records.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this Notice of Privacy Practices
and to make the new provisions effective for all protected health information
we already have about you as well as any protected health information we
create or receive in the future. If we make any changes, we will:
Post the revised Notice in our office, which will contain the new effective
date; and
Make copies of the revised Notice available to you upon request.
B. WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU TO PROVIDE
TREATMENT TO YOU, TO OBTAIN PAYMENT FOR SERVICES RENDERED TO YOU, AND FOR
HEALTHCARE OPERATIONS.
We may use and disclose your protected health information for purposes
of healthcare treatment, payment and healthcare operations as described
below.
1. For Treatment:
We may use and disclose your protected health information to provide you
with medical treatment and services and to coordinate or manage your healthcare
and related services. We may use and disclose your protected health information
to doctors and nurses, as well as lab technicians, dieticians, physical
therapists or other parties involved in your care, both within our organization
and with other healthcare providers involved in your care.
We may disclose information to people outside our organization who may
be involved in your care, such as your family members, clergy or others
who participate in your care. All information is recorded in your medical
record which is necessary for healthcare providers to determine what treatment
you should receive. Healthcare providers will also records actions taken
by them in the course of your treatment and note your reactions. We may
also disclose protected health information to providers or facilities who
may be involved in your care after you leave our facility or our care.
Examples of how we will disclose information for treatment may include
sharing information about you with;
Referring physicians;
Your primary care physician or family physician;
A specialist;
Hospitals;
Ambulatory care centers;
Pharmacies;
Visiting nurses.
2. For Payment:
We may use and disclose your protected health information so that we can
bill and receive payment for the treatment and services you receive from
us. For billing and payment purposes, we may disclose your protected health
information to an insurance company or managed care company, Medicare,
Medicaid, or any other third party payer. The information on the bill may
contain information that identifies your diagnosis, treatment and supplies
used in the course of treatment. We may inform an insurance company about
treatment that we intend to provide to you so that we can obtain the appropriate
approvals and/or to confirm coverage for your treatment.
Examples of how we will disclose information for payment include:
We may contact your health plan to confirm your coverage;
We may contact your health plan for pre-certification of a service;
We may contact any other organizations who provided you with medical services
to obtain payment information from them;
We may provide information to any other healthcare provider who requests
information necessary for them to collect payment;
We may share information with other billing departments of other providers
and healthcare entities;
We may share information with collection departments;
We may share information with agents of health plans (third party administrators)
who are involved in the payment of a claim;
We may share information with consumer reporting agencies (credit bureaus).
3. For Healthcare Operations:
We may use and disclose your protected health information in performing
business activities that we call "healthcare operations". This
includes internal operations, such as for general administrative activities
and to monitor the quality of care you receive at our facility. This type
of use is necessary for us to run our organization and to be sure that
our patients are receiving quality care.
Examples of how we will use and disclose information as it relates to healthcare
operations include one or more of the following:
We may use or disclose your protected health information to review and
improve the quality of care you receive;
We may use or disclose your protected health information to doctors, nurses,
residents, students, volunteers or other medical staff for education and
training purposes;
We may use or disclose your protected health information for planning for
services, such as when we assess certain services that we may want to offer
in the future;
We may use or disclose your protected health information to evaluate the
performance of our employees;
We may use or disclose your protected health information to our lawyers,
consultants, accountants, and business associates;
We may combine information about several patients to determine if we should
offer new services;
We may combine information about several patients to determine if new treatments
are effective;
We may use protected health information to identify groups of patients
who have similar health problems to give them information about treatment
alternatives, programs, or new procedures;
We may use or disclose your protected health information to train students,
residents, other healthcare providers or non-healthcare providers (such
as billing personnel);
We may use or disclose protected health information to organizations that
assess the quality of care we provide to our patients (such as government
agencies or accrediting bodies);
We may use or disclose protected health information to organizations that
evaluate, certify or license healthcare providers, staff or facilities
in a particular specialty;
We may use and disclose protected health information to assist others who
may be reviewing our activities such as accountants, lawyers, consultants,
risk managers, and others who assist us in complying with state and federal
laws;
We may use and disclose protected health information in the process of
selling our business or merging with other healthcare entities, or giving
control to someone else;
We may use and disclose protected health information in the process of
reviewing for healthcare fraud and abuse detection and compliance;
We may use and disclose protected health information when we develop internal
protocols.
In the process of using your protected health information in the course
of treatment, payment and healthcare operations, we may make incidental
disclosures. We will take reasonable steps to limit incidental disclosures.
Other examples. We may disclose information as it relates to healthcare
operations when we:
Leave messages on your answering machine;
Leave messages at your place of employment;
Send appointment reminder postcards;
Call to remind you of an appointment;
Call you by name when you are in our organization.
C. OTHER USES AND DISCLOSURES WE MAY MAKE WITHOUT YOUR WRITTEN AUTHORIZATION
Under the Health Insurance Portability and Accountability Act Privacy Regulations,
we may use and disclose your protected health information in which you
do not have to give authorization or otherwise have any opportunity to
agree or object.
"Use" refers to our internal utilization of your protected health Information.
Specifically, "use" under the privacy regulations means: "with respect
to individually identifiable health information, the sharing, employment,
application, utilization, examination, or analysis of such information
within and entity that maintains such information.
Disclosure refers to the provision of information by use to parties outside
of our organization. Specifically, disclosure means: "the release, transfer,
provision of access to or divulging in any other manner, of information
outside of the entity holding the information".
We may make the following uses and disclosures of yourprotected health
information without obtaining a written authorization from you in situations
such as:
1. Those Required by Law:
We may disclose your protected health information when required to do so
by law. For example, when federal, state, or local law or other judicial
or administrative proceeding required that we disclose information about
you.
2. Public Health Risk:
We may disclose your protected health information for public health activities.
For example, we may disclose protected health information about you if
you have been exposed to a communicable disease or may otherwise be at
risk of spreading a disease. Other examples may include reports about injuries
or disability, reports of births and deaths, reports of child abuse and/or
neglect, and reports regarding recall of products.
3. Our Facility Directory:
Unless you object, we may use and disclose certain limited information
about you in our directory (or on our “sign-in” sheet) while you are in
our organization. This information may include your name and your location
within our organization (such as a department). Our directory will not
include specific medical information about you. We may disclose directory
information to people who ask for you by name.
4. Individual Involved in Your Care or Payment for Your Care:
Unless you object, we may disclose protected health information about you
to a family member, relative, close personal friend, caregiver, neighbor
or other person(s) you identify, including clergy, who are involved in
your care. These disclosures are limited to information relevant to the
person’s involvement in your care or in payment for your care.
5. Disaster Relief:
Unless you object, we may disclose protected health information about you
to a public or private agency (like the American Red Cross) for disaster
relief purposes. Even if you object, we may still share information about
you, if necessary for the emergency circumstances.
6. Reporting Victims of Abuse, Neglect or Domestic Violence:
When authorized by law or if you agree to the report and if we believe
that you have been a victim of abuse, neglect or domestic violence, we
may use and disclose your protected health information to notify a government
authority.
7. Health Oversight Activities:
When authorized by law, we may disclose your protected health information
to a health oversight agency. A health oversight agency is a state or federal
agency that oversees the healthcare system. Some of the activities may
include, for example, audits, investigations, inspections and licensure.
8. Judicial and Administrative Proceedings:
We may disclose your protected health information in response to a lawsuit,
dispute, court or administrative order. We also may disclose protected
health information in response to a subpoena, discovery request, or other
lawful process by another party involved in the action. We will make a
reasonable effort to inform you about the request.
9. Law Enforcement:
We may disclose your protected health information for certain law enforcement
purposes, including, but not limited to:
Reporting certain types of wounds and/or other physical injuries (i.e.
gunshot wounds);
Reports required by law;
Reporting emergencies or suspicious deaths;
Complying with a court order, warrant, subpoena, or other legal process;
Identifying or locating a suspect or missing person, material witness or
fugitive;
Answering certain requests for information concerning crimes, about the
victim of crimes;
Reporting and/or answering requests about a death we believe may be the
result of a crime;
Reporting criminal conduct that took place on our premises; and
In emergency situations to report a crime, the location of the crime or
victim or the identity, description and/or location of a person involved
in the crime.
10. Coroners, Medical Examiners, Funeral Directors, Organ/Tissue Donation
Organizations:
We may release your protected health information to a coroner, medical
examiner, and funeral director. If you are an organ donor, we may release
your protected health information to an organization involved in the donation
of cadaveric organs and tissue to enable them to carry out their lawful
duties. We can release information about deceased patients to funeral directors
as necessary in allowing them to carry out their duties. We may disclose
protected health information about you to a coroner or medical examiner
for the purposes of identifying you should you die.
11. Research:
In some situations, your protected health information may be used for research
purposes if an institutional review board has approved the research. The
institutional review board must have established procedures to insure that
your protected health information remains confidential.
12. To Avert a Serious Threat to Health or Safety:
We may use or disclose your protected health information to someone able
to help lessen or prevent the threatened harm when necessary to prevent
a serious threat to your health or safety or the health or safety of the
public or another person. The disclosure would only be to a person or entity
that would be able to help prevent the threat.
13. Military and Veterans:
If you are a member of the armed forces, we may use and disclose your protected
health information as required by military command authorities. We may
also release medical information about you if you are a member of a foreign
military as required by the appropriate foreign military authority.
14. National Security and Intelligence Activities:
We may disclose protected health information to authorized federal officials
conducting national security, counterintelligence, and intelligence activities
authorized by law.
15. Protective Services for the President and Others:
We may disclose your protected health information to authorized federal
officials as needed to provide protection to the President of the United
States, other persons or foreign heads of states or to conduct certain
special investigations.
16. Inmates/Law Enforcement Custody:
If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may disclose your protected health information
to the correctional institution or official for certain purposes. This
type of disclosure is necessary for the following reasons:
To insure that the correctional institution will provide you with healthcare;
To protect your own health and safety;
To protect the health and safety of others; and/or
For the safety and security of the correctional institution.
17. Workers' Compensation:
We may use or disclose your protected health information to comply with
laws and regulations relating to workers’ compensation or similar programs
established by law that provide benefits for work-related injuries and/or
illness.
18. Fundraising Activities:
We may use limited protected health information
such as your name, address and phone number and the dates you received
treatment or services, to contact you in an effort to raise money for a
program developed by our organization. We may also disclose contact information
for fundraising purposes to a foundation related to our organization. If
you do not want to be contacted in this way, you should notify us in writing.
19. Appointment Reminders:
We may use or disclose protected health information to remind you about:
Appointments with our organization;
Appointments that we have scheduled for you with other healthcare organizations.
20. Treatment Alternatives and Health-Related Benefits and Services:
We may use or disclose your protected health
information to inform you about treatment alternatives and health-related
benefits and services that may be of interest to you. This may include
telling you about:
Treatments
Services
Products
Other healthcare providers
Special programs
Nutritional services
21. Business Associates:
We may disclose your protected health information to our business associates
under a Business Associate Agreement. Some of these business associates
may include, for example:
Answering Service
Transcription Service
Accounting Services
Attorney/Legal Services
D. ANY OTHER USE OR DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION
REQUIRES YOUR WRITTEN AUTHORIZATION
Under any circumstances other than those listed above, we will request
that you provide us with a written authorization before we use and disclose
your protected health information to anyone.
If you sign an authorization allowing us to disclose protected health information
about you in a specific situation, you can later revoke (cancel) your authorization
in writing.
If you cancel your authorization in writing, we will not disclose your
protected health information about you after we receive your cancellation,
except for disclosures, which were already being processed or made before
we received your cancellation.
E. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding
your protected health information that we maintain:
1. The Right to Access Your Personal Protected Health Information:
Upon written request, you have the right to inspect and obtain a copy of
your medical/protected health information except under certain limited
circumstances. Under state law, if we make a copyof your medical record,
we will not charge you more than is permitted by the current rate allowed
by state law for copies. We may also charge you a reasonable fee for x-rays,
mailings and other supplies related to this request. You should submit
your written request to access your health information to our office.
We may deny your request to inspect or receive copies in certain limited
circumstances. If you are denied access to your medical/protected health
information, in some cases you will have the right to request a review
of this denial. A licensed healthcare professional designated by us and
who did not participate in the original decision to deny access will perform
this review.
2. The Right to Request Restrictions:
You have the right to request a restriction on the way we use or disclose
your protected health information for treatment, payment or healthcare
operations.
Additionally, you can request that we limit the information we disclose
about you to those individuals involved in your care or the payment of
your services, such as a relative or friend. For example, you could request
that we not use or disclose information about a procedure that you had
performed by one of our physicians. You should submit your written request
to restrict your health information to our office. You must tell us what
information you want restricted, to whom you want the information restricted,
and whether you want to limit our use, disclosure, or both.
However, we are not required to agree
to such a restriction. If we do agree to the restriction, we will honor
that restriction except in the event of an emergency and will only disclose
the restricted information to the extent necessary for your emergency treatment.
3. The Right to Request Confidential Communications:
You have the right to request that we communicate with you concerning your
health matters in a certain manner or at a certain location. For example,
you can request that we contact you on at a certain phone number or a specific
address.
You should submit your written request for
Confidential Communications to our office. You must tell us how and where
you want to be contacted.
We will accommodate your reasonable requests, but may deny the request
if you are unable to provide us with appropriate methods of contacting
you.
4. The Right to Request an Amendment:
You have the right to request that we make amendments or modify your clinical,
billing and other protected health information for as long as the information
is kept by us. Your request must be made in writing and must explain your
reasons for the requested amendment.
We may deny your request for amendment if
the information:
Was not created by us (unless you prove the creator of the information
is not longer available to amend the record);
Is not part of the records maintained by us;
In our opinion, is accurate and complete; and
Is information to which you do not have a right to access.
If we deny your request for amendment, we will give you a written denial
notice, including the reasons for the denial and explain to you that you
have the right to submit a written statement disagreeing with the denial.
Your letter of disagreement will be attached to your medical record.
You should submit your written request for an amendment to our office.
5. The Right to An Accounting of Disclosures:
You have the right to request an accounting (a report) of certain disclosures
of your protected health information. You may ask for disclosures made
up to six years before your request (but not including disclosures made
prior to April 14, 2003). This is a listing of disclosures made by us or
by others on our behalf. We are not required to include disclosures:
Made for Treatment;
Made for billing or collection of payment for your treatment;
Made Directly to you, that you authorized, or those which are made to individuals
involved in your care;
Allowed by law when the use or disclosure relates to certain government
functions or in other law enforcement custodial situations, and/or;
Made in the process of our healthcare operations.
You must submit your request for an accounting of disclosures in writing
to our office. You must state the time period for which you would like
the accounting. The accounting will include the disclosure date, the name,
address (if known) of the person or entity that received the information,
a brief description of the information disclosed; and a brief statement
of the purpose of the disclosure. If you request a listing of disclosures
more than once within a 12-month period, we will charge you a reasonable
fee for the accounting. The first accounting, within a 12-month period,
is provided to you at no charge. We will inform you of the costs involved
in the event that you wish to withdraw your request.
6. The Right to a Paper Copy of This Notice:
You have the right to obtain a paper copy of this Notice, even if you have
agreed to receive this Notice electronically. You may request a copy of
this Notice at any time by contacting our office.
F. COMPLAINTS
If you believe that your privacy rights have been violated, you may file
a complaint in writing with us or with the government.
1. To File a Complaint with the Government, you may contact:
Office of Civil Rights U.S. Department of Health and Human Services
200 Independence Avenue, S.W., Room 509F
Washington, D.C. 20201
2. To file a complaint with us, you should contact the office.
3. You will not be retaliated against for filing a complaint.
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