NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about your may be used and disclosed and how you can get access to this information. Please review it carefully.
We understand the importance of privacy, and we are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide, and may receive such record from others. We use these records to provide or enable other healthcare providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan, and to enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact us.
(A.) HOW THIS MEDICAL PRACTICE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
The law permits us to use or disclose your health information for the following purposes:
1. TREATMENT
We may use medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing care you need. For example, we may share your medical information with other physicians or other healthcare providers who will provide services which we do not provide. We may also share this information with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test.
2. PAYMENT
We may use and disclose medical information about you to obtain payment for the services we provide. For example, we may give your health plan the information it requires before it will pay us. We may also disclose information to other healthcare providers to assist them in obtaining payment for services they have provided for you.
3. HEALTHCARE OPERATIONS
We may
use and disclose medical information about you to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of the care we provide, or the competence and qualifications of our professional staff. We may also use and disclose this information to request that your health plan authorize services or referrals. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management. We may also share your information by other healthcare providers, a healthcare clearinghouse or health plans that have a relationship with you when they request this information, to help them with their quality assessment and improvement activities, their efforts to improve health or reduce healthcare costs, their review of compliance, qualifications and performance of healthcare professionals, their training programs, their accreditation, certification or licensing activities, or their healthcare fraud and abuse detection and compliance efforts.
4. APPOINTMENT REMINDERS
We may also use and disclose medical information to contact and remind you about appointments. If you are not home, we may leave this information with the person answering the phone or on your answering machine.
5. NOTIFICATION AND COMMUNICATION WITH FAMILY
We may call you name in the waiting room when we are ready to see you. We may disclose your healthcare information to a family member or close friend or other person you identify where relevant to that person's involvement in your care or payment for your care. We may
disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. In the event of a disaster, we may disclose information to a relief organization so that they may coordinate these notification efforts. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures, although me may disclose this information in a disaster even over your objection if we believe it necessary to respond to the emergency circumstances. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communicating with your family and others.
6. REQUIRED BY LAW
As required by law, we will use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law. When the law requires us to report abuse, neglect or domestic violence, or respond to judicial or administrative proceedings, or to law enforcement officials, we will further comply with the requirement set forth below concerning those activities.
7. PUBLIC HEALTH
We may, and are sometimes required by law, to disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child, elder or dependent adult abuse or neglect;
reporting domestic violence; reporting the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. When we report suspected elder or dependent adult abuse or domestic violence, we will inform you or your personal representative promptly unless in our best professional judgment, we believe the notification would place you at risk of serious harm or would require informing a personal representative we believe is responsible for the abuse or harm.
8. HEALTH OVERSIGHT ACTIVITIES
We may, and are sometimes required by law, to disclose your health information to health oversight agencies during the
course of audits, investigations, inspections, licensure and other proceedings.
9. JUDICIAL AND ADMINISTRATIVE PROCEEDINGS
We may, and are sometimes required by law, to disclose your health information in the course of any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order. We may also disclose information about you in response to a subpoena, discover request or other lawful process if reasonable efforts have been made to notify you of the request and you have not objected, or if your objections have been resolved by a court or administrative order.
10. LAW ENFORCEMENT
We may, and are sometimes required by law, to disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order, warrant, grand jury subpoena and other law enforcement purposes.
11. CORONERS
We may, and are often required by law, to disclose your health information to coroners in connection with their investigations of deaths.
12. TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY
We may, and are sometimes required by law, to disclose your health information to appropriate persona in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
13. SPECIALIZED GOVERNMENT FUNCTIONS
We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.
14. WORKERS COMPENSATION
We may disclose your health information as necessary to comply with worker's compensation laws. For example, to the extent your care is covered by workers' compensation, we will make periodic reports to your employer about your condition. We are also required by law to report cases of occupational injury or occupational illness to the employer or workers' compensation insurer.
(B) WHEN THIS MEDICAL PRACTICE MAY NOT USE OR DISCLOSE YOUR HEALTH INFORMATION
Except as described in this Notice of Privacy Practices, the medical practice will not use or disclose your health information, which identifies you without your written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time, except to the extent that we have already taken action in reliance on the authorization.
(C) YOUR HEALTH INFORAMTION RIGHTS
1. RIGHT TO REQUESTION SPECIAL PRIVACY PROTECTIONS
You have the right to request restrictions on certain usages and disclosures of you health information by submitting a written request specifying what information you want to limit and what limitations on our use or disclosure of that information you wish to have imposed. We reserve the right to accept or reject your request, and we will notify you of our decision.
2. RIGHT TO INSPECT AND COPY
You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to and whether you want to inspect it or get a copy of it. We will chare a reasonable fee, as allowed by Connecticut law. We may deny your request under limited circumstances.
3. RIGHT TO AMEND OR SUPPLEMENT
You have a right to request that we amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information, and will provide you with information about this medical practice's denial and how you can disagree with the denial. We may deny your request if we do not have the information, if we did not create the information (unless the person or entity that created the information is no longer available to make the amendment), if you would not be permitted to inspect or copy the information at issue, or if the information is accurate and complete as is.
4. RIGHT TO AN ACCOUNTING OF DISCLOSURES
You have a right to receive an accounting of disclosures of your health information made by this medical practice, except that this medical practice does not have to account for the disclosures provided to your or pursuant to your written authorization, or as described in paragraphs 1 (treatment), 2 (payment), 3 (healthcare operations), 7 (notification and communication with family, and 17 (certain government functions) of Section A of this Notice of Privacy Practices or disclosures of data which exclude direction patient identifiers for purposes of research or public health or disclosures which are incident to a use or disclosure otherwise permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official that providing this accounting would be reasonably likely to impede their activities and certain other disclosures.
5. RIGHT TO RECEIVE A NOTICE OF PRIVACY PRACTICES
You have a right to receive a paper copy of this Notice of Privacy Practices
(D) SPECIAL RULES REGARDING DISCLOSURE OF PSYCHIATRIC, SUBSTANCE ABUSE AND HIV-RELATED INFORMATION
Under Connecticut or federal law, additional restrictions may apply to disclosures of health information that relates to care for psychiatric condition, substance abuse, or HIV-related testing information that relates to care for psychiatric conditions, substance abuse or HIVE-related testing and treatment. This information may not be disclosed without your specific written permission, except as may be specifically required or permitted by Connecticut or federal law. The following are examples of disclosures that mat be made without your specific written permission:
- Psychiatric Information:
We may disclose psychiatric information to a mental health program if needed for your diagnosis or treatment. We may also disclose very limited psychiatric information for payment purposes.
- HIV-related Information:
We may disclose HIV-related information for purposes of treatment or payment.
- Substance Abuse Treatment:
We may disclose information obtained from a substance abuse program in an emergency.
(E) CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
We reserve the right to amend this Notice Of Privacy Practices at any time in the future. Until such amendment is made, we are required by law to comply with this Notice. After an amendment is made, the revised Notice of Privacy Protections will apply to all protected health information that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception area, and provide you with a copy upon request.
(F) COMPLAINTS
Complaints about the Notice of Privacy Practices or how this medical practice handles your health information should be directed to us.
You may also submit a complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Building
200 Independence Avenue, SW
Room 590F HHH Building
Washington, DC 20201
You will not be penalized for filing a complaint.
