For purposes of this document, the Women’s Health Center of Hunterdon County is an organized health care arrangement composed of (1) Affiliates in Obstetrics & Gynecology, P.A., (2) Hunterdon Diagnostics, P.A., and (3) Women’s Mammography Center, P.A. Therefore, in this Notice the word “Practice” refers to all of the entities named above.
A. OUR COMMITMENT TO YOUR PRIVACY:
Our Practice is dedicated to maintaining the privacy of your protected health information (“PHI”). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the privacy of PHI. We also are required by law to provide you with this Notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure of PHI).
We reserve the right to change the terms of this Notice. Any change to this Notice will be effective for all your PHI that our Practice maintains, including PHI that we may have created, received or maintained prior to issuing the new Notice. Our Practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice from our Privacy Officer (see § B below) at any time.
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
C. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (“PHI”) IN THE FOLLOWING WAYS:
The following categories describe the different ways in which we may use and disclose your PHI.
1. Treatment. Our Practice may use your PHI to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your PHI in order to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. Many of the people who work for our Practice – including, but not limited to, our doctors and nurses – may use or disclose your PHI in order to treat you or to assist others in your treatment. Finally, we may also disclose your PHI to another licensed health care professional who is providing, or who has been asked to provide, treatment to you, or whose expertise may assist our Practice in our rendition of professional services.
2. Payment. Our Practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may disclose your PHI to a health insurance company if you have a contract with them which provides that the insurance company may be given access to records in order to assess a claim for monetary benefits or reimbursement. Also, we may use your PHI to bill you directly for services and items.
3. Health Care Operations. Our Practice may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our Practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our Practice.
4. Sharing of PHI Within the Practice. As indicated above, the Women’s Health Center of Hunterdon County is an organized health care arrangement composed of Affiliates in Obstetrics & Gynecology, P.A., Hunterdon Diagnostics, P.A., and the Women’s Mammography Center, P.A. Those three entities will share PHI with each other, as necessary to carry out treatment, payment, or health care operations relating to the Women’s Health Center of Hunterdon County at 121 State Route 31, Flemington, New Jersey.
5. Appointment Reminders. Our Practice may use and disclose your PHI to contact you and remind you of an appointment.
6. Treatment Alternatives. Our Practice may use and disclose your PHI to inform you of possible treatment alternatives.
7. Health-Related Benefits and Services. Our Practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
8. Release of Information to Family, Friends, or Others. We may provide your PHI to a family member, friend, or any other person you indicate, that is either involved in your care or the payment for your health care, unless you object in whole or in part. If your opportunity to agree or object cannot practicably be provided because of an emergency situation, we may disclose your PHI to such a person (but only to the extent that the PHI is directly relevant to that person’s involvement with your health care) if we determine that the disclosure is in your best interests. By way of an example of a non-emergent situation, a parent or guardian may ask that a babysitter take their child to the pediatrician’s office for treatment of a cold. In this example, the babysitter may have access to this child’s medical information.
9. Disclosures Required By Law. Our Practice will use and disclose your PHI when we are required to do so by federal, state or local law.
D. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES:
The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
1. Public Health Activities. We may disclose PHI for the following public health activities and purposes: (A) to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; (B) to report child abuse and neglect to public health authorities or other government authorities authorized by law to receive such reports; (C) to report information about products under the jurisdiction of the U.S. Food and Drug Administration; (D) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and (E) to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.
2. Health Oversight Activities. We may disclose PHI to a health oversight agency that oversees the health care system and ensures compliance with the rules of government health programs such as Medicare or Medicaid.
3. Lawsuits and Similar Proceedings. Our Practice may use and disclose your PHI in response to a court or administrative order. Under certain circumstances, we also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in a dispute.
4. Law Enforcement. Our Practice may release PHI to the police or other law enforcement official as required or permitted by law, or in compliance with a court order. For example, we are required to report gunshot wounds and suspected child abuse.
5. Research. Our Practice can use and disclose your PHI for research purposes without your authorization only if an Institutional Review Board or Privacy Board has approved a waiver of authorization. Generally speaking, such waivers may be approved only if the Board finds that (i) the use or disclosure involves no more than a minimal risk to the individual’s privacy, (ii) the research could not practicably be conducted without the waiver, and (iii) the research could not practicably be conducted without access to and use of the PHI.
6. Serious Threats to Health or Safety. Our Practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.
7. Specialized Government Functions. Under certain circumstances, our Practice may use and disclose PHI to units of the government with special function, such as the U.S. military or the U.S. Department of State.
8. Inmates. Our Practice may disclose a patient’s PHI to correctional institutions or law enforcement officials if the patient is an inmate or under the custody of a law enforcement official, but only if the disclosure is necessary: (a) for the institution to provide health care services to the patient, (b) for the safety and security of the institution, and/or (c) to protect the patient’s health and safety or the health and safety of other individuals.
9. Workers’ Compensation. Our Practice may disclose your PHI as authorized by, and to the extent necessary to comply with, laws relating to workers’ compensation and similar programs.
10. Decedents. We may disclose PHI to a coroner or medical examiner as authorized by law.
11. Organ and Tissue Procurement. We may disclose PHI to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
1. Our Practice will obtain your written authorization for any uses or disclosures of your PHI that are not described in §§ C or D above, or that are not otherwise permitted by law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing, except to the extent that we have already taken action in reliance upon it. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, we are required to retain records of your care.
2. If PHI contains AIDS or HIV related information, that information is confidential and shall not be disclosed without your authorization, except as follows. Such information may be released without your authorization to medical personnel directly involved in your medical treatment. If you are deemed to lack decision-making capacity, we may release such information (only if necessary and unless you requests otherwise) to the person responsible for making health care decisions on your behalf (spouse, primary caretaking partner, an appropriate family member, etc.). Under certain circumstances, such information may also be released without your authorization for scientific research, certain audit and management functions, and as may otherwise be allowed or required by law or court order.
F. YOUR RIGHTS REGARDING YOUR PHI:
You have the following rights regarding the PHI that we maintain about you:
1. Confidential Communications. You have the right to request that our Practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Terry L. Welsh (see § B) specifying the requested method of contact, or the location where you wish to be contacted. Our Practice will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions. You may request restrictions on our use and disclosure of PHI: [A] for treatment, payment and health care operations; [B] to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved with your care or with payment related to your care; or [C] to notify or assist in the notification of such individuals regarding your location and general condition. While we will consider all requests for additional restrictions carefully, we are not required to agree to all requested restrictions. In order to request a restriction on our use or disclosure of your PHI, you must make your request in writing to Terry L. Welsh (see § B). Your request must describe in a clear and concise fashion:
3. Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Terry L. Welsh (see § B) in order to inspect and/or obtain a copy of your PHI. Our Practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our Practice may deny your request to inspect and/or copy in certain limited circumstances; however, [A] you may request a review of our denial, in which case another licensed health care professional chosen by us will conduct reviews, and [B] in any event, copies of your PHI may still be provided upon your request directly to your attorney, another licensed health care professional of your choosing, or your health insurance carrier. Please take note that, if you are a parent or legal guardian of a minor, certain portions of the minor’s medical record may not be accessible to you (for example, records relating to pregnancy, abortion, sexually transmitted disease, substance use and abuse, contraception and/or family planning services).
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our Practice. To request an amendment, your request must be made in writing and submitted to Terry L. Welsh (see § B). You must provide us with a reason that supports your request for amendment. Our Practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: [A] accurate and complete; [B] not part of the PHI kept by or for the Practice; [C] not part of the PHI which you would be permitted to inspect and copy; or [D] not created by our Practice, unless the individual or entity that created the information is not available to amend the information.
5. Accounting of Disclosures. You have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our Practice has made of your PHI for non-treatment or operations purposes. Use of your PHI as part of the routine patient care in our Practice is not required to be documented (for example, the doctor sharing information with the nurse, or the billing department using your information to file your insurance claim). In order to obtain an accounting of disclosures, you must submit your request in writing to Terry L. Welsh (see § B). All requests for an “accounting of disclosures” must state a time period, which can not be greater that six (6) years prior to the date of the request. Disclosures made prior to April 14, 2003, will not be included in the accounting. The first list you request within a 12-month period is free of charge, but our Practice may charge you for additional lists within the same 12-month period. Our Practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
6. Right to a Paper Copy of This Notice. If you agree, we may choose to provide you with this Notice by e-mail. However, even if you so agree, you still have the right, upon request, to obtain a paper copy of this Notice. To obtain a paper copy of this Notice, contact Terry L. Welsh (see § B).
7. Right to File a Complaint. If you believe your privacy rights have been violated, or disagree with a decision that we made about access to your PHI, you may file a complaint with our Practice or with the Secretary of the Department of Health and Human Services (“Secretary”). To file a complaint with our Practice, or to ascertain the address of the Secretary, contact Terry L. Welsh (see § B). All complaints must be submitted in writing. You will not be retaliated against for filing a complaint with us or the Secretary.
AGAIN, IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE OR OUR HEALTH INFORMATION PRIVACY POLICIES, PLEASE CONTACT TERRY L. WELSH
http://www.whchc.com/privacy.htm -- Revised: 04/08/03
Copyright © 2003 Women's Health Center of Hunterdon
County