TEAM REHAB AND WELLNESS CENTER
Notice of Privacy Practices
Effective Date: April 1, 2010
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.
We understand the importance of privacy and are committed to maintaining the confidentiality of medical information. We make a record of the medical are we provide and may receive such records from others. We use these records to provide or enable other health care providers to provide quality 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 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 medical information. If you have any questions about this notice, please contact our Privacy Officers , Carmela M. Bonavita or Dr. Francisco Serrano.
(Please Note: All Front Desk staff at our facility have been designated by this facility to review our Privacy Practices with our patients).
CONTENTS
1. How this Medical Practice may use or disclose your health information, page 2.
2. When this practice may not use or disclose your health information, page 5.
3. Your health information rights, page 6.
4. Changes to this Notice of Privacy Practice, page 7.
5. Privacy officers, page 7.
How this Practice may use of disclose your health information.
This medical practice collects health information about you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of this practice, but the information in the record belongs to you. The law permits us to use or disclose health information for the following purposes:
1. Treatment: We use medical information about you to provide medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, we may share medical information with other physicians or other health care providers who will provide services that we do not provide. Or we may share this information with a laboratory that performs a test.
2. Payment: We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided. You should know that we must discuss your account status with you while you are in the office. For example, when you check out after seeing a physician, you will be given an update of the status of your account with us. This may include discussions of insurance payments, any balance owed on your part, and any updates needed in your personal information on file with us. We will exercise caution in the amount of information discussed in areas of our office where others may overhear our conversations. However, if you wish to have a private conversation about any of these matters, please inform us.
3. Health care 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 care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose this information to get your health plan to 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 medical information with our “business associates”, such as our medical billing service, that perform administrative services for us. We have a written contract with each of these business associates that contains terms requiring them to protect the confidentiality of your medical information. Although, federal law does not protect health information, which is disclosed to someone other than another healthcare provider, health plan or healthcare clearinghouse. We may also share information with other health care providers, health care providers, health care clearinghouses 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 health care costs, their review of competence, qualifications and performance of health care professionals, their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts.
4. Appointment reminders: We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.
5. Sign In Sheet: We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.
6. Notification and Communication with Family: We may disclose 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. We may also disclose information to someone when in involved with your care or helps pay for your care. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures; although we may disclose this information in a disaster even over your objection if we believe it is necessary to respond to the emergency circumstances. If you are unable or available to agree or object, our health professionals will use their best judgement in communicating with your family and others.
7. Marketing: We may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments or health related benefits and services that may be of interest to your, or to provide you with small gifts. We may also encourage you to purchase a product or service when we see you. We will not use or disclose your medical information for these purposes without your written authorization.
8. 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 requirements set forth below concerning those activities.
9. Public Health: We may and are sometimes required by law to disclose health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect; reporting domestic violence; and reporting to the Food and Drug Administration problems with suicide.
10. Health Oversight Activities: We may and are sometimes required by law to disclose health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by federal and Massachusetts law.
11. Judicial and Administrative Proceedings: We may and are sometimes required by law to disclose 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, discovery 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. 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.
12. Law Enforcement: We may and are sometimes required by law to disclose health information to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, professionals their training programs, their accreditation, certification or licensing activities, or their health care fraud and abuse detection and compliance efforts.
13. Coroners: We may and are often required by law, to disclose health information to coroners in connection with their investigations of deaths.
14. Organ or Tissue Donations: We may disclose health information to organizations involved in procuring, banking or transplanting organs and tissues.
15. Public Safety: We may and are sometimes required by law to disclose health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
16. Specialized Government Functions: We may disclose health information for military or national security purposes or to correctional institutions or law enforcement officers that you in their lawful custody. 17. Worker’s Compensation: We may disclose health information as necessary to comply with workers compensation laws. We are required to report cases of occupational injury or occupational illness to the employer or workers compensation insurer.
18. Change of Ownership: In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another physician or medical group.
When this practice may NOT use or DISCLOSE your health information.
Except as described in this Notice of Privacy Practices, this medical practice will not use use or disclose health information which identifies you or your children without your written authorization. If you do not authorize this practice to use or disclose this health information for another purpose, you may revoke your authorization in writing at any time.
Your Health Information Rights.
1. Right to request special privacy protections: You have the right to request restrictions on certain uses and disclosures of your health information, by 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 will notify you of our decision.
2. Right to Request Confidential Communications: You have the right to request that you receive your health information in a specific way or at a specific location. For example, you may ask that we send information to your work address. We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.
3. 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.
4. 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. You also have the right to request that we add to your record a statement of up to 260 words concerning any statement or item you believe to be incomplete or incorrect.
5. 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 pursuant to your written authorization, or as described in Section A of the Notice of Privacy Practices or disclosures for purposes of research or public health which exclude direct patient identifiers or which are incident to a use of disclosures otherwise permitted or authorized by law, or the disclosures to a health oversight agency or law enforcement official to the extent this medical practice has received notice from that agency or official that providing this accounting would be reasonably likely to impede their activities.
6. You have a right to a paper copy of this Notice of Privacy Practices: If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact one of our Privacy Officers: Carmela M. Bonavita or Dr. Francisco K. Serrano.
7. 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 will offer you a copy at each appointment.
8. Privacy Officers: You may contact our Privacy Officers at the listed phone numbers below if you should have a question, concern or complaint.
