Notice of Privacy Practices
Neurosurgery Associates of Northwest CT., P.C.
500 Chase Parkway
Waterbury, Connecticut 06708
Effective Date: April 14, 2003
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 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
records from others. We use these records to provide or enable other
health care 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. 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 our Privacy Officer.
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 the care
you need. For example, we may share your medical information with
other physicians or other health care 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 health
care providers to assist them in obtaining payment for services
they have provided to you.
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. 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 with other health
care providers, a health care 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 health care costs, their
review of compliance, 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. Business Associates. We may share your medical
information with our “business associates”, such as
our billing service that performs 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.
5. Appointment Reminder. We may use and disclose
medical information to contact and remind you about appointments.
If you are not home, we may leave information with the person answering
the phone or on your answering machine.
6. Sign in sheet. We may ask you to sign in when
you arrive at our office. We may also call out your name when we
are ready to see you.
7. Notification and communication with family.
We may disclose your health information to a family member or a
close friend or other person you identify where relevant to that
person’s involvement in your care or payment of 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 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
unavailable to agree or object, our health professionals will use
their best judgment in communicating with your family and others.
8. Marketing. We will not use or disclose your
medical information for marketing purposes without your written
authorization.
9. 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.
10. 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 to the Food and
Drug Administration problems with products and reactions to medications;
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.
11. 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.
12. 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, 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.
13. 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.
14. Coroners. We may, and are often required by
law to, disclose your health information to coroners in connection
with their investigations of deaths.
15. Organ or tissue donation. We may disclose your
health information to organizations involved in procuring, banking
or transplanting organs and tissues.
16. To avert a serious threat to health or safety.
We may, and are sometimes required by law to, disclose your 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.
17. 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.
18. Worker’s compensation. We may disclose
your health information as necessary to comply with workers’
compensation laws. For example, to the extent of 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 carrier.
19. Change of ownership. In the event that this
medical practice is sold or merged with another organization, your
health information/record may be transferred to 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.
B. When This Medical Practice May Not Use or Disclose Your
Health Information
Except as described in the Notice of Privacy Practices, this medical
practice will not use or disclose health information that identifies
you without your written authorization. If you do not 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 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 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 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 at 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. We will charge a reasonable fee,
as allowed by Connecticut law. We may deny your request under limited
circumstances.
4. Right to Amend or Supplement. You have the
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.
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 you or
pursuant to your written authorization, or as described in paragraphs
1 (treatment), 2 (payment), 3 (health care operations), 7 (notification
and communication with family) and 17 (certain government functions)
of Section A of the Notice of Privacy Practices or disclosures of
data which exclude direct 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 to the extent
this medical practice has received notice from that agency or official
that provided this accounting would be reasonably likely to impede
their activities and certain other disclosures.
6. Right to Receive a Notice of Privacy Practices.
You have the right to receive 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
our Privacy Officer.
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
conditions, substance abuse or HIV-related testing and treatment.
This information may not be disclosed without your specific written
permission, except as it may be specifically required or permitted
by Connecticut or federal law. The following are examples of disclosures
that may 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 Practices 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 this Notice of Privacy Practices or how this medical
practice handles your health information should be directed to:
Neurosurgery
Associates of NW CT, P.C.
Privacy Officer
500 Chase Parkway
Waterbury, CT 06708
You may also
submit a complaint to:
Department
of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You will not
be penalized for filing a complaint.
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