Privacy Policy - New Jersey Plastic Surgery
 |
||||||||||||||||
Effective July 1, 2007 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. If you have any questions about this Notice, please ask to speak to our Privacy Officer or call our Privacy Officer at 973-896-5557. This information is available upon request by a patient. This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability & Accountability Act of 1996 (HIPAA) and the Privacy Regulations issued by the Department of Health and Human Services. It describes how we may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This Notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of our Practice, except when the release is required or authorized by law or regulation. This Notice describes our Practice’s policies, which extend to:
PETIENT CONSENT OF THE OPPORTUNITY TO REVIEW THIS NOTICE - You will be asked to sign our Patient Consent Form regarding our HIPAA Privacy Policy, acknowledging that you had the opportunity to review this Notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgment. If you decline to provide a signed acknowledgment, we will continue to provide your treatment, and will use and disclose your protected health information in accordance with law. OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION -"Protected health information" is individually identifiable health information and includes demographic information (for example, age, address, etc.), and relates to your past, present or future physical or mental health or condition and related health care services. Our Practice is required by law to do the following:
We reserve the right to change this Notice at any time. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the Practice. In addition, each time you visit our Practice for treatment or health care services, you may request a copy of the current Notice in effect. HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION Required Uses and Disclosures - By law, we must disclose your health information to you unless it has been determined by a health care professional that it would be harmful to you. Even in such cases, we may disclose a summary of your health information to certain of your authorized representatives specified by you or by law. We must also disclose health information to the Secretary of the U.S. Department of Health and Human Services (HHS) for investigations or determinations of our compliance with laws on the protection of your health information. Treatment - We will use and disclose your protected health information to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we may disclose your protected health information from time to time to another physician or health care provider (for example, a specialist, pharmacist, nurse, technician, medical student, laboratory or hospital personnel) who, at the request of your physician, becomes involved in your care. This includes pharmacists who may be provided information on other drugs you have been prescribed to identify potential interactions. In emergencies, we will use and disclose your protected health information to provide the treatment you require. Payment - Your protected health information will be used, as needed, to obtain payment for your health care services from you, an insurance company or any other third party. This may include certain activities we may need to undertake before your health care insurer approves or pays for the health care services recommended for you, such as determining eligibility or coverage for benefits. For example, obtaining approval for a surgical procedure might require that your relevant protected health information be disclosed to obtain approval to perform the procedure at a particular facility. Health Care Operations - We may use or disclose, as needed, your protected health information to support our daily activities related to providing health care. This will allow us to run our practice more efficiently and make sure that all of our patients receive quality care. These activities include billing, collection, quality assessment, licensing and staff performance reviews. For example, we may disclose your protected health information to a billing agency in order to prepare claims for reimbursement for the services we provide to you. We may ask that you sign in at the Receptionists’ desk in a “Sign In” log on the day of your appointment with the Practice. We may call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information as necessary to contact you to remind you of your appointment. For example, we may contact you at your home telephone number, on your mobile telephone, in writing email or otherwise, which may be received or intercepted by others, to remind you of your next appointment. From time to time, we may send you mailings regarding plastic surgery, our services, and our Practice to your home address. We will share your protected health information with other persons or entities who perform various activities (for example, a transcription service) for our Practice. These business associates of our Practice will also be required to protect your health information. We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that might interest you. We may use or disclose your protected health information in order to review our treatment and services, to evaluate the performance of our staff, to decide what additional services to offer, and whether certain new treatments are effective. We may use or disclose information to doctors, nurses, technicians, medical students, and other personnel for review and learning purposes. We may also combine the medical information we have with the medical information from other Practices to help us evaluate how we are doing and determine where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so that others may use it to study health care and health care delivery without learning the identity of the specific patients. We may also use or disclose information about you for internal or external utilization review and/or quality assurance to business associates for purposes of helping us to comply with our legal requirements, to auditors to verify our records, to billing companies to aid us in this process and the like. We shall endeavor, at all times when business associates are used, to advise them of their continued obligation to maintain the privacy of your medical records. Required by Law - We will use or disclose your protected health information if federal, state or local laws or regulations require the use or disclosure. Public Health - We may disclose your protected health information to a public health authority that is permitted by law to collect or receive the information, when law or public policy requires us to do so. Some examples of when such disclosure may be necessary are as follows:
Communicable Diseases - We may disclose your protected health information, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition. Health Oversight - We may disclose your protected health information to a local, state or federal health oversight agency for activities authorized by law, such as audits, investigations, licensure and inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, other regulatory programs or civil rights laws. Food and Drug Administration - We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events; track products; enable product recalls; make repairs or replacements; or, conduct post-marketing review, as required. Legal Proceedings and Disputes - We may disclose protected health information during any judicial or administrative proceeding, in response to a court order or administrative tribunal (if such disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful process. We may also use such information to defend ourselves or any member of our Practice in any actual or threatened legal action. Law Enforcement - We may disclose protected health information for law enforcement purposes, including:
Coroners, Funeral Directors, and Organ Donations - We may disclose protected health information to coroners or medical examiners for identification of a deceased person, to determine the cause of death or for the performance of other duties authorized by law. We may also disclose protected health information to funeral directors as authorized by law. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donations. Research - We may disclose protected health information to researchers when authorized by law. For example, if their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information. We will obtain an Authorization from you before using or disclosing your individually identifiable health information, unless the authorization requirement has been waived. If possible, we will make the information non-identifiable to a specific patient. If the information has been sufficiently de-identified, an authorization for the use or disclosure is not required. Threat to Health or Safety - Under applicable Federal and State laws, we may disclose your protected health information to law enforcement or another health care professional if we believe in good faith that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. Any disclosure, however, would only be to someone able to help prevent such threat. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual. Military Activity and National Security - When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel for activities believed necessary by appropriate military command authorities to ensure the proper execution of the military mission, including determination of fitness for duty; or to a foreign military authority if you are a member of that foreign military service. We may also disclose your protected health information, under specified conditions, to authorized Federal officials for conducting national security and intelligence activities, including protective services to the President or others. Workers' Compensation - We may disclose your protected health information to comply with workers' compensation laws and other similar legally established programs that provide benefits for work-related injuries or illness. Inmates - We may use or disclose your protected health information, under certain circumstances, if you are an inmate of a correctional facility or under the custody of a law enforcement official. Such release of information may be necessary: for the institution to provide you with health care; to protect your health and safety or the health and safety of others; or, for the safety and security of the correctional institution. Parental Access - State laws concerning minors permit or require certain disclosures of protected health information to parents, guardians, and persons acting in a similar legal status. We will act consistently with the laws of this State (or, if you are treated by us in another state, the laws of that state) and will make disclosures following such laws, once proof of the appropriate legal relationship has been provided to us. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR PERMISSION Individuals Involved in Your Health Care - Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. We may also give information to someone who helps pay for your care. Additionally, we may use or disclose protected health information to notify or assist in notifying a family member, personal representative authorized by you or by a legal mandate (a guardian or other person who has been named to handle your medical decisions, should you become incompetent), or any other person who is responsible for your care, general condition, or death. If you have provided us with your permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you. You understand that we are unable to take back any disclosures that we have already made with your permission, and that we are required to retain our records of the care that we provided to you. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and coordinate uses and disclosures to family or other individuals involved in your health care relating to your condition, status or location. PATIENT RIGHTS Your Rights Regarding Your Protected Health Information Right to Inspect and Copy - You may inspect and/or obtain a copy of your protected health information that is contained in a "designated record set" for as long as we maintain the protected health information. A designated record set contains medical and billing records and any other records that our Practice uses for making decisions about you. This right does not include inspection and copying of the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding; and protected health information that is subject to a law that prohibits access to protected health information. You will be charged a fee for a copy of your record, any postage costs, or any other supplies (tapes, disks, etc.) associated with your request. We will advise you of the exact fee at the time you make your request. We may offer to provide a summary of your information and, if you agree to receive a summary, we will advise you of the fee at the time of your request. All requests must be submitted in writing to our Privacy Officer. We may deny your request to inspect and copy your designated record set in certain very limited circumstances. If you are denied access to medical information, you may request that our Privacy Committee review the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome and recommendations from that review. Right to Request Restrictions - You may ask us not to use or disclose any part of your protected health information for treatment, payment or health care operations. You may also request that we limit the medical information we disclose about you to someone who is involved in your care or the payment for your care (a family member or friend). For example, you could ask that we not use or disclose information about a particular treatment you received. Your request must be made in writing to our Privacy Officer. In your request, you must indicate: (1) what information you want restricted; (2) whether you want to restrict our use or disclosure, or both; (3) to whom you want the restriction to apply (e.g. disclosures to your spouse, children, parents, etc.); and, (4) an expiration date. If we believe that the restriction is not in the best interests of either party, or that we cannot reasonably accommodate the request, we are not required to agree to your request. If the restriction is mutually agreed upon, we will not use or disclose your protected health information in violation of that restriction, unless it is needed to provide emergency treatment or we are otherwise required to do so by law. You may revoke a previously agreed upon restriction, at any time, in writing. Right to Request Alternative Confidential Communications - You may request that we communicate with you about medical matters using alternative means or at an alternative location. We will not ask you the reason for your request. We will accommodate reasonable, written requests, when possible, which specify how or where you wish us to contact you. Right to Request Amendment - If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information for as long as our Practice maintains this information. Such request must be submitted in writing, along with your intended amendment and a reason that supports your request to amend. The request must be signed and dated by you, and notarized. While we will accept requests for amendment, we are not required to agree to the request. Right to an Accounting of Disclosure - You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This is a list of disclosures we made of medical information about you to others. This right applies to disclosures made for purposes other than treatment, payment or health care operations as described in this Notice and excludes disclosures made directly to you, to others pursuant to an authorization from you, to family members or friends involved in your care, or for notification purposes. The accounting will only include disclosures made on or after April 14, 2003, and no more than 6 years prior to the date of your request. The right to receive this information is subject to additional exceptions, restrictions, and limitations as described earlier in this Notice. All such requests must be made in writing. We will notify you of the costs involved and you may choose to withdraw or modify your request at that time before any costs are incurred. Right to Obtain a Copy of this Notice – You have the right to a paper copy of this notice. You may obtain a paper copy of this Notice from us by requesting one at any time. Even if you have agreed to receive this Notice electronically or to view such Notice at our Practice's website at www.drwise.com, you are still entitled to a paper copy of this Notice, upon request. Special Protections - This Notice is provided to you as a requirement of HIPAA. There are several other privacy laws that also apply to HIV-related information, mental health information and substance abuse information. These laws have not been superseded and have been taken into consideration in developing our policies and this Notice. Complaints - If you believe these privacy rights have been violated, you may file a written complaint with our Privacy Officer, who can be reached at our office at 973-305-1400 or directly at 973-896-5557, who will direct you on how to file an office complaint, or with the U.S. Department of Health and Human Services' Office for Civil Rights. We will provide their address upon your request. You will not be penalized or retaliated against for filing a complaint. All complaints must be submitted in writing, and all complaints will be investigated without repercussion to you. CONTACT INFORMATION: Our Privacy Officer is our Office Manager and can be contacted at our office at 973-305-1400 or by calling her directly at 973-896-5557. You may contact our Privacy Officer for further information about our complaint process or for further explanation of this Notice of Privacy Practices. You may also email questions to our Privacy Officer at allison@drwise.com. |
||||||||||||||||
 |
 |
||||||||||
 |
 |
|||
|
|||
 |
|
|||
|
|||
|
