NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCIBES HOW MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Health Insurance Portability and Accountability Act of
1996 (“HIPAA”) is a federal program that requires
all medical records and other individually identifiable health
information used or disclosed by us in any form, whether electronically,
on paper, or orally, are kept properly confidential. This
act gives you, the patient, significant new rights to understand
and control how your health information is used. “HIPAA”
provides penalties for covered entities that misuse personal
health information.
As required by “HIPAA”, we have prepared this
explanation of how we are required to maintain the privacy
of your health information and how we may use and disclose
your health information.
We may use and disclose your medical records only for each
of the following purposes: treatment, payment, and health
care operations.
- Treatment means providing, coordinating, or managing health
care and related services by one or more health care providers.
An example would include a physical examination.
- Payment means such activities as obtaining reimbursement
for services, confirming coverage, billing or collection
activities, and utilization review. An example of this would
be sending a bill for your visit to your insurance company
for payment or to your attorney if you have a legal claim
pending.
- Health care operations include the business aspects of
running our practice, such as conducting quality assessment
and improvement activities, auditing functions, cost-management
analysis, and customer service. An example would be a quality
assessment review.
We may also create and distribute de-identified health information
by removing all references to individually identifiable information.
We may contact you to provide appointment reminders or information
about other benefits or services that may be of interest to
you. We may leave messages at your home with a family member,
personal representative, or on your answering machine regarding
appointment dates or instructions for care.
Any other uses or disclosures will be made only with your
written authorization. You may revoke such authorization in
writing and we are required to honor and abide by that written
request, except to the extent that we have already taken actions
relying on your authorization.
You have the following rights with respect to your protected
health information, which you can exercise by presenting a
written request to the Privacy Officer.
- The right to request restrictions on certain uses and
disclosures of protected health information, including those
related to disclosures to family members, other relatives,
close personal friends, or any other person identified by
you. We are, however, not required to agree with a requested
restriction. If we do agree to a restriction, we must abide
by it unless you agree in writing to remove it.
- The right to reasonable requests to receive confidential
communications of protected health information from us by
alternative means or at alternative locations.
- The right to inspect and copy your protected health information.
- The right to request amendments to your protected health
information.
- The right to receive an accounting of disclosures of protected
health information upon request.
- The right to obtain a paper copy of this notice from us
upon request.
We are required by law to maintain the privacy of your protected
health information and to provide you with notice of our legal
duties and privacy practices with respect to protected health
information.
This notice is effective as of April 15, 2003, and we are
required to abide by the terms of the Notice of Privacy Practices
currently in effect. We reserve the right to change the terms
of our notice of privacy practices and to make the new notice
provisions effective for all protected health information
that we maintain. We will post and you may request a written
copy of a revised Notice of Privacy Practices from this office.
You have recourse if you feel that your privacy protections
have been violated. You have the right to file a written complaint
with our privacy officer, or with the Department of Health
& Human Services, Office of Civil Rights, about violations
of the provisions of this notice or the policies and procedures
of our office. We will not retaliate against you for filing
a complaint.
Please contact us for more information:
Henry E. Rakov
Privacy Officer
299 Washington St.
Newton, MA 02458
(617) 219-6388
For information about HIPAA or to file a complaint:
The U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: (877) 696-6775 |
