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 Patient Privacy Information |
JOSEPH P. ADDABBO FAMILY HEALTH CENTER
is required by law to maintain the privacy of your protected
health information and to provide you with notice of its legal
duties and privacy practices with respect to protected health
information. USES AND DISCLOSURES REQUIRING A CONSENT. Except
where a use or disclosure is required by law or necessary to
provide service to you or to provide for medical audits by the
Department of Health and Human Services, JOSEPH
P. ADDABBO FAMILY HEALTH CENTER will use or disclose
your protected health information, even where a specific written
authorization is not required, only pursuant to your written
consent. You may revoke your consent at any time except to the
extent JOSEPH P. ADDABBO FAMILY HEALTH
CENTER has acted in reliance on it. USES AND DISCLOSURES
REQUIRING AN AUTHORIZATION. Except as otherwise provided in
this Notice, JOSEPH P.ADDABBO FHC
will use and disclose protected health information only upon
your specific written authorization relating to the protected
health information to be used or disclosed. You may revoke such
an authorization at any time except to the extent JOSEPH
P. ADDABBO FAMILY HEALTH CENTER has acted in reliance
on it. USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION FOR
TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS. JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may use or disclose
your protected health information without your specific written
authorization for its own treatment, payment, or health care
operations and may disclose protected health information for
treatment activities of a health care provider, to another health
care organization or provider for payment activities of the
provider that receives the information, or, under certain circumstances,
to another health care organization for health care operations
activities of that organization. Treatment means provision,
coordination, or management of a patient’s care by a health
care provider or providers, including coordination or management
of a patient’s care with a third party, consultation between
health care providers about a patient, or referral of a patient
from one provider to another. For example, JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may disclose protected
health information to its own or other health care providers
who need such information for a patient’s care. Payment means
a health care provider’s activities to provide or receive reimbursement
for health care services provided to a patient, including, for
example, determinations of eligibility or coverage; billing,
claims management, collection activities, and related health
care data processing; review of health care services for medical
necessity, coverage under a health plan, appropriateness of
care, or justification of charges; utilization review activities;
and certain reimbursement-related disclosures to consumer reporting
agencies. For example, JOSEPH P. ADDABBO
FAMILY HEALTH CENTER may send a bill to a patient’s
insurer that includes information identifying the patient, the
patient’s diagnosis, and the procedures and supplies used. Health
Care Operations include activities such as conducting quality
assessment and improvement activities; population-based activities
relating to improvement of health care; reviewing the competence
or qualifications of health care professionals; conducting training
programs for health care professionals; accreditation, certification,
licensing, and credentialing activities; conducting or arranging
for medical review, legal services, and auditing functions;
business planning and development; and business management and
general administrative activities. For example:
JOSEPH P. ADDABBO FAMILY HEALTH CENTER’s quality
improvement team may use information in a patient’s health record
to assess the care and outcomes in the patient’s case and others
like it in an effort to continually improve the quality and
effectiveness of the care it provides. JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may also disclose
a patient’s health record with another health care provider
who treated the patient for that provider’s quality assessment
activities. Appointment Reminders, Treatment Alternatives, and
Other Health-Related Benefits: JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may contact you to
provide appointment reminders, information about treatment alternatives,
or other health-related benefits and services that may be of
interest to you. Fund-Raising: JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may contact you to
raise funds for JOSEPH P. ADDABBO FAMILY
HEALTH CENTER. OTHER PERMITTED OR REQUIRED USES AND
DISCLOSURES. JOSEPH P. ADDABBO FAMILY
HEALTH CENTER may also use or disclose protected
health information without your specific written authorization
where permitted or required by law. The permitted and required
uses and disclosures are described below. With the Opportunity
to Agree or Object. While the uses and disclosures described
below may be done without your specific written authorization,
you must usually be given an opportunity to agree or object.
To Those Involved with a Patient’s Care:
JOSEPH P. ADDABBO FAMILY HEALTH CENTER may disclose
to a family member, other relative, close personal friend of
a patient, or any other person identified by a patient, protected
health information directly relevant to that person’s involvement
with the patient’s care or payment related to the patient’s
care. For Notification of a Patient’s Location, General Condition,
or Death: JOSEPH P. ADDABBO FAMILY
HEALTH CENTER may use or disclose protected health
information to notify or assist in notifying a family member,
a patient’s personal representative, or another person responsible
for a patient’s care of a patient’s location, general condition,
or death. For Disaster Relief Purposes: JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may use or disclose
protected health information to an organization authorized by
law or by its charter to assist in disaster relief efforts for
the purpose of coordinating notification to a family member,
a patient’s personal representative, or another person responsible
for a patient’s care of a patient’s location, general condition,
or death. Without the Opportunity to Agree or Object. So long
as the privacy rule requirements are followed, the uses and
disclosures described below may be done without your specific
written authorization and without giving you an opportunity
to agree or object. Required by Law: JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may use or disclose
protected health information to the extent the use or disclosure
is required by law, complies with, and is limited to the relevant
requirements of such law. Public Health Activities: JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may disclose protected
health information for a variety of public health activities.
These include, for example, disclosure (i) to a public health
authority authorized by law to collect or receive information
for the prevention or control of disease, injury, or disability
or to a public health or other authority authorized by law to
receive reports of child abuse or neglect; (ii) to a person
under the jurisdiction of the FDA regarding an FDA-regulated
product or activity for which that person has responsibility
for purposes related to the quality, safety, or effectiveness
of the FDA-regulated product or activity; if authorized by law
to do so, to someone who may have been exposed to a communicable
disease; or to an employer about an employee to whom
JOSEPH P. ADDABBO FAMILY HEALTH CENTER provides health
care at the employer’s request to conduct an evaluation relating
to medical surveillance of the workplace or to evaluate whether
the employee has a work-related illness or injury. Abuse, Neglect,
or Domestic Violence: JOSEPH P. ADDABBO
FAMILY HEALTH CENTER may disclose protected health
information about a patient whom JOSEPH
P. ADDABBO FAMILY HEALTH CENTER reasonably believes
to be a victim of abuse, neglect, or domestic violence to a
government authority authorized to receive this information
to the extent such use or disclosure is required by law, complies
with, and is limited to the relevant requirements of such law;
where the patient agrees to the disclosure; or, under certain
circumstances, where expressly authorized by law. Health Oversight
Activities: JOSEPH P. ADDABBO FAMILY
HEALTH CENTER may disclose protected health information
to a health oversight agency for oversight activities authorized
by law, including audits; civil, administrative, or criminal
investigations, proceedings, or actions; inspections; licensure
or disciplinary actions; or other activities necessary for the
oversight of the healthcare system, government benefit programs,
or compliance with governmentally-regulated program standards
or civil rights laws where health information is necessary to
determine compliance. Where the patient is the subject of the
investigation or activity, there are restrictions on when such
information may be used or disclosed. Judicial and Administrative
Proceedings: JOSEPH P. ADDABBO FAMILY
HEALTH CENTER may disclose protected health information
in a judicial or administrative proceeding in response to a
court or administrative tribunal order, or, so long as certain
requirements are met, a subpoena, discovery request, or other
lawful process not accompanied by a court or tribunal order.
Law Enforcement Purposes: JOSEPH P.
ADDABBO FAMILY HEALTH CENTER may disclose protected
health information for a law enforcement purpose to a law enforcement
official under certain specified circumstances. Coroners, Medical
Examiners, and Funeral Directors: JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may disclose protected
health information to coroners or medical examiners for the
purpose of identifying a deceased person, determining a cause
of death, or other duties as authorized by law. JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may also disclose
protected health information to funeral directors as necessary
to carry out their duties. Research: So long as certain requirements
are met, JOSEPH P. ADDABBO FAMILY HEALTH
CENTER may disclose protected health information
to researchers for reviews preparatory to research, for research
on a decedent's information, and when the research has been
approved by an institutional review board. Threat to Health
or Safety: JOSEPH P. ADDABBO FAMILY
HEALTH CENTER may, subject to certain exceptions
and so long as certain requirements are met, use or disclose
protected health information to designated organizations or
individuals where necessary to prevent or lessen a serious and
imminent threat to the health or safety of a person or the public
or to identify or apprehend someone who may have caused serious
physical harm to another person or who appears to have escaped
from custody. Other Specialized Government Functions:
JOSEPH P. ADDABBO FAMILY HEALTH CENTER may use or
disclose protected health information in certain instances related
to military and other specialized government functions, for
example, for members of the armed forces, as deemed necessary
by appropriate military command authorities. Workers’ compensation:
JOSEPH P. ADDABBO FAMILY HEALTH CENTER may disclose
protected health information as authorized by and to the extent
necessary to comply with laws relating to workers’ compensation
or other similar legally-established programs. OTHER RESTRICTIONS
ON USE OR DISCLOSURE. Notwithstanding any statement elsewhere
in this Notice, JOSEPH P. ADDABBO FAMILY
HEALTH CENTER will not use or disclose protected
health information in any way that is restricted or prohibited
by law. Uses and disclosures to which this applies include:
Protected Health Information of Minor Patients:
JOSEPH P. ADDABBO FAMILY HEALTH CENTER is required
by law not to disclose protected health information of minor
patients to their parents or guardians under certain circumstances.
Protected Health Information Relating to Certain Diseases: Except
where specifically required or permitted by law, JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may not disclose
a patient's protected health information relating to certain
conditions, including HIV disease and substance abuse, without
the patient's specific written authorization. Psychotherapy
Notes: Except for use by the originator of the psychotherapy
notes for treatment or use or disclosure by JOSEPH
P. ADDABBO FAMILY HEALTH CENTER for its own training
programs or to defend itself in a legal action or other proceeding
brought by the patient, JOSEPH P. ADDABBO
FAMILY HEALTH CENTER may not use or disclose psychotherapy
notes without the patient's specific written authorization.
Marketing: Except for face-to-face communication with a patient
or to give the patient a gift of nominal value, JOSEPH
P. ADDABBO FAMILY HEALTH CENTER may not use or disclose
protected health information for marketing without the patient's
specific written authorization. PATIENT RIGHTS. You have the
following rights concerning protected health information about
you: Right to Request Restrictions: You have the right to request
restrictions on uses and disclosures of protected health information
to carry out treatment, payment, or health care operations;
to those involved with your care; or for notification of your
location, general condition, or death. JOSEPH
P. ADDABBO FAMILY HEALTH CENTER is not required to
agree to the restriction. Right to Confidential Communications:
You have the right to receive reasonable accommodation of requests
to receive communications of protected health information by
alternative means or at alternative locations.
JOSEPH P. ADDABBO FAMILY HEALTH CENTER may not require
an explanation from you as to the reason for the request. Right
of Access: With certain exceptions, you have the right of access
to inspect and copy protected health information. Right to Amend:
You have the right to amend protected health information.
JOSEPH P. ADDABBO FAMILY HEALTH CENTER
may deny the request under certain circumstances, for example,
if it determines that the information is accurate and complete.
Right to an Accounting: With certain exceptions, you have the
right to receive an accounting of disclosures of protected health
information. The right to an accounting does not include, for
example, disclosures to carry out treatment, payment, or health
care operations or pursuant to an authorization. Right to Receive
a Copy of this Notice: You have the right, upon request, to
obtain a paper copy of this Notice from
JOSEPH P. ADDABBO FAMILY HEALTH CENTER. CHANGES TO
THIS NOTICE. JOSEPH P. ADDABBO FAMILY
HEALTH CENTER is required by law to abide by the
terms of the Notice currently in effect. JOSEPH
P. ADDABBO FAMILY HEALTH CENTER reserves the right
to change the terms of this Notice and to make the new Notice
provisions effective for all protected health information that
it maintains. Should JOSEPH P. ADDABBO
FAMILY HEALTH CENTER’s practices regarding protected
health information change, the revised Notice will be made available
to you at your request and will be posted in a clear and prominent
location at your service site. FOR MORE INFORMATION, TO REVOKE
A CONSENT OR AUTHORIZATION, OR TO REPORT A PROBLEM. For the
procedure regarding exercising any of your rights under this
Notice, or if you have questions or would like additional information
about the matters covered by this Notice, you may contact [Michael
Menschel, RHIT (718) 945-7150 ext. 240 of Privacy Contact at
JOSEPH P. ADDABBO FAMILY HEALTH CENTER].
To revoke an existing consent or authorization, please contact
[Michael Menschel, RHIT (718) 945-7150 ext. 240 of Privacy Contact
at JOSEPH P. ADDABBO FAMILY HEALTH
CENTER]. If you believe your privacy rights have
been violated, you may file a complaint with JOSEPH
P. ADDABBO FAMILY HEALTH CENTER or with the Secretary
of the United States Department of Health and Human Services.
To file a complaint with JOSEPH P.
ADDABBO FAMILY HEALTH CENTER, please contact [Michael
Menschel, RHIT (718) 945-7150 ext. 240 of Privacy Contact at
JOSEPH P. ADDABBO FAMILY HEALTH CENTER].
For HIPPA complaints to the Secretary of DHHS that involve covered
entities located in New York, Puerto Rico, the Virgin Island,
and New Jersey, DHHS has designated Region II, Office for Civil
Rights, U.S. Department of Health and Human Services Jacob Javits
Federal Building 26 Federal Plaza, Suite 3312 New York, New
York 10278 Tel: 212-264-3313 Fax: 212-264-3039 TDD: 212-264-2355
All complaints must be submitted in writing. There will be no
retaliation against you for filing a complaint. |
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