NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and comply with certain legal requirements. This notice applies to all of the records of your care generated by this practice, whether made by your personal doctor or others working in this office. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:

• make sure that health information that identifies you is kept private;
• give you this notice of our legal duties and privacy practices with respect to health information about you; and
• follow the terms of the notice that is currently in effect.

For Treatment: We may use health information about you to provide you with health care treatment or services. We may disclose health information about you to doctors, nurses, technicians, health students, or other personnel who are involved in taking care of you. They may work at our office, at the hospital if you are hospitalized under our supervision, or at another doctor’s office, lab, pharmacy, or other health care provider to whom we may refer you for consultation, to take x-rays, to perform lab tests, to have prescriptions filled, or for other treatment purposes. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian at the hospital if you have diabetes so that we can arrange for appropriate meals. We may also disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

For Payment: We may use and disclose health information about you so that the treatment and services you receive from us may be billed to and payment collected from you, an insurance company, or third party. For example, we may need to give our health plan information about your office visit so your health plan will pay us or reimburse you for the visit. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

For Health Care Operations: We may use and disclose health information about you for office operations. These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, whether certain new treatments are effective, or to compare how we are doing with others and to see where we can make improvements. We may remove information that identifies you from this set of health information so others may use it to study health care delivery without learning who our specific patients are.

Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment either in our office or an outside facility, such as the hospital for a surgical procedure.

Individuals Involved In Your Care Or Payment For Your Care: We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps to pay for your care such as an attorney. We may also tell your family or friends your condition.

To An Outside Collection Agency: Should your account become delinquent we may forward personnel information to our collection agency or collection attorney to assist them in the collection of past due monies.

Transcription Services: We may disclose medical information to a company that provides our transcription service.

Research: Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with the patients’ need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through this research approval process, but we may disclose health information about you to people preparing to conduct a research project. For example, we may help potential researchers look for patients with specific health needs, so long as the health information they review does not leave our facility. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care.

As Required By Law: We will disclose health information about you when required to do so by federal, state, or local law.

To Avert A Serious Threat To Health Or Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone to help prevent the threat.

Military Or Veterans: If you are a member of the armed forces or separated/discharged from military service, we may release health information about you as required by military command authorities or the department of Veterans Affairs as may be applicable. We may also release health information about foreign military personnel to the appropriate foreign military authorities.

Workers’ Compensation: We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

No Fault: We may release health information about you if you are involved in an auto accident to someone involved in providing benefits for an auto related injury or illness.

Public Health Risks: We may disclose health information about you for public heath activities. These activities generally include the following:

• to prevent or control disease, injury or disability.
• to report births and deaths.
• to report child abuse or neglect.
• to report reactions to medications or problems with products;
• to notify people of recalls of products they may be using.
• to notify a person or organization required to receive information on FDA-regulated products.
• to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
• to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care systems, government programs, and compliance with civil right laws.

Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose information about you in response to a court or demonstrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request.

Law Enforcement: We may release health information if asked to do so by a law enforcement official.

• in reporting certain injuries, as required by law, gunshot wounds, burns, injuries to perpetrators of crime:
• in response to a court order, subpoena, warrant, summons or similar process:
• to identify or locate a suspect, fugitive, material witness, or missing person:
• about the victim of a crime, if the victim agrees to disclosure or under other certain limited circumstances,
• about a death we believe may be the result of criminal conduct.
• about criminal conduct at our facility
• in emergency circumstances to report a crime; the location of the crime or victims; or the identity , description or location of the person who committed the crime.

Coroners, Health Examiners, and Funeral Directors: We may release health information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine to cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties.

National Security for the President and Others: We may disclose health information about you to authorized federal officials for intelligence, counter intelligence, and other national security activities authorized by law.

Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release may be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety and the health and safety of others; or (3) for the safety and security of the correctional institution.

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy: You may have the right to inspect and copy health information that may be used to make decisions about your health care.

Usually, this includes health and billing records. This does not include psychotherapy notes.

To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to the Practice Manager. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, faxing or other supplies and services associated with your request. If you request to inspect your records there will be a hourly fee charges. All fees must be paid at the time of service. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another professional chosen by our practice will review your request and the denial. The person conducting the review will not be the same person who denied your request. We will comply with the outcome of the review.

Right to Amend: If you feel that health information we have about you is incorrect or incomplete you may ask to amend the information. You have the right to request an amendment for as long as we keep the information. To request an amendment, your request must be made in writing to the Practice Manager, and must be contained on one piece of paper legibly handwritten or typed in at least 10 point font size. In addition, you must provide a reason that supports your request for an amendment. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

• was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• is not part of the health information kept by or for our practice;
• is not part of the information which you would be permitted to inspect and copy; or
• is accurate and complete.

Any amendment we make to your health information will be disclosed to those with whom we disclose information as previously specified.

Right to an Accounting of Disclosures: You have the right to request a list accounting for any disclosures of your health information we have made, except for uses and disclosures for treatment, payment and health care operations, as previously described.

To request the list of disclosures, you must submit your request in writing to the Practice Manager. Your request must state a time period which may not be longer than six years and may not include dates before November 6, 2001. The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures in paper from within 30 days of your request, or notify you if we are unable to supply the list within that time period and by what date we can supply the list; but this date will not exceed a total of 60 days from the date you made the request.

Right to Request Restrictions: You have the right to request restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not disclose information to your spouse regarding a surgery you had.

We are not required to agree to your request for restrictions if it is not feasible for us to ensure our compliance or believe it will negatively impact the way we provide care to you. If we do not agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request a restriction, you must make your request in writing to the Practice Manager. In your request, you must tell us what information you want to limit and to whom you want the limits to apply. Please be aware that some restrictions may cause you additional obligations.

Right to Request Confidential Communications: You have the right to request that we communicate with you about health matters in a certain way or location. For example, you can ask that we only contact you at work or by mail to a post office box. To request confidential communications, you must make your request in writing to the Practice Manager. We will not ask a reason for the request. We will accommodate reasonable requests. Your request must be specific.

Right to Paper Copy of This Notice: You have the right to obtain a paper copy of this notice at any time. To obtain a copy please ask one of the receptionists at the front desk.

We reserve the right to change this notice. 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 our facility. This notice will contain on the first page, in the top right-hand corner, the effective date. In addition each time you register at our office for treatment or service we will offer you a copy of the current notice.

COMPLAINTS: If you believe your privacy rights have been violated, you may file a complaint with this office, or with the Secretary of the Department of Health and Human Services. To file a complaint with this office, please contact the Practice Manager at 973-971-3500. All complaints must be made in writing. To file a complaint with D.H.H.S. call 1-877-696-6775. YOU WILL NOT BE PENALIZED FOR FILING A COMPLAINT.

OTHER USES OF MEDICAL INFORMATION: Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us 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 no longer use or disclose medical information about you for the reason covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our record of the care that we provide.