NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW CLINICAL 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, Catherine Clancy or call our Privacy Officer at (609) 924-7080,
ext. 12.
This Notice of Privacy Practices is provided to you as a requirement of the
Health Insurance Portability & Accountability Act (HIPAA). 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.
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE - You will be asked to
provide a signed acknowledgment of receipt of 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:
- Keep your protected health information private
- Present to you this Notice of our legal duties and privacy practices
related to the use and disclosure of your protected health information
- Follow the terms of the Notice currently in effect
- Communicate to you any changes we may make in the Notice
We reserve the right to change this Notice. Its effective date is at the top
of the first page and at the bottom of the last page. 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.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Following are examples of permitted uses and disclosures of your protected
health information. These examples are not exhaustive.
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 who, at the request of your
physician, becomes involved in your care.
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. 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
treatment might require that your relevant protected health information be
disclosed to obtain approval to perform the procedure at a particular facility.
We will continue to request your authorization to share your protected health
information with your health insurer or third party payer, such as a school
district.
Health Care Operations - We may use or disclose, as needed, your
protected health information to support our daily activities related to
providing health 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 or insurance
company when requested to assist patient in preparing claims for reimbursement
for the services we provide to you. We may call you by name in the waiting room
when your therapist 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 to
remind you of your next appointment, on occasion.
We will share your protected health information with other persons or
entities who perform various activities 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. For example, your
name and address may be used to send you a newsletter about our Practice and our
services.
Required by Law - We may use or disclose your protected health
information if law or regulations requires the use or disclosure.
Public Health - We may disclose your protected health information to a
public health authority who is permitted by law to collect or receive the
information. For example, the disclosure may be necessary to prevent or control
disease, injury or disability; report births and deaths; or report reactions to
medications or problems with products.
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 protected health information to a
health oversight agency for activities authorized by law, such as audits,
investigations, 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 - 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
ceratin conditions in response to a subpoena, discovery request, or other lawful
process.
Law Enforcement - We may disclose protected health information for law
enforcement purposes, including responses to legal proceedings; information
requests for identification and location; and circumstances pertaining to
victims of a crime.
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.
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. 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.
Parental Access - State laws concerning minors permit or require
certain disclosure 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.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR
PERMISSION
In some circumstances, you have the opportunity to agree or object to the use
or disclosure of all or part of your protected health information. Following are
examples in which your agreement or objection is required.
Individuals Involved in Your Health Care - Unless you object, we may
disclose to a member of your family, a relative, a close friend, a nanny, 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, or any other person who is responsible for your
care, of your location, general condition, or death. 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.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You may exercise the following rights by submitting a written request to our
Privacy Officer. Our Privacy Officer can guide you in pursuing these options.
Please be aware that our Practice may deny your request; however, in most cases
you may seek a review of the denial.
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 and 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.
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. Your request must be made in writing to our Privacy Officer. In
your request, you must tell us: (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, for example, disclosures to your spouse; 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.
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 using alternative means or at an
alternative location. We will not ask you the reason for your request. We will
accommodate reasonable requests, when possible.
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 as long as we maintain this information. While we
will accept requests for amendment, we are not required to agree to the
amendment.
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 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.
Right to Obtain a Copy of this Notice - You may obtain a paper copy of
this Notice from us by requesting one, or view it or download it electronically
at our Practice's website at www.psllcnj.com.
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 or with the U.S.
Department of Health and Human Services' Office for Civil Rights. We will
provide their address upon your request. No retaliation will occur against you
for filing a complaint.
CONTACT INFORMATION: Our Privacy Officer is Diane Ford and can
be contacted at this office or by calling our telephone number, (609) 924-7080.
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
DianeF@psllcnj.com.
This Notice is effective in its entirety as of April 14, 2003.
