Effective Date: 4/15/2003
Due to new Federal health information privacy rules, this notice is provided to describe how information about you be disclosed and how you can get access to this information.
PLEASE REVIEW IT CAREFULLY
Understanding your health record
A record is made each time you visit our office. Information about your examination and test results are recorded. These records provide information about your treatment as well as research data.
Understanding what information is retained in your record and how that information may be used will help you to ensure its accuracy, and enable you to know who, when, where, and why others may be allowed access to your health information. This effort is being made to assist you in making informed decisions before authorizing the disclosure of your medical information to others. Use or disclosure of your health information will follow the stringent State or Federal laws.
Understanding your privacy rights
Your health record is the physical property of the health care practitioner or facility that compiled it but the content is about you, and therefore belongs to you.
- You have the right to a list of disclosures of your health information for up to 6 years prior to the date of your request. This does not include: (1) disclosures made for treatment and healthcare operations as described below; or (2) disclosures made in circumstances where you have given authorization or (3) other disclosures made in accordance with the law.
- Other than activity that has already occurred, you have the right to revoke any further authorizations to use or disclose your health information.
- You also have the right to request that medical information about you be communicated by alternative means to maintain confidentiality, such as sending your mail to an address other than your home.
- In most cases, you have the right to review or obtain a copy of your health information. To do so, you must submit a written request to the address below. If we deny your request, you are entitled to a review of that decision.
- You have the right to request restrictions on certain uses and disclosures of your information, and to request amendments be made to your health record.
Our Institutions’ Privacy Practices
We understand that health information about you is personal, and we are committed to protecting that information. In meeting legal requirements and honoring our promise to protect your health information we:
- Keep your medical information private. Other than for reasons described in this notice, this office agrees not to use or disclose your health information to individuals who without your authorization.
- Provide you with this notice of your rights and our legal commitment and privacy practices with respect to the information we collect and maintain about you.
- Abide by the terms of this notice and notify you if we are unable to grant your requested restrictions or reasonable desires to communicate your health information by alternative means or to alternative locations.
- Take all possible steps to safeguard your health information.
- Ensure that all healthcare professionals and individuals with privileges, including staff members and abide by our privacy policy and practices.
Understanding our office policy for specific disclosures
- Authorization – As a research participant, your health information will be disclosed to those you have specifically authorized to receive this information.
- Business Associates – Some or all of your health information may be subject to disclosure through contracts for services to assist this office in providing services. To protect your health information, we require these Business Associates to follow the same standards held by this office through terms detailed in a written agreement.
- Communications with Family– Using best judgment, a family member, or close personal friend, identified by you, may be given information relevant to your care.
- Health Care Operations - The medical staff in this office will use your health information to assess the care you received and the outcome of your case compared to others like it. Your information may be reviewed in our efforts to continually improve the quality and effectiveness of the care and services we provide.
- Limited Data Set – We may use or disclose information about you without your authorization as part of a “limited data set” which includes limited information (such as a city, but not your name or address) for research purposes. The recipient of this information must sign a promise to restrict the use of this information.
- Marketing – This office reserves the right to contact you with appointment reminders or information about treatment alternatives and other health-related services that might be appropriate to you.
- Fund Raising – We reserve the right to contact you as part of fundraising efforts.
- Food and Drug Administration (FDA) – This office is required by law to disclose health information to the FDA related to any adverse effects of food, supplements, products, and product defects for surveillance to enable product recalls, repairs, or replacements.
- Public Health – This office is required by law to disclose health information to public health and/or legal authorities charged with tracking mandatory reports of health statistics, such as injuries and communicable diseases.
- Law Enforcement – (1) Your health information will be disclosed for law enforcement purposes as required under state law or in response to a valid subpoena. (2) Provisions of federal law permit the disclosure of your health information to appropriate health oversight agencies and authorities when a report is made in good faith that there has been unlawful conduct or violations of professional clinical standards.
- Treatment – Your health information is used for research purposes, and in some cases to help determine the course of your treatment. In those cases, the sharing of your health information may with others involved in your treatment, such as specialty physicians or lab technicians.
If we have a change in policy
This office reserves the right to change its practices, and affect new policy to enhance the privacy standards of research participant records. You will be informed of changes at your research visits. This office will also post changes to this notice on our websites.
For additional information or to report a problem
For further explanation of this notice you may contact our Privacy Officer at
(203) 401-4300. If you believe your privacy rights have been violated, you have the right to file a complaint with this office by contacting the individual above, or by contacting the Secretary of the U.S. Department of Health and Human Services, with no fear of retaliation by this office.
NOTICE OF PRIVACY PRACTICES:
The terms described in this notice will be posted in the office and on the organizations’ websites. All individuals receiving care will be given a hard copy. We have asked that you acknowledge receipt of this notice, as such it is expected that you have read and have had the opportunity to discuss questions about our privacy policy.