The HIPAA Privacy Rule requires health plans and covered health care providers to develop and distribute a notice that provides a clear, user friendly explanation of individuals rights with respect to their personal health information and the privacy practices of health plans and health care providers.
This document explains your rights as a patient to your personal health information:
HIPAA NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003
THIS NOTICE DESCRIBES HOW HEALTH 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 contact Meg O’Toole Oser, Privacy Officer at (973) 564-5642.
ORGANIZED HEALTHCARE ARRANGEMENT:
This notice describes the practices that will be used regarding your medical information received or generated by The Stone Center and New Jersey Anesthesia Associates, P.C. in connection with your relationship as a patient with those entities while receiving care at The Stone Center.
The following organizations and physicians are members of this organized healthcare arrangement:
- The Stone Center, LLC
- American Anesthesiology of NJ
In order to facilitate the provision of care to you, the entities listed above shall follow the terms of this joint Notice of Privacy Practices as an organized healthcare arrangement (the “OHCA”). As members of the OHCA, they may share medical information with each other for treatment, payment or operations purposes described in this notice. However, except for The Stone Center’s obligation to furnish this Notice of Privacy Practices on behalf of the OHCA, under no circumstances shall a member of the OHCA be considered an agent or representative of another member of the OHCA as a result of its participation in the OHCA.
References to “we” shall refer to any and all entities listed above.
OUR PLEDGE REGARDING HEALTH INFORMATION:
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 to comply with certain legal requirements. This notice applies to all of the records of your care generated by this health care institution, whether made by your personal doctor or others working in this facility. 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 that are set forth in this Notice of Privacy Practices .
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.
The following categories describe the various ways in which we use and disclose your health information. For each category of uses or disclosures we will briefly explain the type of use or disclosure of your health information and we will also provide you with an example consistent with that type of use or disclosure. It is important to note that our examples are an exhaustive listing but is for illustrative purposes only. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment: We may use health information about you to provide you with healthcare treatment or services. We may disclose health information about you to doctors, nurses, technicians, health students, or other personnel who are involved in your care. They may work at our facility and/or at the hospital if you are hospitalized prior to or following treatment at our facility. 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 your health information to enable us to be paid by the proper payor for the services that we provide, including disclosures to your third party insurance company, managed care or other health care payor or health plan. For example, we may need to give your health plan information about your procedure so your health plan will pay us or reimburse you for the visit. We may also tell your health plan about procedures you are receiving or will receive to obtain prior approval or determine whether your plan will cover your procedure at our facility.
For Health Care Operations: We may use and disclose health information about you for operations of our facility. These uses and disclosures are necessary to run our facility and make sure that all of our patients receive quality care. For example, we may use your health information to perform quality assurance or utilization review or perform an audit of 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 your health information to contact you as a reminder that you have an appointment. Please let us know if you do not wish to have us contact you concerning your appointment, or if you wish to have us use a different telephone number or address to contact you for this purpose.
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 able to help prevent the threat.
Military and Veterans. If you are a member of the armed forces or separated/discharged from military services, 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.
Public Health Risk. We may disclose health information about you for public health activities. These activities generally include the following:
- To prevent or control disease, injury, or disability;
- To report child abuse or neglect;
- To report reactions to medications or problems with products;
- To notify people of recalls of products being used;
- To notify person(s) or organization(s) 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 system, government programs, and compliance with civil rights laws.
Lawsuit and Disputes. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in a 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 or to obtain an order protecting the information requested.
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:
- Name and address
- Date of birth or place of birth;
- Social security number;
- Date and time of treatment and or death, if applicable; and
- A description of distinguishing physical characteristics.
- About the victim of a crime, if the victim agrees to disclosure or under certain limited circumstances, we are unable to obtain the person’s agreement;
- About criminal conduct at our facility; and
- 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 the cause of death. We may also release information about patients to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities. We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
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 would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU.
You have the following rights regarding health information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records.
To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to The Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies and services associated with your request.
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 licensed health care professional chosen by our facility will review your request and the denial. The person conducting the review will not be the 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 us 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 in writing, submitted to The Privacy Officer, and must be legibly handwritten or typed and may not exceed one page . 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 facility;
- 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. Subject to various exceptions, you have the right to request a list of accounting for disclosures of your health information that we have made. Generally, such uses and disclosures pursuant to treatment, payment and health care operations are exempt from this right, in addition to any uses and disclosures pursuant to an authorization that is signed by you or your personal representative.
To request this list of disclosures, you must submit your request in writing to The Privacy Officer. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. 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 form 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 a restriction or limitation on the health information that 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 can ask that you restrict a specified nurse from use of your information, or that we not disclose information to your spouse about treatment 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 care we may provide you. If we do 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 Privacy Officer. In your request, you must tell us what information you want to limit and to whom you want the limits to apply; for example, use of any information by a specified nurse, or disclosure of specified treatment to your spouse.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain 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 requests in writing to The Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice. If you desire to have another copy of this notice, you have a right to obtain a paper copy of this notice at any time. To obtain a copy, please request it from The Privacy Officer.
You may also obtain a copy of this notice either from our website, www.thestonecenter.org, or by requesting a copy of this notice be sent through electronic mail to email@example.com. If we know that the electronic message failed to be delivered, a paper copy of the notice will be provided. Even if you have received a notice electronically, you still retain the right to receive a paper copy upon request.
CHANGES TO THIS NOTICE
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. The notice will contain on the first page, in the top-right hand corner, the effective date. In addition, each time you are scheduled for treatment, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact The Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of health 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 health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons 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 records of the care that we provided you.
Acknowledgement of Receipt of this Notice
We will request that you sign a separate form or notice acknowledging you have received a copy of this notice. If you choose, or are not able to sign, a staff member will sign his/her name, and date to document he/she made a reasonable effort to provide you with this notice. This acknowledgement will be filed with your records.