| Notice
of Health Information Practices
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Introduction
At The Center for Spine, Sports and Pain Management we are
committed to treating and using protected health information
about you responsibly. This Notice of Health Information Practices
describes the personal information we collect, and how and
when we use or disclose that information. It also describes
your rights as they relate to your protected health information.
This Notice is effective [DATE], and applies to all protected
health information as defined by federal regulations.
Understanding Your Health Record/Information
Each time you visit The Center for Spine, Sports and Pain
Management, a record of your visit is made. Typically, this
record contains your symptoms, examination and test results,
diagnoses, treatment, and a plan for future care or treatment.
This information, often referred to as your health or medical
record, serves as a:
o Basis for planning your care and treatment,
o Means of communication among the many health professionals
who contribute to your care,
o Legal document describing the care you received,
o Means by which you or a third-party payer can verify that
services billed were actually provided,
o A tool in educating heath professionals,
o A source of data for medical research,
o A source of information for public health officials charged
with improving the health of this state and the nation,
o A source of data for our planning and marketing,
o A tool with which we can assess and continually work to
improve the care we render and the outcomes we achieve,
Understanding what is in your record and how your health
information is used helps you to: ensure its accuracy, better
understand who, what, when, where, and why others may access
your health information, and make more informed decisions
when authorizing disclosure to others
Your Health Information Rights
Although your health record is the physical property of The
Center for Spine, Sports and Pain Management, the information
belongs to you. You have the right to:
o Obtain a paper copy of this notice of information practices
upon request,
o Inspect and copy your health record as provided for in 45
CFR 164.524,
o Amend your health record as provided in 45 CFR 164.528,
o Obtain an accounting of disclosures of your health information
as provided in 45 CFR 164.528,
o Request communications of your health information by alternative
means or at alternative locations,
o Request a restriction on certain uses and disclosures of
your information as provided by 45 CFR 164.522, and
o Revoke your authorization to use or disclose health information
except to the extent that action has already been taken.
Our Responsibilities
The Center for Spine, Sports and Pain Management is required
to:
o Maintain the privacy of your health information,
o Provide you with this notice as to our legal duties and
privacy practices with respect to information we collect and
maintain about you,
o Abide by the terms of this notice,
o Notify you if we are unable to agree to a requested restriction,
and
o Accommodate reasonable requests you may have to communicate
health information by alternative means or at alternative
locations.
We reserve the right to change our practices and to make
the new provisions effective for all protected health information
we maintain. Should our information practices change, we will
mail a revised notice to the address you've supplied us, or
if you agree, we will email the revised notice to you.
We will not use or disclose your health information without
your authorization, except as described in this notice. We
will also discontinue to use or disclose your health information
after we have received a written revocation of the authorization
according to the procedures included in the authorization.
For More Information or to Report a Problem
If have questions and would like additional information,
you may contact the practice's Privacy Officer, Dr. Edward
Magaziner at (732) 297-2600.
If you believe your privacy rights have been violated, you
can file a complaint with the practice's Privacy Officer,
or with the Office for Civil Rights, U.S. Department of Health
and Human Services. There will be no retaliation for filing
a complaint with either the Privacy Officer or the Office
for Civil Rights. The address for the OCR is listed below:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
Examples of Disclosures for Treatment, Payment and Health
Operations
We will use your health information for treatment.
For example: Information obtained by a nurse, physician,
or other member of your health care team will be recorded
in your record and used to determine the course of treatment
that should work best for you. Your physician will document
in your record his or her expectations of the members of your
health care team. Members of your health care team will then
record the actions they took and their observations. In that
way, the physician will know how you are responding to treatment.
We will also provide your physician or a subsequent health
care provider with copies of various reports that should assist
him or her in treating you once you're discharged from this
hospital.
We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer.
The information on or accompanying the bill may include information
that identifies you, as well as your diagnosis, procedures,
and supplies used.
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality
improvement manager, or members of the quality improvement
team may use information in your health record to assess the
care and outcomes in your case and others like it. This information
will then be used in an effort to continually improve the
quality and effectiveness of the healthcare and service we
provide.
Business associates: There are some services provided in
our organization through contacts with business associates.
Examples include physician services in the emergency department
and radiology, certain laboratory tests, and a copy service
we use when making copies of your health record. When these
services are contracted, we may disclose your health information
to our business associate so that they can perform the job
we've asked them to do and bill you or your third-party payer
for services rendered. To protect your health information,
however, we require the business associate to appropriately
safeguard your information.
Directory: Unless you notify us that you object, we will
use your name, location in the facility, general condition,
and religious affiliation for directory purposes. This information
may be provided to members of the clergy and, except for religious
affiliation, to other people who ask for you by name.
Notification: We may use or disclose information to notify
or assist in notifying a family member, personal representative,
or another person responsible for your care, your location,
and general condition.
Communication with family: Health professionals, using their
best judgment, may disclose to a family member, other relative,
close personal friend or any other person you identify, health
information relevant to that person's involvement in your
care or payment related to your care.
Research: We may disclose information to researchers when
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 health information.
Funeral directors: We may disclose health information to
funeral directors consistent with applicable law to carry
out their duties.
Organ procurement organizations: Consistent with applicable
law, we may disclose health information to organ procurement
organizations or other entities engaged in the procurement,
banking, or transplantation of organs for the purpose of tissue
donation and transplant.
Marketing: We may contact you to provide appointment reminders
or information about treatment alternatives or other health-related
benefits and services that may be of interest to you.
Fund raising: We may contact you as part of a fund-raising
effort.
Food and Drug Administration (FDA): We may disclose to the
FDA health information relative to adverse events with respect
to food, supplements, product and product defects, or post
marketing surveillance information to enable product recalls,
repairs, or replacement.
Workers compensation: We may disclose health information
to the extent authorized by and to the extent necessary to
comply with laws relating to workers compensation or other
similar programs established by law.
Public health: As required by law, we may disclose your health
information to public health or legal authorities charged
with preventing or controlling disease, injury, or disability.
Correctional institution: Should you be an inmate of a correctional
institution, we may disclose to the institution or agents
thereof health information necessary for your health and the
health and safety of other individuals.
Law enforcement: We may disclose health information for law
enforcement purposes as required by law or in response to
a valid subpoena.
Federal law makes provision for your health information to
be released to an appropriate health oversight agency, public
health authority or attorney, provided that a work force member
or business associate believes in good faith that we have
engaged in unlawful conduct or have otherwise violated professional
or clinical standards and are potentially endangering one
or more patients, workers or the public.
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