HIPAA
Notice of Privacy Practices
CENTRA PC
5000 Sagemore Drive, Suite 205
Marlton, NJ 08053
856—985—3030
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED
AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This
Notice of Privacy Practices describes how we may use and disclose your
protected health information (PHI) to carry out treatment, payment or
health care operations (TPO) and for other purposes that are permitted
or required by law. It also describes your rights to access and control
your protected health information. “Protected health information” is
information about you, including demographic information, that may
identify you and that relates to your past, present or future physical
or
mental health or condition and related health care
services.
1.
Uses and Disclosures of
Protected Health Information
Uses
and Disclosures of Protected Health
Information
Your
protected health information may be used and disclosed by your
physician, our office staff and others outside of our office that are
involved in your care and treatment for the purpose of providing health
care services to you, to pay your health care bills, to support the
operation of the physician’s practice, and any other use required by
law.
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 would disclose your protected health information,
as necessary, to a home health agency that provides care to you. For
example, your protected health information may be provided to a
physician to whom you have been referred to ensure that the physician
has the necessary information to diagnose or treat you.
Payment:
Your protected health information will be used, as needed, to obtain
payment for your health care services. For example, obtaining approval
for a hospital stay may require that your relevant protected health
information be disclosed to the health plan to obtain approval for the
hospital admission.
Healthcare
Operations:
We may use or disclose, as-needed, your protected health information in
order to support the business activities of your physician’s practice.
These activities include, but are not limited to, quality assessment
activities, employee review activities, training of medical students,
licensing, and conducting or arranging for other business activities.
For example, we may disclose your protected health information to
medical school students that see patients at our office. In addition, we
may use a sign-in sheet at the registration desk where you will be asked
to sign your name and indicate your physician. We may also call you by
name in the waiting room when your physician 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.
We
may use or disclose your protected health information in the following
situations without your authorization. These situations include: as
Required By Law, Public Health issues as required by law, Communicable
Diseases: Health Oversight: Abuse or Neglect: Food and Drug
Administration requirements: Legal Proceedings: Law Enforcement:
Coroners, Funeral Directors, and Organ Donation: Research: Criminal
Activity: Military Activity and National Security: Workers’
Compensation: Inmates: Required Uses and Disclosures: Under the law, we
must make disclosures to you and when required by the Secretary of the
Department of Health and Human Services to investigate or determine our
compliance with the requirements of Section 164.500.
Other
Permitted and Required Uses and Disclosures Will Be Made Only With Your
Consent, Authorization or Opportunity to Object unless required by law.
You
may revoke this authorization, at any time, in writing, except to the
extent that your physician or the physician’s practice has taken an
action in reliance on the use or disclosure indicated in the
authorization.
YOUR RIGHTS
Following
is a statement of your rights with respect to your protected health
information.
You have the right to inspect and copy your protected
health information.
Under
federal law, however, you may not inspect or copy 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 law that prohibits access
to protected health information.
You
have the right to request a restriction of your protected health information. This means you may ask us not to use or
disclose any part of your protected health information for the purposes of
treatment, payment or healthcare operations. You may also request that any
part of your protected health information not be disclosed to family
members or friends who may be involved in your care or for notification
purposes as described in this Notice of Privacy Practices. Your request
must state the specific restriction requested and to whom you want the
restriction to apply.
Your
physician is not required to agree to a restriction that you may request.
If physician believes it is in your best interest to permit use and
disclosure of your protected health information, your protected health
information will not be restricted. You then have the right to use another
Healthcare Professional.
You have the right to request to receive confidential
communications from us by alternative means or at an alternative location.
You have the right to obtain a paper copy of this notice from us,
upon request, even if you have agreed to accept this notice alliteratively
i.e. electronically.
You
may have the right to have your physician amend your protected health
information.
If we deny your request for amendment, you have the right to file a
statement of disagreement with us and we may prepare a rebuttal to your
statement and will provide you with a copy of any such rebuttal.
You
have the right to receive an accounting of certain disclosures we have
made, if any, of your protected health information.
We
reserve the right to change the terms of this notice and will inform you
by mail of any changes. You then have the right to object or withdraw as
provided in this notice.
Complaints
You
may complain to us or to the Secretary of Health and Human Services if you
believe your privacy rights have, been violated by us. You may file a
complaint with us by notifying our privacy contact of your complaint. We
will not retaliate against you for filing a complaint.
This
notice was published and becomes effective on/or before April 14, 2003.
We
are required by law to maintain the privacy of, and provide individuals
with, this notice of our legal duties and privacy practices with respect
to protected health information. If you have any objections to this form,
please ask to speak with our HIPAA Compliance Officer in person or by
phone at our Main Phone Number.
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