Privacy Policy
Health Insurance Portability
And Accountability Act of 1996
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.
If you have any questions about
this Notice, please contact our Privacy Officer at the number
listed at the end of this Notice.
Each time you visit a health care
provider, a record of your visit is made. Typically, this record
contains your symptoms, examination and test results, diagnoses,
treatment, a plan for future care or treatment, and
billing-related information. This Notice applies to all of the
records of your care generated by your health care provider.
Our Responsibilities
is required by law to
maintain the privacy of your health information and to provide you
with a description of our legal duties and privacy practices
regarding your health information. The current Notice will be
posted in the reception room. The notice will include the
effective date. In addition, we will make our best effort to
provide you with a copy of this notice that we request you
acknowledge with your signature.
We are required by law to abide
by the terms of this Notice and notify you of we make changes to
this Notice, which may be at any time. Changes to the Notice will
apply to your medical information that we already maintain as well
as new information received after the change occurs. If we change
our Notice, it will be posted in the reception room. You may also
request that a revised Notice be sent to you in the mail or you
may ask for one at your next appointment or appropriate visit.
This Notice will also serve to advise you as to your rights with
regard to your medical information.
How We May Use and Disclose
Medical Information About You
The following categories describe examples of the way we use and
disclose medical information:
For Treatment:
We may use medical information about you to provide, coordinate
and manage your treatment or services. We may disclose medical
information about you to other doctors, nurses, technicians,
medical students, or other personnel who are involved in your
care. For example, a laboratory or medical specialist may need
to know information about you to run tests or to provide
treatment.
We may also provide a
subsequent health care provider with copies of various reports
that should assist him in treating you. For example, your
medical information may be provided to a physician to whom you
have been referred so as to ensure that the physician has
appropriate information regarding your previous treatment and
diagnosis.
For Payment:
We may use and disclose medical information about your treatment
and services to bill and collect payments from you, your
insurance company or a third party payer. For example, we may
need to give your insurance company information before it
approves or pays for the health care services we recommend for
you. The insurance company may use that information in
connection with making a determination of eligibility or
coverage for insurance benefits, reviewing services provided to
you for medical necessity, and undertaking utilization review
activities. 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.
For Health Care
Operations: We may use or disclose, as needed,
your health information in order to support our business
activities. These activities may include, but are not limited to
quality assessment activities, employee review activities,
training of medical students, licensing, marketing, legal
advice, accounting support, medical records storage and
conducting or arranging for other business activities. For
example, we provide medical records to a storage company for
long-term safekeeping. In addition, 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 by
telephone.
Business Associates:
There are some services provided in our organization through
contracts with business associates. Examples include quality
accounting, software support, transcription, accounting, billing
and collections. When these services are contracted, we may
disclose your health information to our business associate so
that they can perform the job that we have 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
through a written contract.
Other Permitted and Required
Uses and Disclosures That May Be Made With Your Consent,
Authorization, or Opportunity to Object
We also may use and disclose your health information as set forth
below. You have the opportunity to agree or object to the use or
disclosure of all or part of your health information in these
instances. If you are not present or able to agree or object to
the use or disclosure of the health information (such as in an
emergency situation), then your clinician may, using professional
judgment, determine whether the disclosure is in your best
interest. In this case, only the information that is relevant to
your health care will be disclosed.
Individuals Involved in
Your Care or Payment for Your Care: Unless you object,
we may release medical information about you to a friend or
family member who is involved in your medical care or who helps
to pay for your care. In addition, we may disclose medical
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.
Future Communication:
We may communicate to you via newsletters, mailings or other
means regarding treatment options; information on health-related
benefits or services, disease-management programs; wellness
programs; to assess your satisfaction with our services; to
remind you that you have an appointment for medical care; as
part of fund raising efforts; for population-based activities
relating to improving health or reducing health care costs; for
conducting training programs or reviewing competence of heath
care professionals; or other community based initiatives or
activities in which is participating. If you are
not interesting in receiving these materials please
.
Others Permitted and Required
Uses and Disclosures That May Be Made Without Your Consent,
Authorization or Opportunity to Object
We may use or disclose your health information in the following
situations without your authorization or without providing you
with an opportunity to object. These situations include:
As required by law:
We may use and disclose health information to the following
types of entities, including, but not limited to:
- Food and Drug Administration
- Public Health or Legal
Authorities charged with preventing or controlling disease,
injury or disability
- Correctional Institutions
- Workers Compensation Agents
- Organ and Tissue Donation
Organizations
- Military Command Authorities
- Health Oversight Agencies
- Funeral Directors, Coroners
and Medical Directors
- National Security and
Intelligence Agencies
- Protective Service for the
President and Others
- Authority that receives
reports on abuse and neglect
- Law Enforcement/Legal
Proceedings: We may disclose health information for law
enforcement purposes as required by law or in response to
a valid subpoena.
State-Specific
Requirements: Many states have requirements for
reporting including population-based activities relating to
improving health or reducing health care costs.
Your Health Information Rights
Although your health record is the physical property of
that compiled it, you have
the right to:
Inspect and Copy:
You have the right to inspect and copy medical information that
may be used to make decisions about your care. We ask that you
submit these requests in writing. Usually this includes medical
and billing records, but does not include psychotherapy notes or
information compiled in reasonable anticipation or for use in a
civil, criminal, or administrative action or proceeding. We may
deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to medical information,
you may request that the denial be reviewed. The person
conducting the review will not be the person who denied your
request. We will comply with the outcome of the review. Requests
for access to and copies of your medical information must be
submitted to in
writing. The cost for copies of medical records is a $10 search
fee, plus $1 per page up to 100 pages, then $.25 per page up to a
maximum of $200 for the entire chart as indicated by state
statute. We have up to 30 days to furnish you with a copy.
Amend: If
you felt that medical information we have about you is incorrect
or incomplete, you may ask us to amend the information by
submitting a request in writing. You have the right to request
an amendment for as long as we keep the information. We may deny
your request for an amendment and, if this occurs, you will be
notified of the reason for the denial.
An Accounting of
Disclosures: You have the right to request an
accounting of our disclosures of medical information about you
except for certain circumstances, including disclosures for
treatment, payment, health care operations or where you
specifically authorized a disclosure. The Princeton Center for
Plastic Surgery will provide the first accounting to you in any
12-month period without charge. will impose a fee of $10 for each subsequent request for
an accounting within the 12-month period. We ask that you submit
these requests in writing.
Request Restrictions:
You have the right to request a restriction or limitation on the
medical information we use or disclose about you for treatment,
payment or health care operations. You also have the right to
request a limit on the medical information we disclose about you
to someone who is involved in your care or the payment for your
care, like a family member or friend. We are not
required to agree to your request. If we do agree,
we will comply with your request unless the information is
needed to provide you with emergency care.
Request Confidential
Communications: You have the right to request that
we communicate with you about medical matters in a certain way
or at a certain location. We agree to the request to the extent
that it is reasonable for us to do so.
Complaints:
If you believe your privacy rights have been violated, you may
file a complaint with us by and asking for Maria
Romero, The Privacy Officer. All complaints must be also
submitted in writing. You will not be penalized for filing a
complaint.
Other Uses of Medical
Information
Other uses and disclosures of medical 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 medical information about you, you may revoke your
permission, in writing, at any time. If you revoke your
permission, we will no longer use or disclose medical information
about you for the reasons covered by your written authorization.
However, we are unable to take back any disclosures we have
already made with your permission and we are required to retain
our records of the care that we provided to you.
Privacy Officer: Maria Romero, Office Manager
Telephone Number:
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