Effective Date of this Policy: January 1, 2014
Below is our Notice of Privacy Practices. If you have any questions regarding this policy, or would like a full copy, please contact our office during normal business hours and ask to speak with the Practice Administrator / Privacy Officer.
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 (“Notice”) describes the ways in which we may use and disclose your protected health information. It also describes your rights and our legal obligations with respect to your protected health information.
WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION TO PROVIDE YOU WITH TREATMENT, TO OBTAIN PAYMENT FOR SERVICES RENDERED TO YOU, AND FOR HEALTH CARE OPERATIONS.
- For treatment: We may use and disclose your protected health information to provide you with medical treatment and services, and to coordinate or manage your health care and related services.
- For Payment: We may use and disclose your protected health information to bill and receive payment for the treatment and services we provide.
For HealthCare Operations: We may use and disclose your protected health information as necessary for us to operate our medical practice.
WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION IN LIMITED SITUATIONS.
We will share your information if the law requires it. Please see our full policy for a listing of those specific situations.
YOUR AUTHORIZATION IS REQUIRED FOR ALL OTHER USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION.
- The Right to Access Your Protected Health Information: Upon written request, you have the right to inspect and obtain a copy of your protected health information.
- The Right to Request Restrictions: You have the right to request a restriction on the way we use or disclose your protected health information for treatment, payment or health care operations.
- The Right to Request Confidential Communications: You have the right to request that we communicate with you concerning your health matters in a certain manner or at a certain location.
- The Right to Request an Amendment: You have the right to request that we amend medical or billing records, or other protected health information maintained by us, for as long as the information is kept by us. Your request must be made in writing and must explain the reasons for the requested amendment.
- The Right to An Accounting of Disclosures: You have the right to request an accounting of certain disclosures of your protected health information made after April 14, 2003. An accounting is a listing of disclosures made by us or by others on our behalf.
- The Right to a Paper Copy of This Notice: You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time by contacting our office in writing or by phone. In addition, you may obtain a copy of this Notice on our website, www.holyokepediatrics.com
Right to Be Notified of a Breach of Unsecured Protected Health Information: You have the right to be notified in the event there is a breach of your unsecured protected health information.
SPECIAL RULES REGARDING THE DISCLOSURE OF MENTAL HEALTH CONDITIONS, SUBSTANCE ABUSE, AND HIV-RELATED INFORMATION.
For uses and disclosures of your protected health information related to care for mental health conditions, substance abuse, or HIV-related information, special restrictions may apply.
- If you believe that your privacy rights have been violated, you may file a complaint in writing with us or with the federal government.
- You will not be retaliated against for filing a complaint.
To file a complaint with the federal government, you may contact:
Peter Chan, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
J.F.Kennedy Federal Building - Room 1875
Boston, MA 02203
Voice phone (800) 368-1019
FAX (617) 565-3809
TDD (800) 537-7697
You may file a complaint through the OCR Complaint Portal at: