Brunswick Princeton Family Practice (BPFP) and Brunswick Princeton Industrial Medical Center (BPIMC)
Bradley H. Kline, D.O.
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.
We, at BPFP AND BPIMC, understand that health information about you and your health is personal.
We therefore are committed to and required by law to maintain the privacy of your health information
and to provide you with notice of legal duties and privacy practices with respect to your health information.
We will not use or disclose your health information except as described in this Notice.
This Notice applies to all of the health information maintained by our units, and our Centers and
Institutes, which are collectively referred to as BPFP AND BPIMC.
How We May Use and Disclose Your Health Information:
We may use and disclose your health information as described below.
However, this is only meant to give you a general overview and not to describe all
specific possible uses and disclosures that may occur.
Treatment
We may use your health information to provide medical/dental treatment, items or services.
For example, we may disclose all or any portion of your health information to your
other treating physician, treating dentist, consulting physician(s), nurses, technicians,
and other health care professionals who have a need for such information for your care and treatment.
Treatment Alternatives
We may use and disclose your health information to tell you about possible
treatment options or alternatives or other health related benefits that
may be of interest to you
Payment
We may use and disclose health information about you so that we may bill and
receive payment for treatment and services that you receive. Your information
may also be necessary for purposes of determining coverage, medical necessity,
pre-authorization or certification and for utilization management.
The information may be released to an insurance company, third party payer
or other entity (or their authorized representatives) involved in the payment
of your medical bill and may include copies or portions of your medical/dental
record, which are necessary for payment of your account. For example, a bill
sent to an insurance company may include information that identifies you, your
diagnosis, and the procedures and supplies used. Also, your health information
may be disclosed to consumer reporting and/or to collection agencies.
Healthcare Operations
We may use and disclose your health information for our health care operations,
including quality assurance, utilization review, medical/dental review, internal
auditing, accreditation, social services certification, licensing or credentialing
activities of BPFP AND BPIMC, certain medical research, and educational purposes.
For example, BPFP AND BPIMC may review your health information to make sure that
BPFP AND BPIMC is providing quality care to all of its patients.
Other Health Care Providers, Health Plans, and Clearinghouses
We may use and disclose your health information to your health plan,
or a clearinghouse involved in the billing of services and treatment
provided to you, for the purpose of providing you treatment, receiving
or processing payment, and to conduct certain operational activities
as permitted by law.
Other Health Care Providers, Health Plans, and Clearinghouses
We may use and disclose your health information to your health plan,
or a clearinghouse involved in the billing of services and treatment
provided to you, for the purpose of providing you treatment, receiving
or processing payment, and to conduct certain operational activities
as permitted by law.
Appointment Reminders
We may use and disclose your health information to contact you as a reminder
that you have an appointment for treatment or medical care at BPFP AND BPIMC.
Persons Involved in Your Care
We will not disclose your health information to family members, other
relatives, close personal friends, or any other person(s) not involved
with your clinical or financial medical care without your consent.
Disaster Relief
Unless you object, we may use or disclose your health information to a
public or private entity authorized by law or by charter to assist in disaster
relief efforts including notifying your family about your condition,
status and location.
Health Related Benefits and Services
We may use and disclose your health information to tell
you of health-related benefits or services that may be of
interest to you.
Business Associates
We may use and disclose health information to business associates.
A business associate is an individual or entity under contract with
us to perform or assist BPFP AND BPIMC in a function or activity
which requires the use or disclosure of health information.
Examples of business associates, include, but are not limited to,
copy services to copy medical records, consultants, accountants,
lawyers, and medical transcriptionists. We require the business
associate to enter into an agreement to protect the confidentiality
of your health information.
De-Identified Data or Limited Data Sets
We may use or disclose health information about you if we remove all
information that could be used to identify you, i.e. "de-identified"
information. We are required to remove over fifteen (15) different
pieces of information that could be used to possibly identify you.
We may also use or disclose a limited amount of health information
about you in a "limited data set" for the purposes of research, public
health, or health care operations if we enter into a data use
agreement with the recipient of the data.
Health Oversight Agencies
We may use and disclose your health information to a health oversight agency
for activities authorized by law, including, but not limited to, licensure,
certification, audits, investigations and inspections. These activities are
necessary for the government and certain private health oversight agencies to
monitor the healthcare system, government programs, and compliance with civil
rights.
Law Enforcement
We may use and disclose your health information for law enforcement purposes to a law enforcement official if required by law, or where permitted by law, or in response to a valid subpoena. Also, we may disclose health information if it is necessary for law enforcement authorities to identify or locate an individual.
Disclosures in Judicial/Legal Proceedings
We may use and disclose your health information to a court or administrative agency when a judge or administrative agency orders us to do so. We may also use and disclose information about you in legal proceedings, such as in a response to a discovery request, subpoena, court order, etc. Also, BPFP AND BPIMC may use or disclose your health information in preparation for any dispute or litigation between you and BPFP AND BPIMC.
Public Health Risk
We may use and disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. For example, we are required by law to report the existence of a communicable disease, such as acquired immune deficiency syndrome ("AIDS"), to the New Jersey State Department of Health to protect the health and well being of the general public. Other activities generally disclosed include the following:
- To prevent or control disease, injury or disability.
- To report births and deaths.
- To report child abuse and neglect.
- To report reactions to medications or problems with products.
- To notify a person who may have been exposed to a communicable disease
or may be at risk for contracting or spreading a disease or condition.
- To notify the appropriate government authority if BPFP AND BPIMC believes
a patient has been the victim of abuse, neglect or domestic violence.
Safety of a Person or the Public
We may use and disclose your health information to prevent or lessen a serious
and imminent threat to the health or safety of a person or the public.
Workers' Compensation
We may use and disclose health information about you for workers'
compensation or similar programs. These programs provide benefits for
work-related injuries or illnesses.
Military/Veterans
We may use and disclose your health information as required by military
command authorities, if you are a member of the armed forces.
Inmates
If you are an inmate of a correctional institution or under the custody
of a law enforcement officer, we may release your medical/dental record
information to the correctional institution or law enforcement official.
This release would be necessary:
- for the institution to provide you with health care;
- to protect your health and safety and that of others;
- for the safety and security of the correctional institution.
Required by Law
We may use and disclose health information about you when required to do
so by State or Federal law. For example, we may disclose certain health
information to those persons who have a risk exposure related to a
mmunicable disease, as required by New Jersey law.
National Security and Intelligence Activities
We may use and disclose your medical/dental information about you to
authorized federal officials for intelligence, counterintelligence, and
other National Security activities as authorized by law. We may also
disclose health information about you to authorized federal officials so
they may provide protection to the President or other authorized persons.
Coroners, Medical Examiners, Funeral Directors
We may release your health information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person or to
determine a cause of death. BPFP AND BPIMC may also release your health
information to funeral directors as necessary to carry out their duties.
You would have to be part of such a program and be told of its operation.
For example: if you work in a noisy environment, we may be asked to
perform hearing tests and disclose this information to your employer
so that they can comply with OSHA hearing surveillance programs.
Employers
We may use and disclose your health information to your employer to conduct
medical surveillance of the workplace, or to evaluate whether you have a
work-related illness or injury. This would occur if you were part of such
a surveillance program, or if we were the workers compensation position
for you and your company. We would not disclose this information without
a signed released by you and we were not sure Workers-Worker's compensation
physician.
Secretary of the Department of Health and Human Services
We may use and disclose your health information when required by the
Secretary of Health and the Department of Health and Human Services
for purposes of investigating or determining compliance with the privacy
law.
Other Uses
Any other uses and disclosures of your health information will be made
only with your written authorization.
Your Rights Regarding Your Health Records
Although your health records are BPFP AND BPIMC's property, you have
the following rights:
- Right to Confidential Communications
You have the right to receive confidential communications of your health
information by alternative means or at alternative locations.
- Right to Request to Inspect and to Obtain a Copy
You have the right to inspect and to obtain a copy of your health information.
However, such requests may be denied as permitted under the law. You have the
right to appeal such denials. (Copying fees may be imposed.)
- Right to Request Amendment
You have the right to request to amend your health information. However,
BPFP AND BPIMC may deny your request to amend your health information
under certain circumstances. All requests for amendments must be in
writing and provide a reason supporting your request for an amendment.
- Right to Request Restrictions
You have the right to request restrictions on certain uses and disclosures
of your health information. However, BPFP AND BPIMC is not required to
agree to such request. You have the right to receive confidential
communications of your health information by alternative means or at
alternative locations. You must communicate your specific request
in writing.
_Right to Request Restrictions of information contained in your record
You have the right to request restrictions on certain information within
your medical record, these requests must be received in writing and signed by you.
- Right to an Accounting of Uses and Disclosures
You have the right to request that we provide you with an accounting of
disclosures we have made of your health information. An accounting is a
list of disclosures. This list will not include disclosures of your health
information made for treatment, payment, or health care operations, made to
you, or made pursuant to an authorization signed by you.
The request should state the time period for which you wish to receive an
accounting. This time period should not be longer than six (6) years and
should not include dates before April 14, 2003. The first accounting you
request within a twelve (12) month period will be free. For additional
requests during the same twelve month period, we will charge you for costs
of the accounting. We will notify you of the amount we will charge and you
may choose to withdraw or change your request before you are charged any
costs. To exercise your right, please contact the address below.
- Right to Receive a Copy of this Notice
You have the right to receive a paper copy of this Notice, upon request.
You may also obtain a copy of this notice at our website at:
www.family-practice-doctor.com and/or www.workers-comp.org
- Right to Revoke Your Prior Authorization
You have the right to revoke your authorization (your permission) to use
or disclose your health information except to the extent that action has
already been taken in reliance on your prior authorization. To exercise
your right, please contact us at our office address.
For More Information or to Make a Complaint
If you have questions and would like additional information, you may call
the HIPAA hotline: (800)-215-9664. If you believe your privacy rights
have been violated, you may file a complaint with BPFP AND BPIMC or with
the Secretary of the Department of Health and Human Services. To file a
complaint, please contact the Office of Ethics, Compliance & Corporate
Integrity above address. There will be no retaliation for filing a complaint.
Changes to This Notice
BPFP AND BPIMC will abide by the terms of the Notice currently in effect.
However, BPFP AND BPIMC reserves the right to change the terms of its Notice
and to make the new Notice provision(s) effective for all health information
that it maintains. BPFP AND BPIMC will promptly post the revised Notice on
the BPFP AND BPIMC web site: : www.family-practice-doctor.com and/or www.workers-comp.org
Reliance on this Notice by Other Healthcare Entities
BPFP AND BPIMC may sometimes participate in an organized healthcare arrangement
with providers and entities that may not be employed by BPFP AND BPIMC, but
participate in your health care. Any providers or entities participating in
this arrangement may rely on this Notice as providing you with notice of their
privacy practice.
The effective date of the Notice is 10/2/13
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