2014 HIPAA Notice of Privacy Practices
Effective as of: June 11, 2014
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.
The Health Insurance Portability and Accountability Act of 1996 (“HIPAA’*) is a Federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept confidential. HIPAA gives you. the patient, the right to understand and control how your protected health information is used. HIPAA provides penalties for covered entities that misuse personal health information.
WHO WILL FOLLOW THIS NOTICE
This Notice describes the privacy practices of Maxillofacial & Implant Surgery of Western Mass, P.C. (MISWM). As used in this Notice, MISWM means Maxillofacial & Implant Surgery of Western Mass, P.C., their employees (including physicians, nurses, surgical assistants and administrative personnel) and other individuals who work at MISWM. This Notice applies to all medical records generated by MISWM.
ABOUT THIS NOTICE
This Notice will tell you about the ways we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information. We are required by law to:
- maintain the privacy of protected health information;
- give you this Notice of our legal duties and privacy practices with respect to your health information; and
- abide by the terms of the Notice currently in effect.
ELECTRONIC HEALTH RECORDS
This oral surgery practice collects health information about you and stores it in a chart and in an electronic health record. This is your medical record. The medical record is the property of this oral surgery practice, but the information in the medical record belongs to you. One of the advantages of electronic health records is the ability to share and exchange health information among our personnel and other health care providers who are involved in your care. When we enter your information into an electronic health record, we may share that information as permitted by law by using shared clinical databases and health information exchanges. We may also receive information about you from other health care providers who are involved in your care by using shared databases or health information exchanges. If you have any questions or concerns about the sharing or exchange of your information, please discuss them with your provider.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and give examples.
- For Treatment. We may use health information about you to provide you with medical treatment or services and to send you appointment reminders. We may disclose health information about you to doctors, nurses, surgical assistants, administrative personnel, or other individuals who are involved in your care. Different departments within MISWM may share health information about you in order to coordinate the different services or items you need, such as prescriptions, lab work, x-rays or surgical booking.
- For Payment. We may use and disclose health information about you to bill and collect payment from you, your insurance company or a third party payer. For example, we may need to give your insurance company information about your surgery so they will pay us or reimburse you for the treatment. We may also tell your health plan about the treatment you are going to receive to determine whether your plan will cover it. Your health plan may request additional information.
- For Healthcare Operations. We may use and disclose health information about you for operations of MISWM. These uses and disclosures are necessary to run MISWM and make sure that all of our patients receive quality care. For example, we may use health information to evaluate the performance of our staff in caring for you. We may combine health information about many patients to evaluate the need for new services. We may disclose information to doctors, nurses, surgical assistants, administrative personnel and medical students and other MISWM employees for educational purposes. We may also disclose health information about you to other healthcare facilities that have treated you for their quality review related to that treatment.
- Marketing. Health information about you cannot be used for marketing purposes without your authorization, unless the activity relates to certain permitted exceptions that relate to your treatment or care.
- Individuals Involved in Your Care or Payment for Your Care. We may release relevant health information about you to a friend or family member who is involved in your medical care or who helps pay for your care only if you have added them to your release form.
USES AND DISCLOSURES THAT ARE REQUIRED OR PERMITTED BY LAW
Subject to requirements of federal, state and local laws, we are either required or permitted to report your health information for various purposes. Some of these report requirements and permissions include:
- Public Health Activities. We may disclose your health information to public health officials for activities related to the prevention or control of communicable disease; to report suspected abuse, neglect or domestic violence or when required to avert a serious threat to health or safety.
- Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections and licensure.
- Judicial or Administrative Proceeding. We may disclose your health information when required by court order or warrant.
- Law Enforcement. We may disclose your health information to a law enforcement official if required by law or by a warrant or court order.
- Coroners, Medical Examiners and Funeral Directors. We may disclose health information to a coroner or a medical examiner. This may be necessary to identify a person who died or to determine the cause of death. We may disclose health information to help a funeral director carry out his/her duties.
- Organ and Tissue Procurement. We may disclose your health information to organizations that facilitate organ, eye, or tissue procurement, banking or transplantation.
- Research. We may use or disclose your health information for research approved by an Institutional Review Board or Privacy Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
- Workers’ Compensation. We may disclose your health information as necessary to comply with workers’ compensation laws.
- Military. If you are a member of the armed forces of the United States or another country, we may disclose health information about you as required by military command authorities.
- National Security. We may disclose your health information to federal official(s) for national security activities authorized by law.
USES AND DISCLOSURES SPECIFICALLY AUTHORIZED BY YOU
We may make other uses and disclosures of your health information only with your specific written authorization. Specifically, we may not use or disclose your health information for marketing purposes and we may not sell your health information without your written authorization. Additionally, if psychotherapy notes are part of your health information, they may not be disclosed unless you provide written authorization.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding your health information:
- Right to Inspect and Copy. You have the right to inspect and copy health information that may be
used to make decisions about your care. Usually this includes medical and billing records, but does not
include psychotherapy notes, if applicable. All requests to inspect and copy health information must be
made in writing to MISWM’s Medical Records Department. We may charge a reasonable fee for the costs of
copying, mailing or other supplies associated with your request.
- Right to Amend. You have the right to request an amendment to your health information that you believe is incorrect or incomplete. Submit your request in writing to MISWM’s Medical Records Department as provided on the last page of this Notice, including your reason for the amendment. We may deny your request if we believe that the information that you would like to amend is accurate and complete or other circumstances apply. If your request for amendment is denied, you will be notified in writing of the reason for the denial and you may submit a written statement disagreeing with the information which will become part of your medical record.
- Right to Request Confidential Communications. You have the right to request that we communicate with you about health care matters in a certain way or at a certain location. For example, you can ask that we only contact you at an alternative location from your home address, such as work, or only contact you by mail instead of phone. Your request must specify how or where you wish to be contacted. We do not require a reason for the request. We will accommodate all reasonable requests.
- Right to Receive a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. To obtain a paper copy of this Notice at any time contact the Medical Records Department. The Medical Records Department contact information is listed below.
- Right to Receive Notification Following a Breach of Your Health Information. We will provide you written notification in the event of a breach of the confidentiality of your health information.
CHANGES TO THIS NOTICE
We may change the terms of this Notice at any time. If we change this Notice, we may make the new terms effective for all health information that we maintain including any information created or received prior to issuing the new Notice. You may obtain a new Notice by contacting the Medical Records Department. The Medical Records Department contact information is listed below.
If you believe your privacy rights have been violated, you may file a complaint with MISWM. To file a complaint with MISWM, please call the Practice Administrator and you will be further instructed. All complaints must be submitted in writing. We will not take action against you for filing a complaint. You also may file a complaint with the Secretary of Health and Human Services (www.mass.gov/eohhs).
FOR MORE INFORMATION OR FURTHER QUESTIONS PLEASE CONTACT:
The Medical Records Department
Maxillofacial & Implant Surgery of Western Mass, P.C.
382 N. Main Street, Suite 202
East Longmeadow, MA 01028
Phone: Maxillofacial & Implant Surgery of Western Mass Phone Number (413) 525-0100
Effective Date: June 11, 2014