Notice of BPFP Privacy Practices for Protected Health Information

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:
  1. for the institution to provide you with health care;
  2. to protect your health and safety and that of others;
  3. 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

 
 
 
 
©All rights reserved. Brunswick Princeton Industrial Medical Center