Notice of Privacy Practices
Privacy Officer: Trish Perry, Practice Administrator, 301‑671‑2400
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 understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to:
- Provide—or enable other providers to provide—quality medical care
- Obtain payment for services, as allowed by your health plan
- Meet our legal and professional obligations
We are required by law to:
- Maintain the privacy of protected health information
- Give you this Notice of our legal duties and privacy practices
- Notify you following a breach of unsecured protected health information
If you have any questions, please contact our Privacy Officer above.
Table of Contents
- A. How This Medical Practice May Use or Disclose Your Health Information
- B. When This Medical Practice May Not Use or Disclose Your Health Information
- C. Your Health Information Rights
- Right to Request Special Privacy Protections
- Right to Request Confidential Communications
- Right to Inspect and Copy
- Right to Amend or Supplement
- Right to an Accounting of Disclosures
- Right to a Paper or Electronic Copy of this Notice
- D. Changes to this Notice of Privacy Practices
- E. Complaints
A. How This Medical Practice May Use or Disclose Your Health Information
This practice collects health information about you and stores it in a chart, on a computer, and in an electronic health record. The medical record itself belongs to this practice, but the information in it belongs to you. The law permits us to use or disclose your information for:
-
Treatment
We use your information to provide care and share it with other providers (e.g., specialists, pharmacists, labs). We may also share with family or others who help care for you, or—if you’re deceased—those assisting after your death. -
Payment
We provide your health plan with the information it needs to pay us. We may also share info with other providers to help them get paid. -
Health Care Operations
We use/disclose info to run and improve our practice: quality reviews, staff training, audits, fraud detection, business planning, and to get insurance authorizations. We share with “business associates” (e.g., our billing service) under strict confidentiality contracts.
- Appointment Reminders: We may leave messages on your answering machine or with someone who answers your phone.
-
Sign‑In Sheet
We may ask you to sign in when you arrive and call your name when it’s your turn. -
Notification & Communication With Family
We may share your location or general condition with family or others involved in your care or payment—unless you instruct otherwise. In a disaster, we may notify relief organizations. If you can agree or object, we’ll seek your preference; if not, our professionals will use their best judgment. -
Marketing
Without payment, we may contact you about products/services related to your care, healthy‑lifestyle reminders, disease management programs, or government health programs. We may receive compensation only for communications about your medications; any other marketing requires your prior written authorization, which you can revoke at any time. -
Sale of Health Information
We will not sell your information without your prior written authorization, which you may revoke at any time. -
Required by Law
We must use/disclose your information when the law demands—e.g., reporting abuse, court orders, or to law enforcement. -
Public Health
We may report to public health authorities for disease control, abuse reporting, FDA safety issues, and more. If notifying you would place you at serious risk, we may delay the notice. -
Health Oversight
For audits, investigations, licensure, and other oversight activities. -
Judicial & Administrative Proceedings
In response to court orders, subpoenas or similar legal processes. -
Law Enforcement
To identify/locate suspects, comply with warrants, subpoenas, or other law enforcement requests. -
Coroners
For death investigations. -
Organ or Tissue Donation
To organ procurement organizations. -
Public Safety
To prevent or lessen serious threats to health or safety. -
Proof of Immunization
To schools requiring immunization records. -
Specialized Government Functions
For military, national security, or correctional institutions. -
Workers’ Compensation
To comply with workers’ compensation laws and report on occupational injuries/illnesses. -
Change of Ownership
If this practice is sold or merged, your records become the new owner’s—but you can request copies be transferred to another provider. -
Breach Notification
We will notify you as required by law of any breach of unsecured protected health information, via email or other appropriate methods.
B. When This Medical Practice May Not Use or Disclose Your Health Information
Except as described above, we will not use or disclose your identifiable health information without your written authorization. You may revoke any authorization in writing at any time.
C. Your Health Information Rights
-
Right to Request Special Privacy Protections
Ask us in writing to restrict uses/disclosures. We’ll honor requests not required for treatment or legal reasons, and we’ll notify you of our decision. -
Right to Request Confidential Communications
Request in writing a specific way or place to receive communications (e.g., a work address or email). -
Right to Inspect and Copy
Submit a written request specifying what you want to see or copy and the form (electronic or paper). We’ll provide it in the requested format if readily producible or offer an alternative. Fees may apply. You can appeal denials. -
Right to Amend or Supplement
Request in writing corrections to your record, with reasons. We may deny if the info wasn’t created by us, is accurate, or if access is restricted by law. You can submit a statement of disagreement. -
Right to an Accounting of Disclosures
Ask for a list of non‑routine disclosures we’ve made in the past six years (excluding treatment, payment, operations, certain public health disclosures, or those you’ve authorized). -
Right to a Paper or Electronic Copy of This Notice
Even if you agreed to email, you can request a paper copy. Contact our Privacy Officer to exercise any rights.
D. Changes to this Notice of Privacy Practices
We may amend this Notice at any time. The new Notice will apply to all protected health information we maintain. A copy of the current Notice will be posted in our reception area and available at each appointment.
E. Complaints
If you believe your privacy rights have been violated, contact our Privacy Officer. If you’re not satisfied, you may file a complaint with:
Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
150 S. Independence Mall West, Suite 372
Public Ledger Building
Philadelphia, PA 19106‑9111
Phone: (800) 368‑1019
Fax: (215) 861‑4431
TDD: (800) 537‑7697
Email: OCRmail@hhs.gov
The e-mail address is OCRmail@hhs.gov and the complaint form may be found at www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf. You will not be penalized in any way for filing a complaint.
