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Privacy Policies |
Notice of Privacy Practices Connecticut Multispecialty Group, P.C. 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. Connecticut Multispecialty Group, P.C. ("Connecticut Multispecialty Group") is required to maintain the privacy of your health information and to provide you with a notice of its legal duties and privacy practices. Connecticut Multispecialty Group will not use or disclose your health information except as described in this notice. This notice applies to all of the medical records generated by Connecticut Multispecialty Group. YOUR RIGHTS REGARDING USES AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION: The following categories describe the ways that Connecticut Multispecialty Group may use and disclose your health information. Treatment: Connecticut Multispecialty Group will use your health information in the provision and coordination of your health care. We may disclose all or any portion of your medical record information to your referring physician, consulting physician(s), nurses, and other health care providers who have a legitimate need for such information in the care and continued treatment of you, as a patient. Family/Friends: Medical information may also be disclosed to other people involved in your medical care, such as family members, friends, clergy, and others who provide services that are part of your care. We may also give information to someone who helps pay for your care. Treatment Alternatives: Connecticut Multispecialty Group may use and disclose your medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. For example, we may contact you to inform you of the release of new or improved pharmaceuticals which may aid in the treatment of your particular condition. Payment: Connecticut Multispecialty Group may release medical information about you for the purposes of determining coverage, billing, claims management, medical data processing, and reimbursement. 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 excerpts of your medical record, which are necessary for payment of your account. For example, a bill sent to a third party payer may include information that identifies you, your diagnosis, and the imaging procedures you had. Routine Healthcare Operations: Connecticut Multispecialty Group may use and disclose your medical information during routine health care operations, including those for quality assurance, compliance programs, utilization review, medical review, internal auditing, accreditation, certification, licensing, credentialing, training, peer review, case management activities, coordination of care, referrals to other providers, legal services, and business planning. Communications: Connecticut Multispecialty Group may use and disclose medical information to contact you by telephone or mail and remind you of an appointment for an examination or care, to ask you for information necessary to appropriately schedule and perform an examination, to give you information or instructions about your examination, or to give you the results of your examination. Health-Related Business and Services: Connecticut Multispecialty Group may use and disclose your medical information to tell you of health-related benefits or services that may be of interest to you. Business Associates: Connecticut Multispecialty Group may use and disclose certain medical information about you to its Business Associates. A Business Associate is an individual or entity under contract with Connecticut Multispecialty Group to perform or assist Connecticut Multispecialty Group in the performance of functions or activities which necessitate the use and disclosure of medical information. Examples of Business Associates include, but are not limited to, third- party billing companies, medical transcriptionists, imaging archival companies, medical record copying services, companies hired to destroy or dispose of out-dated medical records and imaging studies, lawyers, accountants, and consultants. Connecticut Multispecialty Group requires its Business Associate to protect the confidentiality of your medical information. Research: Under certain circumstances, Connecticut Multispecialty Group may use and disclose medical information about you to researchers when their clinical research study has been approved by a review board. While most clinical research studies require specific patient consent, there are some instances where a retrospective record review with no patient contact may be conducted by such researchers. For example, the research project might involve a review of how well a particular disease was detected on various modalities. Marketing: Connecticut Multispecialty Group may disclose certain contact information to a third party to provide marketing materials and information related to health care services to you. Regulatory Agencies: Connecticut Multispecialty Group may disclose your medical 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 health care system, government programs, and compliance with civil rights. Law Enforcement: Connecticut Multispecialty Group may disclose your medical information for law enforcement purposes as required by law or in response to a valid subpoena or court order. Public Health: As required by law, Connecticut Multispecialty Group may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. For example, the law requires reporting cases of tuberculosis and cases of suspected child abuse. Workers Compensation: Connecticut Multispecialty Group may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illnesses. Military Veterans: Connecticut Multispecialty Group may disclose your medical 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 institute or under the custody of a law enforcement officer, Connecticut Multispecialty Group may release your medical record information to the correctional institute or law enforcement official. Required by Law: Connecticut Multispecialty Group will disclose medical information about you when required to do so by law. Coroners, Medical Examiners, Funeral Directors: Connecticut Multispecialty Group may release your medical 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. Connecticut Multispecialty Group may also release your medical information to funeral directors as necessary to carry out their duties. Other Uses: Any other uses and disclosures will be made only with your written authorization. PATIENT HEALTH INFORMATION RIGHTS: Although all of your records and imaging data at Connecticut Multispecialty Group are the property of Connecticut Multispecialty Group, you have the following rights concerning your medical information. Right to Confidential Communications: You have the right to receive confidential communications of your medical information by alternative means or at alternative locations. For example, you may request in writing that Connecticut Multispecialty Group only contact you at work or by mail. Right to Inspect and Copy: You have the right to inspect and copy your medical information as provided by 45 CFR 164.524. Copying fees will be charged. Right to Amend: You have the right to request amendment of your medical information as provided by 45 CFR 164.526. Connecticut Multispecialty Group requires completion of a written amendment request, including your reason for the requested amendment. Right to an Accounting: You have the right to obtain a statement of the disclosures of your medical information made for purposes other than treatment, payment, and health care operations, as provided by 45 CFR 164.528. The request must be in writing. Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your medical information as provided by 45 CFR 164.522. However, Connecticut Multispecialty Group is not required to agree to honor your request. Right to Receive Copy of this Notice: You have the right to receive a paper copy of this Notice, upon request. Right to Revoke Authorization: You have the right to revoke your authorization to use or disclose your medical information except to the extent that action has already been taken in reliance on your authorization. SPECIAL RULES REGARDING DISCLOSURE OF PSYCHIATRIC, SUBSTANCE ABUSE, AND HIV-RELATED INFORMATION: For disclosures concerning health information relating to care for psychiatric conditions, substance abuse or HIV-related testing and treatment, special restrictions may apply. For example, we generally may not disclose this specially protected information in response to a subpoena, warrant or other legal process unless you sign a special Authorization or if a court orders the disclosure. Psychiatric Information: If needed for your diagnosis or treatment in a mental health program, psychiatric information may be disclosed based on your general Authorization, and limited information may be disclosed for payment purposes. Otherwise, we will not disclose records relating to a diagnosis or treatment of a mental condition between the patient and the psychiatrist or which are prepared at a mental health facility without specific written Authorization or as required or permitted by law. HIV-Related Information: HIV-related information will not be disclosed, except under limited circumstances set forth under State or Federal law, without your specific written Authorization. A general authorization for release of medical or other information will not be sufficient for purposes of releasing HIV-related information. As required by Connecticut law, if we make a lawful disclosure of HIV-related information, we will enclose a statement that notifies the recipient of the information that they are prohibited from further disclosing the information. Substance Abuse Treatment: If you are treated in a specialized substance abuse program, information which could identify you as an alcohol or drug-dependent patient will not be disclosed without your specific Authorization except for purposes of treatment, or where specifically required or allowed under State or Federal law. FOR MORE INFORMATION OR TO REPORT A PROBLEM: If you have questions and would like additional information, please ask one of our Connecticut Multispecialty Group employees or physicians. If they cannot provide the information, please ask for our Privacy Officer. If you believe your privacy rights have been violated, you may file a complaint with Connecticut Multispecialty Group or with the Secretary of the Department of Health and Human Services. To file a complaint with Connecticut Multispecialty Group, please write to:Privacy Officer, Connecticut Multispecialty Group, P.C., 2110 Silas Deane Highway, Rocky Hill, CT 06067. You may also file a complaint with: Office for Civil Rights, U.S. Department of Health and Human Services, Government Center, J.F. Kennedy Federal Building, Room 1875, Boston, Massachusetts, 02203 Voice Phone: (617) 565-1340 FAX: (617) 565-3809 TDD: (617) 565-1343 All complaints must be submitted in writing. There will be no retaliation for filing a complaint. CHANGES TO THIS NOTICE: Connecticut Multispecialty Group will abide by the terms of the Notice currently in effect. Connecticut Multispecialty Group reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all protected health information that it maintains. If the Notice revision reflects a change in the subsequent potential uses and disclosures of your health information, Connecticut Multispecialty Group will mail any revised Notice (prior to implementation of same) to the address for you on file with Connecticut Multispecialty Group or such other address as you may designate in writing from time to time. NOTICE EFFECTIVE DATE: The effective date of this Notice is April 14, 2003. |