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.
Northern Fertility
and Reproductive Associates, P.C. creates, retains, uses
and discloses health information about you for treatment,
to obtain payment for treatment, for administrative purposes,
to evaluate the quality of care that you receive, and
for various other reasons required and/or permitted by
law. Your health information is contained in a medical
record that is the physical property of Northern Fertility
and Reproductive Associates, P.C. The terms of this Notice
apply to individually identifiable health information,
as defined in 45 CFR 164.501, which is created, maintained,
used or disclosed by Northern Fertility and Reproductive
Associates, Ltd.
How
Northern Fertility and Reproductive Associates, P.C. May
Use or Disclose Individually Identifiable Health Information
Without Your Written Authorization:
Treatment.
Northern Fertility may use your health information to
provide you with medical treatment or services. For example,
we may instruct you to have laboratory tests, and we may
use the results to diagnose your condition. We may refer
your information to other physicians who will subsequently
treat you. We may provide your health information to a
pharmacy for the purposes of ordering a prescription.
We may coordinate the management of your care with other
individuals, including other physicians with whom we consult.
Payment.
Northern Fertility may use and disclose your health information
to others for the purpose of obtaining payment for treatment
and services that you receive. For example, a bill may
be sent to you or a third-party payer, such as an insurance
company or health plan. The information on the bill may
contain information that identifies you, your diagnosis,
and treatment or supplies used in the course of treatment.
Health
Care Operations. Northern Fertility may use and
disclose health information about you for operational
purposes. For example, your health information may be
disclosed to members of our staff for the purpose of evaluating
the performance of our staff; assessing the quality of
care and outcomes in your case and similar cases; and
for learning how to improve our facilities, health care
and other services. We may also disclose information about
you to other entities or persons with whom you have had
some relationship if such disclosures relate to the quality
assessment or improvement activities of those entities,
the qualification or evaluation of their health care providers,
or for the purpose of ensuring compliance with health
care fraud and abuse laws.
Incidental
Uses & Disclosures. Incidental uses and disclosures
of your health information are acceptable provided Northern
Fertility has in place reasonable safeguards for preventing
wrongful disclosures. For example, the physical setup
of our office may be such that two patients requiring
care at the same time will be treated within close proximity
to one another.
Family & Friends. Northern Fertility may
determine, in its professional judgment, that disclosures
to family or friends of patients are necessary and in
the best interest of the patients, provided patient consent
is implied or patient agreement has been obtained. For
example, during your treatment, your spouse may be involved
in discussions concerning your health.
Phone
Calls/Voice Mail. In order to treat you efficiently,
we may discuss you care over the phone with you, with
other physicians, and in certain cases, with family members
or significant others involved in your care. We will take
proper measures to ensure the identity of the individual
with whom we are speaking. In addition, we may leave voice
mail messages for you that relate to your treatment. We
will, however, ensure our patient contact information
is up-to-date and accurate, and we will tailor any messages
to remove health information that is individually identifiable
and include only the minimum amount of information necessary.
For
Disaster Relief Purposes. Northern Fertility
may determine, in its professional judgment, that it must
use your health information in disaster relief efforts.
For example, we may provide your information to authorities
to assist in evacuation of individuals during a flood
or fire.
Health
Oversight Activities. Northern Fertility may
use or disclose your health information for the purpose
of conducting or participating in health oversight activities
such as audits, licensure review activities and health
related investigations.
Appointments/Treatment
Options. Northern Fertility may use your information
to provide appointment reminders or information about
treatment alternatives or other health-related benefits
and services that may be of interest to you.
Required
by Law. Northern Fertility may use and disclose
information about you as required by law. For example,
Northern Fertility may disclose information for the following
purposes:
· for judicial and administrative proceedings pursuant
to legal authority: if we receive a court or administrative
order we may release your information without your authorization;
if we receive a discovery request, subpoena or other lawful
request not accompanied by a court or administrative order,
we will make an effort to inform you of the request and/or
obtain written assurances from the requesting party that
you have been notified or that the information will be
protected as required by law.
· to report information related to victims of abuse,
neglect or domestic violence; and
· to assist law enforcement officials in their
law enforcement duties;
· to report crimes in emergencies
Public
Health. Your health information may be used or
disclosed for public health activities such as reporting
of vital statistics to the Society for Assisted Reproductive
Technology and the Centers for Disease Control; assisting
public health authorities or other legal authorities to
prevent or control disease, injury, or disability, including
disclosures to individuals exposed to communicable diseases,
provided we are authorized by law to make such disclosures;
activities within the jurisdiction of the FDA, such as
product recalls; and, in limited circumstances and after
patient notification, to employers about workplace injuries,
illnesses or medical surveillance.
Decedents.
Health information about decedents may be disclosed to
funeral directors or coroners to enable them to carry
out their lawful duties.
Organ/Tissue
Donation. Your health information may be used
or disclosed for cadaveric organ, eye or tissue donation
purposes.
Research.
Northern Fertility may, in limited circumstances prescribed
by law, use your health information for research purposes,
provided an institutional review board or privacy board
has reviewed the research proposal, established protocols
to ensure the privacy of your health information, approved
of the research and assured us the use of your information
will comply with all applicable law.
Health
and Safety. Your health information may be disclosed
to avert a serious threat to the health or safety of you
or any other person, pursuant to applicable law.
Government
Functions. Your health information may be disclosed
for specialized government functions such as intelligence
and national security efforts, protection of public officials
or reporting to various branches of the armed services
of which you may be a member.
Workers'
Compensation. Your health information may be
used or disclosed in order to comply with laws and regulations
related to Workers' Compensation.
Other
Uses. Our practice will obtain your written authorization
for uses and disclosures that are not identified in this
Notice unless we are permitted by law to make such disclosures
without authorizations. You may revoke any authorization,
in writing, except to the extent Northern Fertility has
taken action in reliance on such authorization.
Your
Health Information Rights
You have the
right to:
· Request a restriction on certain uses and disclosures
of information. Your request should be detailed in writing.
Northern Fertility is not required to agree to a requested
restriction;
· Obtain a paper copy of this notice of information
practices upon request;
· Inspect and obtain a copy of your health record
as provided for in 45 C.F.R. Sec. 164.524. You should
submit your request in writing to our Privacy Officer.
We may charge copying and mailing fees. We may deny your
request in certain circumstances, but you may request
a review of our denial by another health care professional
of our choosing;
· Request that your health record be amended as
provided in 45 C.F.R. §164.526. Such request should
be in writing and state the reasons for amendment. We
may deny your request in certain circumstances;
· Request communications of your health information
by alternative means or at alternative locations, for
example, you may ask not to be contacted by our office
while you are at work. We will accommodate all reasonable
requests;
· Receive an accounting of disclosures made of
your health information as provided by 45 C.F.R. §164.528.
However, you should note that our office may not be required
by law to document, or provide access to records of, all
disclosures made by our office.
Complaints
You may complain
to Northern Fertility and/or to the Department of Health
and Human Services if you believe your privacy rights
have been violated. Complaints should be forwarded, in
writing, to our Privacy Officer. You will not be retaliated
against for filing a complaint.
Obligations
of Northern Fertility and Reproductive Associates, P.C.
Northern Fertility
and Reproductive Associates, P.C. is required by law to:
· maintain the privacy of protected health information;
· provide you with this Notice of its legal duties
and privacy practices with respect to your health information;
· abide by the terms of this Notice as it is currently
in effect;
· notify you if we are unable to agree to a requested
restriction on how your information is used or disclosed;
· accommodate reasonable requests you may make
to communicate health information by alternative means
or in alternative locations.
Northern Fertility
reserves the right to change its information practices
and to make the new provisions effective for all protected
health information it maintains. Revised notices will
be made available to you directly through those who provide
treatment to you or through our privacy officer.
Contact
Information
If
you have any questions or complaints, please contact:
Rhonda Fair, Privacy Officer
1650 Huntingdon Pike
Medical Office Building
Suite 154
Meadowbrook, PA 19046
215-938-1515
