RaisingMOM is required by law to maintain the privacy of Protected Health Information (APHI@) about you and to provide you with Notice of our legal duties and privacy practices with respect to PHI. RaisingMOM is required to abide by the terms of the Notice currently in effect when we use or disclose PHI.(164.520(b)(1)(v)(A) and 164.520(b)(1)(v)(B))
Treatment - PHI will be used and disclosed by us to provide you with Treatment. Treatment includes the determination of a diagnosis of an illness or injury and treatment of the illness or injury.(154.520(b)(ii)(A)) RaisingMOM may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you. (154.520(b)(iii)(A))
Payment - PHI will be used and disclosed by us to obtain verify that a third party payor of services will pay for services rendered to you and to obtain payment for said services.(154.520(b)(ii)(A))
Health Care Operations - PHI will be used and disclosed by us for our health care operations. These include, but are not limited to, administration and planning of activities, evaluation of programs, and evaluation of personnel.(154.520(b)(ii)(A))
Other uses and disclosure of PHI by RaisingMOM will be made only with your written authorization, which may be revoked, except to the extent that action was taken by RaisingMOM in reliance on your authorization. (164.520(b)(1)(ii)(E)) Revocation of your authorization is made by your delivery of a written statement of revocation to the Privacy Office, at the location described herein.(164.508(b)(5)).
If psychotherapy notes are maintained by RaisingMOM, an authorization is required for the use of psychotherapy notes for treatment, payment, and health care operations.
PHI may be used by RaisingMOM without your consent or authorization when you require emergency treatment (164.506(a)(3)(i)(A)); if we are required by law to treat you, and we attempt to obtain your consent, but are unable to obtain it (164.506(a)(3)(i)(B)); and we attempt to obtain your consent, but are unable to obtain it due to substantial barriers in communicating with you and in our judgment your consent is inferred in the circumstances (164.506(a)(3)(i)(C)).
RaisingMOM may use or disclose PHI to a family member, other relative, a close personal friend, or any other person identified by you when you are present for, or otherwise available prior to, the disclosure, if we obtain your agreement, or, we provide you with the opportunity to object to the disclosure and you do not object, or, we can reasonably infer from the circumstances that you do not object to the disclosure.(164.510(b)(2)).
If you are not present, or the opportunity to agree or object to a use or disclosure of PHI cannot practicably be provided because of your incapacity or an emergency circumstance exists, RaisingMOM may exercise our professional judgment to determine whether a disclosure is in your best interests. If we disclose PHI, we will disclose only information that is directly relevant to the person=s involvement with your health care. RaisingMOM will use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to act on your behalf with respect to certain forms of PHI.(164.510(b)(3)).
RaisingMOM may use and disclose PHI about you to identify health-related services and products that may be beneficial to your health and may contact you about these services and products. If you do not wish to receive these contacts in the future, you should notify the Privacy Office at the location described herein.(164.514(e))
RaisingMOM may disclose PHI about you for public health activities to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability, or to report child abuse and neglect to public health authorities or other government authorities authorized by law to receive such reports, or to report information to the U.S. Food and Drug Administration, or to alert a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition, or to report information to your employer as required by law regarding work related injuries or illnesses. (164.512(b))
RaisingMOM may disclose PHI about you if we reasonably believe that you are a victim of abuse, neglect, or domestic violence to a government authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence.(164.512(c))
RaisingMOM may disclose PHI about you to a health oversight agency for oversight activities authorized by law, including audits, civil, administrative, or criminal investigations, inspections, licensure or disciplinary actions, civil, administrative or criminal proceedings or actions, or other activities necessary for appropriate oversight of the health care system, Government health programs requiring eligibility or compliance with program standards, or civil rights laws for which health information is necessary for determining compliance.(164.512(d))
RaisingMOM may disclose PHI about you in the course of a judicial or administrative proceeding in response to a court order or other lawful process. (164.512(e))
RaisingMOM may disclose PHI about you for a law enforcement purpose to law enforcement officials as required by law or as required by a court order. (164.512(f))
RaisingMOM may disclose PHI about a decedent to a coroner or medical examiner as authorized by law. (164.512(g))
RaisingMOM may disclose PHI about you for cadaveric, organ, eye and tissue donation to organizations or entities engaged in procurement, banking, or transplantation. (164.512(h))
RaisingMOM may use or disclose PHI about you for research purposes if our Institutional Review Board or Privacy Board approves a waiver of authorization for disclosure. (164.512(i))
RaisingMOM may use or disclose PHI about you to avert a serious threat to health or safety of a person or the public. (164.512(j))
RaisingMOM may use or disclose PHI about you for specialized government functions, such as the United States Armed Forces under specific circumstances. (164.512(k))
RaisingMOM may disclose PHI about you as authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs. (164.512(l))
NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
You have the right to adequate notice of the uses and disclosures of your PHI by RaisingMOM and your rights and our legal duties with respect to your PHI. If you need further information about the privacy practices of RaisingMOM, or question a decision or have a complaint about our use of your PHI, you should contact the Privacy Office at the location described herein. (164.530(a)(1)(ii)) You may also file written complaints with the Director, Office of Civil Rights of the U.S. Department of Health and Human Services. We will not retaliate against you if you file a complaint.(164.520(b)(1)(vi))
You have the right to request restrictions on our use and disclosure of your PHI for treatment, payment and health care operations, to individuals involved with your care, or to notify or assist in the notification of individuals regarding your location and general condition. We will consider your request for restrictions, but are not required to agree to a requested restriction. (164.520(b)(1)(iv)(A)) To request restrictions, you should file a written request with the Privacy Office at the location described herein. We will send you a written response to your request. (164.522(a))
You have the right to receive confidential communications. You may request, and we will accommodate, any reasonable request for you to receive your PHI by alternate means of communication or at alternate locations. (164.522(b), 164.520(b)(1)(iv)(B))
You have the right to inspect and copy your health information. You may request access to your patient/client record file and billing records maintained by RaisingMOM in order to inspect and request copies of records. We may deny your access under limited circumstances. To access your records, you should file a written request with the Privacy Office at the location described herein .If you request copies, the charge is $0.75 per page.(164.524,164.520(b)(1)(iv)(C))
You have a right to amend your records. You may request that we amend your PHI in your patient record or billing records. To request an amendment of your records, you should file a written request with the Privacy Office at the location described herein. We will comply with your request unless we believe that the information is accurate and complete or other circumstances apply. (164.526, 164.520(b)(1)(iv)(D))
You have the right to an accounting of disclosures of your PHI during any period of time prior to the date of your request, so long as this time period does not exceed six years (164.528, 164.520(b)(1)(iv)(E). If you request an accounting more than once in a twelve month period, we will charge you $0.75 per page.
You have the right to receive a paper copy of this Notice, despite your agreement to receive this Notice electronically. (164.520(c)(3), 164.520(b)(1)(iv)(F))
PRIVACY OFFICE
RaisingMOM
P.O. Box 231023
Great Neck, NY 11023
212-725-6667
www.RaisingMOMny.com
Dr. Daniel Roshan
EFFECTIVE DATE OF NOTICE: April 1, 2009
RaisingMOM may change the terms of this Notice at any time. If we change the terms of this Notice, we can apply the changes retroactively to apply to PHI created or received prior to the change. We will post the changes to the Notice, and you can obtain a copy from the Privacy Office at the location described herein.
