THIS NOTICE DESCRIBES
HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU CAN GET ACCESS TO THIS INFORMATION
THIS NOTICE CAREFULLY
This Notice of Privacy Practices (Notice) describes how the Neighborhood Health Services Corporation (Center) may use and disclose your protected health information.
Protected Health Information ("Health Information") is information
about you, including demographic information, that may identify you and
that relates to your past, present or future physical or mental health,
and the provision of health care and payment for health care. The Center
may use and disclose this information 1) to carry out treatment payment
or health care operations, 2) for other purposes that are permitted or
required by law and 3) for other purposes only with your written authorization.
This Notice also describes your rights to access and to control your protected
health information and the Center’s duties to maintain the privacy
of your protected health information. If you are legally or otherwise
incapable of exercising your rights, you may have a person who is authorized
under State law (for example power of attorney) to act on your behalf.
In the case of a minor child, the parent or guardian can exercise the
child’s rights with respect to protected health information.
How the Center Uses
and Discloses Protected Health Information for Treatment, Payment and
Health Care Operations
Your Health Information
may be used by the Center, to provide health care services to you, to
submit claims for reimbursement and to support the operations of the Center.
The following are some but not all of the ways in which we may use your
1. Treatment. Health Information may be used for the provision of health
care, coordination or management of your treatment or the provision of
related services to you by one or more health care providers. For example
the Center may consult with another health care provider. The Center may
send a copy of your medical record to a specialist who needs the information
to treat you or to a hospital to which you are admitted.
2. Payment. The Center may use and disclose Health Information to so that
the Center may obtain payment for the services provided to you. For example
the Center may disclose Health Information to determine your eligibility
for payment; to bill third party insurance companies or Medicaid or Medicare;
or to attempt to collect payment from you and for other related activities.
Health Information may be disclosed to consumer reporting agencies relating
to our collection efforts. The Center may disclose Health Information
to make sure that the insurance or Medicaid or Medicare will cover the
service or to obtain pre authorizations or for quality evaluations by
your health plan. For example Health Information could be disclosed to
obtain approval from your health plan for treatment or hospital admission.
3. Healthcare Operations.
The Center may use your Health Information to assess the care and outcomes
in your case and others like it. This information will then be used in
an effort to continually improve the quality of the healthcare the Center
provides; reduce costs; and evaluate the performance of our staff. The
Center may also use your Health Information for training health care professionals,
accreditation and other administrative activities of the Center. The Center
may use your Health Information to evaluate the Center contracts with
insurance companies or to audit compliance with the law. The Center may
disclose your Health Information to legal counsel or other persons who
are performing services for us. To protect your health information, however,
we require these persons to appropriately safeguard your Health Information.
The Center may ask
you to sign a consent form to use and disclose your Health Information
for treatment, payment and health care operations although we are not
obligated to do so.
The Center may also
use a sign-in sheet at the registration desk, where you will be asked
to sign your name and indicate your physician. You may be called by name
in the waiting room when the physician is ready to see you. The Center
may send you appointment reminders.
The Center may use
or disclose your Health Information, as necessary, to provide you with
information about treatment alternatives or other health-related benefits
and services that may be of interest to you. The Center may send you a
The Center may disclose
to a business associate or a foundation Health Information in an effort
to raise money for the Center. Please let us know if you do not want us
to contact you about fundraising. Our fundraising materials will tell
you how to tell us that you do not want to receive information about fundraising.
When the Use and Disclosure
of Protected Health Information by the Center Requires An Opportunity
for You to Agree or Object
The Center may use
and disclose your Health Information under circumstances in which you
have the opportunity to agree or object to all or part of the use or disclosure.
If you are not able to agree or object, then the Center may determine
whether the use and disclosure is in your best interest.
1. Communication with family. The Center may disclose to a family member,
other relative, close personal friend or any other person you identify
Health Information relevant to that person’s involvement in your
care or payment related to your care.
2. Facility Directories. The Center may use Health Information to maintain
a directory of individuals in its facility. The Center will advise you
of the Health Information contained in the directory and to whom it may
When the Center May
Use and Disclose Protected Health Information Based Upon Your Written
Certain other uses and disclosures of your Health Information will be
made only with your written Authorization, as described below unless otherwise
permitted or required by law without authorization. You may revoke this
Authorization at any time in writing, except to the extent that the Center
or your physician or has taken an action in reliance on your signing the
1. Psychotherapy Notes. In most instances, the Center must obtain an Authorization
from you for use and disclosure of psychotherapy notes. “Psychotherapy
notes” are notes by a mental health professional documenting or
analyzing the contents of conversation during a private counseling or
group session that are separated from the rest of your medical records.
They do not include symptoms, diagnosis or a treatment plan.
2. Marketing. Except in certain circumstances the Center must obtain your
authorization for any use of Health Information for marketing. If the
Center receives compensation from a third party for the marketing, the
authorization will disclose this. For example, the Center may not provide
a patient list to a pharmaceutical company for drug promotions without
When the Center May Use and Disclose Protected Health Information without
Your Consent or Authorization or Opportunity to Object
Your Protected Health Information may be used or disclosed by the Center
without your consent or authorization or opportunity to object. The following
are some examples.
1. Required by Law. The Center may disclose your Health Information to
the extent that the use or disclosure is required by Federal, State or
2. Public Health. We may disclose your Health Information to public health
or legal authorities charged with preventing or controlling disease, injury
3. Food and Drug Administration (FDA). The Center may disclose to the
FDA health information relative to adverse events with respect to food,
supplements, product and product defects or post marketing surveillance
information to enable product recalls, repairs or replacement.
4. Communicable Diseases. The Center may disclose your Health Information,
to a person who may have been exposed to a communicable disease or may
otherwise be at risk of contracting or spreading the disease or condition.
5. Abuse or Neglect. The Center may disclose your Health Information to
a public health authority that is authorized by law to receive reports
of child abuse or neglect. In addition, we may disclose your protected
health information if we believe that you have been a victim of abuse,
neglect or domestic violence to the governmental entity or agency authorized
to receive such information.
6. Health Oversight. The Center may disclose Health Information to a health
oversight agency for activities authorized by law, such as audits, investigations
and inspections. Oversight agencies seeking this information include government
agencies that oversee the health care system, government benefit programs,
other government regulatory programs and civil rights laws.
7. Judicial and Administrative Proceedings. The Center may disclose your
Health Information in the course of any judicial or administrative proceeding,
in response to an order of a court or administrative tribunal, to the
extent that such disclosure is expressly authorized and in certain conditions
in response to a subpoena, discovery request or other lawful process.
8. Law Enforcement. The Center may disclose Health Information so long
as applicable legal requirements are met, for law enforcement purposes.
These law enforcement purposes include (1) legal processes and otherwise
required by law; (2) limited information requests for identification and
location purposes; (3) pertaining to victims of a crime; (4) suspicion
that death has occurred as a result of criminal conduct; (5) in the event
that a crime occurs on the premises of the Center; and (6) medical emergency
(not on the Center’s premises) and it is likely that a crime has
9. Funeral Directors and Coroners. The Center may disclose Health Information
to funeral directors consistent with applicable law to permit them to
carry out their duties. Health Information may be disclosed to a coroner
or medical examiner for identification purposes, determining the cause
of death or for the coroner or medical examiner to perform other duties
authorized by law.
10. Organ procurement organizations. The Center may disclose information
consistent with applicable health information to organ procurement organizations
or other entities engaged in the procurement, banking, or transplantation
of organs for the purpose of organ, eye or tissue donation and transplant.
11. Research. The Center may disclose information to researchers when
their research has been approved by an institutional review board that
has reviewed the research proposal and established protocols to ensure
the privacy of your protected health information or with an authorization
12. Military Activity and National Security. When appropriate conditions
apply, the Center may use or disclose Health Information of individuals
who are Armed Forces personnel for activities deemed necessary by appropriate
military command authorities; or who are foreign military personnel to
a foreign military authority. We may also disclose your Health Information
to authorized federal officials conducting national security and intelligence
activities including the provision of protective services to the President
or others legally authorized.
13. Correctional Institution. If you are an inmate of a correctional institution
or in the custody of a law enforcement officer the Center may disclose
to the institution or agents thereof Health Information necessary for
your health and the health and safety of other individuals and other purposes.
14. Workers Compensation. The Center may disclose Health Information related
to workers compensation or other similar programs dealing with work-related
illnesses or injuries.
AND HOW TO EXERCISE THEM
Although your health
record is the physical property of the Center, the information in it belongs
to you. You have the following rights:
1. Restrictions. You may request restrictions on certain uses and disclosures
of your Health Information such as for treatment, payment or health care
operations or disclosure to family members. Your request must state the
specific restriction requested and to whom you want the restriction to
apply. The Center is not required to agree to a restriction that you may
request. If the Center agrees to the requested restriction, we will not
use or disclose your protected health information in violation of the
restriction, unless it is needed to provide emergency treatment. You may
request a restriction in writing on a form provided by the Center. In
your request you must tell us what information you want to limit and to
whom the Health Information should not be disclosed.
2. Notice. You may obtain a paper copy of this Notice of Privacy Practices
upon request, even if you have received the Notice electronically.
3. Inspection and copies. You may inspect and obtain a copy of your health
record. This does not include psychotherapy notes, information compiled
in reasonable anticipation of or for use in a civil, criminal or administrative
action or proceeding and protected health information that is subject
to law that prohibits access to protected health information. To inspect
or request a copy of your health record; submit your request to the Privacy
Official at the Neighborhood Health Services Corporation in
writing on a form for provided by the Center. We may charge a fee for
the costs of locating, copying, mailing or other supplies and services
associated with your request.
4. Amendments. You may request amendments to your health record if you
believe that the information in inaccurate. In certain cases, the Center
may deny your request for an amendment. For example the request will be
denied if it is not in form provided to us; you have not provided sufficient
support for the request; the Center did not create the health record;
the Center does not keep that information; is information that you are
not permitted to inspect or is accurate and complete. You will then have
the right to file a statement of disagreement with the Center. The Center
or your physician may place a counterstatement in your medical record.
5. Accounting of Disclosures. You may obtain an accounting of the disclosures
of your health information by the Center by submitting your request to
the Neighborhood Health Services Corporation Privacy Officer
in writing on a form provided by the Center to you. This does not apply
to disclosures for treatment, payment or healthcare operations as described
in this Notice. It also excludes disclosures the Center may have made
to you, family members or with an Authorization. The right to receive
this accounting is subject to certain exceptions, restrictions and limitations.
6. Confidential Communications. You have the right to request communications
of your health information by alternative means or at alternative locations.
The Center will accommodate reasonable requests. We may ask you for information
as to how payment will be handled or request an alternative address or
other method of contact. Make your request in writing to the Privacy Officer
on a form provided by the Center.
The Center has the
1. Privacy. The Center is required by law to maintain the privacy of your
2. Notice. The Center must provide you with this Notice as to our legal
duties and privacy practices with respect to the Health Information that
we collect and maintain about you and abide by the terms of the Notice
currently in effect. We reserve the right to change our privacy practices
and this Notice and to make the new provisions effective for all protected
heath information we maintain. Should our information practices change,
we will post the new Notice in the Center and on our web site and make
the revised Notice available to you upon request.
3. Restrictions. The Center will notify you if we are unable to agree
to a requested restriction of use and disclosure of your Health Information.
4. Confidential Communications. The Center will accommodate reasonable
requests you may have to communicate heath information by alternative
means or at alternative locations.
For More Information
or to Report a Problem
If you have any questions
about this Notice and would like additional information, you may contact
the Center’s Privacy Officer at [phone number].
If you believe your
privacy rights have been violated, you can file a complaint with the Center’s
Privacy Officer at 1700 Myrtle Avenue, Plainfield New Jersey or with the
Secretary of Health and Human Services. There will be no retaliation for
filing a complaint.
Portability and Accountability Act (HIPAA 96, Public Law 104-191 and Regulations
– Standards for Privacy of Individual Identifiable Health Information
(the Privacy Rule), 45 CFR Parts 160 and 164.