Updated December 12, 2022
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.
I understand that medical information about you and your health is personal and we are committed to maintaining and protecting that privacy. I make a record of the medical care I provide and I may receive medical records and health care information from others. I use this protected health information to provide or enable other health care providers to provide quality medical care and to enable us to meet our professional and legal obligations. I am required by law to maintain the privacy of protected health information, to provide individuals with notice of my legal duties and privacy practices with respect to protected health information, and to notify individuals following a breach of their unsecured protected health information. This notice describes how I may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact our Privacy Officer, Katie Creedon at 508-202-0279.
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask me to correct your medical record
You can ask me to correct health information about you that you think is incorrect or incomplete. I may deny your request, but will tell you why in writing within 60 days.
Request confidential communications
You can ask me to contact you in a specific way (for example, cell, home or office phone) or to send mail to a different address.
Ask us to limit what we use or share
You can ask me not to use or share certain health information for treatment, payment, or our operations. I am not required to agree to your request, and I may say “no” if it would affect your care.
If you pay for a service or health care item out-of-pocket in full, you can ask me not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
You can ask for a list of the times I have shared your health information for six years prior to the date you ask, who I shared it with, and why.
I will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures, such as any you asked us to make. We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
You can complain if you feel we have violated your rights by contacting our Privacy Officer, Katie Creedon at 508-202-0279
You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html
I will not retaliate against you for filing a complaint.
For certain health information, you can tell me your choices about what I share. If you have a clear preference as to how I share your information in the situations described below, tell me what you want me to do and I will follow your instructions.
In these cases, you have both the right and choice to tell me to:
Share information with your family, close friends, or others involved in your care
If you are not able to tell me your preference, for example if you are unconscious, I may go ahead and share your information if I believe it is in your best interest. I may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
Marketing or Advertising purposes
Our Uses and Disclosures
How do I typically use or share your health information? I typically use or share your health information in the following ways.
I can use your health information and share it with other professionals who are treating you.
Run our organization
I can use and share your health information to run the practice, improve your care, and contact you when necessary.
Bill for your services
I can use and share your health information to bill for services.
How else can we use or share your health information?
I am allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
I can share health information about you for certain situations such as:
Helping with product recalls
Reporting adverse reactions to medications
Reporting suspected abuse, neglect, or domestic violence
Preventing or reducing a serious threat to anyone’s health or safety
I can use or share your information for health research.
Comply with the law
I will share information about you if state or federal laws require it, including with the MA Dept. Public Health or the US Department of Health and Human Services if they want to see that I am complying with state and federal privacy laws.
Respond to organ and tissue donation requests
I can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
I can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
I can use or share health information about you:
For workers’ compensation or disability claims
For law enforcement purposes or with a law enforcement official
With health oversight agencies for activities authorized by law
For special government functions such as military, national security, and presidential protective services
Respond to Lawsuits and Legal Actions
I can share health information about you in response to a court or administrative order, or in response to a subpoena.
I am required by law to maintain the privacy and security of your protected health information.
I will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
I must follow the duties and privacy practices described in this notice and give you a copy of it.
I will not use or share your information other than as described here unless you consent to such disclosure in writing. If you tell me that I can, you may change your mind at any time. Advise me in writing if you change your mind.
Changes to the Terms of this Notice
I can change the terms of this Privacy Notice, and the changes will apply to all information we have about you. The new notice will be available upon request and on the practice’s website.
If you would like clarification or more information on any part of this Notice, you may contact our Privacy Officer, Katie Creedon, NP by calling 508-202-0279