NOTICE OF PRIVACY PRACTICES...

This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

We are affiliated with Therapeutic Lifestyle Change Center. All other office sites of Northeastern Rehabilitation Associates, PC as well as the TLC site may share information with each other for treatment, payment or healthcare operations as described in this notice.

Northeastern Rehabilitation Associates, P.C. has a responsibility as a health care provider to comply with the regulations of the Health Insurance Portability and Accountability Act (HIPAA). This act defines Protected Health Information and the responsibility of the healthcare provider to insure the privacy of this information.

Protected Health Information is any health information, including demographics, that is collected from the patient or created or received by a health care provider or other person, that relates to the past, present or future physical or mental health or condition of an individual, or the providing of such healthcare, or the past, present or future payment for this healthcare at our practice that could potentially identify you as an individual.

We are required by law to make sure that health information that identifies you is kept private and to give you this notice of our legal duties and privacy practices with respect to health information about you. This policy is in effect no matter how the information is received: in person, from another healthcare provider, in writing, by facsimile or by telephone.

Information We Collect

We obtain personal information about you from the following sources:
  - You, the patient
  - Referring physicians and other healthcare providers

HOW WE USE & DISCLOSE THIS INFORMATION

Your personal health information is used & disclosed only as is permitted or required by law: The following categories describe different ways we use and disclose health information.

1) Treatment: We may use health information about you to provide you with health care treatment or services. We may disclose health information about you to doctors, nurses, technicians, health students or other personnel who are involved in taking care of you. They may work at our offices, at the hospital if you are hospitalized under our supervision or at another doctor’s office, lab, pharmacy, or other health care providers to whom we may refer you for consultation, to take x-rays, to perform lab tests, to have prescriptions filled, or for other treatment purposes.

2) Payment: We may use and disclose health information about you so that treatment and services you receive from us may be billed to you and payment collected from you, an insurance company or a third party.

3) Health Care Operations: We may use and disclose information about you for operations of our health care practice. These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care.

4) Workers’ Compensation: We may release health information about you to for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

5) As Required by Law: We will disclose health information about you when required to do so by federal, state or local law.

6) To Avert a Serious Threat to Health & Safety: We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to prevent the threat.

7) Military & Veterans: If you are a member of the armed forces or are separated/discharged from military services, we may release health information about you as required by military command authorities or the Department of Veterans Affairs as may be applicable. We may also release health information about foreign military personnel to the appropriate foreign military authorities.

8) Public Health Risk: We may disclose health information about you for public health activities. These activities generally include the following: to prevent or control disease, injury or disability, to report births and deaths, to report child abuse or neglect, to report reactions to medications or problems with products, to notify people of recalls of products they may be using, to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition, to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

9) Lawsuits & Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request or other lawful process by someone else invoked in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

10) Law Enforcement: We may release health information if asked to do so by a law enforcement official: in response to a court order, subpoena, warrant, summons or other similar process, to identify or locate a suspect, fugitive, material witness or missing person, about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement, about a death we believe may be the result of criminal conduct, about criminal conduct at our facility and in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.

11) Protective Services for the President and Others: We may disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

12) Coroners, Health Examiners and Funeral Directors: We may release health information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties.

13) National Security and Intelligence Activities: We may release health information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.

14) Health-Related Services and Treatment Alternatives: We may use and disclose health information to tell you about health-related services or recommend possible treatment options or alternatives that may be of interest to you. Please let us know if you not wish us to send you this information or if you wish us to use a different address to send this information to you.

15) Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws. The most common reasons for use and disclosure are the first four categories listed above. We ask that you sign a form acknowledging you have seen our Privacy Practices. Remember, any time you have a question as to the reason why someone is receiving your information, you may discuss this with our Privacy Officer.

Your Rights Regarding Health Information About You:
You have the following rights regarding health information we maintain about you:
You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records. This does not include psychotherapy notes.

To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to our Privacy Officer You will be charged a fee for the inspection. If you request a copy of the information, you will be charged a fee for the cost of copying, mailing or other supplies and services associated with your request. We may deny your request to inspect and copy health information in certain very limited circumstances. If you are denied access to health information, you may request the denial to be reviewed. Another licensed health care professional chosen by our practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be in writing, submitted to our Privacy Officer and must be contained on one page of legibly handwritten or typed in at least10 point font size. In addition, you must provide a reason that supports your request for an amendment. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that was not created by us, unless the person or entity that created that information is no longer available to make the amendment, is not part of the health information kept by or for our practice, is not part of the information which you would be permitted to inspect and copy or is accurate and complete. Any amendment to your health information will be disclosed to those with whom we disclose information previously specified.

Accounting of Disclosures and Restrictions:
You have the right to request a list accounting for disclosures of your health information we have made, except for the uses and disclosures for treatment, payment and healthcare operations as previously described. To request this list of disclosures, you must submit your request in writing to our Privacy Officer. The request must state a specific time period and may not exceed six (6) years and may not include dates before April 14, 2003. The first list requested in a 12 -month period is free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. We will mail you a list of disclosures in paper form within 30 days of your request, or notify if we are unable to supply the list within that time period and by what date we can supple the list, but this date will not exceed a total of 60 days from the date you made the request.

Other Disclosures:
Other uses and disclosures not covered by this notice will be done only with your written permission that may be withdrawn at any time. This will not affect information previously disclosed under your written authorization.

Complaints:
If you believe your right to privacy has been violated you may file a complaint with our Privacy Officer or the Secretary of the Department of Health and Human Services. Your complaint must be in writing. You will not be penalized for filing a complaint.

Right to a Paper Copy of this Notice:
You have the right to obtain a paper copy of this notice at any time.