HIPPA
HIPPA Laws at Cheryl L. Moccio, DMD Oral Surgeon Office in Denville, NJ
Notice of Privacy Practice
As Required by the Privacy Regulations Created as a Result
of the Health Insurance Portability
and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION
ABOUT YOU (AS A PATIENT OF THIS CARE CENTER) MAY
BE USED AND DISCLOSED, AND HOW YOU CAN GET
ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE
HEALTH INFORMATION.
PLEASE REVIEW THIS NOTICE
CAREFULLY.
A. OUR
COMMITMENT TO YOUR PRIVACY
Our care
center is dedicated to maintaining the privacy of your individually
identifiable health information (IIHI). In conducting our business, we will
create records regarding you and the treatment and services we provide to you.
We are required by law to maintain the confidentiality of health information
that identifies you. We also are required by law to provide you with this
notice of our legal duties and the privacy care centers that we maintain in our
care center concerning your IIHI. By federal and state law, we must follow the
terms of the notice of privacy care centers that we have in effect at the time.
We realize that these laws are complicated, but we must provide you with the
following important information:
• How we may
use and disclose your IIHI
• Your
privacy rights in your IIHI
• Our
obligations concerning the use and disclosure of your IIHI
The terms of
this notice apply to all records containing your IIHI that are created or retained
by our care center. We reserve the right to revise or amend this Notice of
Privacy Practices. Any revision or amendment to this notice will be effective
for all of your records that our care center has created or maintained in the
past, and for any of your records that we may create or maintain in the future.
Our care center will post a copy of our current Notice in our offices in a
visible location at all times, and you may request a copy of our most current
Notice at any time.
B. IF YOU
HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT the office of:
Dr Cheryl L.
Moccio, D.M.D.,
1Indian Rd.
Denville, NJ
07834
973.625.4220
C. WE MAY
USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI)
IN THE
FOLLOWING WAYS
The
following categories describe the different ways in which we may use and
disclose your IIHI.
1. Treatment. Our office may use your IIHI to treat you. For example, we
may ask you to have laboratory tests (such as blood or urine tests), and we may
use the results to help us reach a diagnosis. We might use your IIHI in order
to write a prescription for you, or we might disclose your IIHI to a pharmacy
when we order a prescription for you. The people who work for our office
including, but not limited to, our doctors and nurses - may use or disclose
your IIHI in order to treat you or to assist others in your treatment.
Additionally, we may disclose your IIHI to others who may assist in your care,
such as your spouse, children or parents. Finally, we may also disclose your
IIHI to other health care providers for purposes related to your treatment.
2. Payment.
Our office may use and disclose your IIHI in order to bill and collect payment
for the services and items you may receive from us. For example, we may contact
your health insurer to certify that you are eligible for benefits (and for what
range of benefits), and we may provide your insurer with details regarding your
treatment to determine if your insurer will cover, or pay for, your treatment.
We also may use and disclose your IIHI to obtain payment from third parties
that may be responsible for such costs, such as family members. Also, we may
use your IIHI to bill you directly for services and items. We may disclose your
IIHI to other health care providers and entities to assist in their billing and
collection efforts.
3. Health
Care Operations. Our office may use and disclose your IIHI to operate our
business. As examples of the ways in which we may use and disclose your
information for our operations, our care center may use your IIHI to evaluate
the quality of care you received from us, or to conduct cost-management and
business planning activities for our care center. We may disclose your IIHI to
other health care providers and entities to assist in their health care
operations.
4.
Appointment Reminders. Our office may use and disclose your IIHI to contact you
and remind you of an appointment. We may also use your IIHI to contact you to
inform you of test results. We may leave the results of certain tests on your
answering machine, but will do so only if your message identifies your name or
telephone number.
5. Treatment
Options. Our office may use and disclose your IIHI to inform you of potential
treatment options or alternatives.
6.
Health-Related Benefits and Services. Our office may use and disclose your IIHI
to inform you of health-related benefits or services that may be of interest to
you.
7. Release
of Information to Family/Friends. Our office may release your IIHI to a friend
or family member that is involved in your care, or who assists in taking care
of you. For example, a parent or guardian may ask that a babysitter take their
child to the pediatrician’s office for treatment of a cold. In this example,
the babysitter may have access to this child’s medical information.
8.
Disclosures Required By Law. Our office will use and disclose your IIHI when we
are required to do so by federal, state or local law.
D. USE AND
DISCLOSURE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
1. Public Health Risks. Our office may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:
• maintaining vital records, such as births and deaths
• reporting child abuse or neglect
• preventing or controlling disease, injury or disability
• notifying a person regarding potential exposure to a communicable disease
• notifying a person regarding a potential risk for spreading or contracting a disease or condition
• reporting reactions to drugs or problems with products or devices
• notifying individuals if a product or device they may be using has been recalled; notifying appropriate
government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult
patient (including domestic violence); however, we will only disclose this information if the patient
agrees or we are required or authorized by law to disclose this information
• notifying your employer under limited circumstances related primarily to workplace injury or illness or
medical surveillance.
2. Health Oversight Activities. Our office may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings. Our office
may use and disclose your IIHI in response to a court or administrative order,
if you are involved in a lawsuit or similar proceeding. We also may disclose
your IIHI in response to a discovery request,
subpoena, or other lawful process by another party involved in the dispute, but
only if we have made an effort to inform you of the request or to obtain an
order protecting the information the party has requested.
4. Law Enforcement. We may release IIHI if
asked to do so by a law enforcement official:
• Regarding a crime victim in certain
situations, if we are unable to obtain the person’s agreement
• Concerning a death we believe has resulted
from criminal conduct
• Regarding criminal conduct at our offices
• In response to a warrant, summons, court
order, subpoena or similar legal process
• To identify/locate a suspect, material
witness, fugitive or missing person
• In an emergency, to report a crime
(including the location or victim(s) of the crime, or the description,
identity or
location of the perpetrator)
5. Deceased Patients. Our office may release
IIHI to a medical examiner or coroner to identify a deceased individual or to
identify the cause of death. If necessary, we also may release information in
order for funeral directors to perform their jobs.
6. Organ and
Tissue Donation. Our office may release your IIHI to organizations that handle
organ, eye or tissue procurement or transplantation, including organ donation
banks, as necessary to facilitate organ or tissue donation and transplantation
if you are an organ donor.
7. Research. Our office or affiliated research
company may use and disclose your IIHI for research purposes in certain limited
circumstances. We will obtain your written authorization to use your IIHI for research
purposes except when an Internal Review Board or Privacy Board has determined
that the waiver of your authorization satisfies the following: (i) the use or
disclosure involves no more
than a
minimal risk to your privacy based on the following: (A) an adequate plan to
protect the identifiers from improper use and disclosure; (B) an adequate plan
to destroy the identifiers at the earliest opportunity consistent with the
research (unless there is a health or research justification for retaining the identifiers
or such retention is otherwise required by law); and (C) adequate written
assurances that the PHI will not be re-used or disclosed to any other person or
entity (except as required by law) for authorized oversight of the research
study, or for other research for which the use or disclosure would otherwise be
permitted; (ii) the research could not practicably be conducted without the
waiver; and (iii) the research could not practicably be conducted without
access to and use of the PHI.
8. Serious Threats
to Health or Safety. Our office may use and disclose your IIHI when necessary
to reduce or prevent a serious threat to your health and safety or the health
and safety of another individual or the public. Under these circumstances, we
will only make disclosures to a person or organization able to help prevent the
threat.
9. Military.
Our office may disclose your IIHI if you are a member of U.S. or foreign
military forces (including veterans) and if required by the appropriate
authorities.
10. National
Security. Our office may disclose your IIHI to federal officials for
intelligence and national security activities authorized by law. We also may
disclose your IIHI to federal officials in order to protect the President,
other officials or foreign heads of state, or to conduct investigations.
11. Inmates.
Our office may disclose your IIHI to correctional institutions or law
enforcement officials if you are an inmate or under the custody of a law
enforcement official. Disclosure for these purposes would be necessary: (a) for
the institution to provide health care services to you, (b) for the safety and
security of the institution, and/or (c) to protect your health and safety or
the health and safety of other individuals.
12. Workers’
Compensation. Our office may release your IIHI for workers’ compensation and
similar programs.
E. YOUR
RIGHTS REGARDING YOUR IIHI
You have the
following rights regarding the IIHI that we maintain about you:
1. Confidential Communications. You have the
right to request that our office communicate with you about your health and
related issues in a particular manner or at a certain location. For instance,
you may ask that we contact you at home, rather than work. In order to request
a type of confidential communication, you must make a written request to Dr. Cheryl
Moccio, D.M.D., 1 Indian Rd, Suite 7, Denville, NJ 07834, 973.624.4220
specifying the requested method of contact, or the location where you wish to
be contacted. Our care center will accommodate reasonable requests. You do not
need to give a reason for your request.
2.
Requesting Restrictions. You have the right to request a restriction in our use
or disclosure of your IIHI for treatment, payment or health care operations.
Additionally, you have the right to request that we restrict our disclosure of
your IIHI to only certain individuals involved in your care or the payment for
your care, such as family members and friends. We are not required to agree to
your request; however, if we do agree, we are bound by our agreement except
when otherwise required by law, in emergencies, or when the information is
necessary to treat you. In order to request a restriction in our use or
disclosure of your IIHI, you must make your request in writing to Dr. Cheryl
Moccio, D.M.D., 1 Indian Rd, Suite 7, Denville, NJ 07834, 973.625.4220. Your
request must describe in a clear and concise fashion:
(a) the information you wish restricted;
(b) whether you are requesting to limit our
care center’s use, disclosure or both; and
(c) to whom you want the limits to apply.
3.
Inspection and Copies. You have the right to inspect and obtain a copy of the
IIHI that may be used to make decisions about you, including patient medical
records and billing records, but not including psychotherapy notes. You must
submit your request in writing to Dr. Cheryl Moccio, D.M.D., 1 Indian Rd, Suite
7, Denville, NJ 07834, 973.625.4220 in order to inspect and/or obtain a copy of
your IIHI. Our care center may charge a fee for the costs of copying, mailing,
labor and supplies associated with your request. Our care center may deny your
request to inspect and/or copy in certain limited circumstances; however, you
may request a review of our denial. Another licensed health care professional
chosen by us will conduct reviews.
4.
Amendment. You may ask us to amend your health information if you believe it is
incorrect or incomplete, and you may request an amendment for as long as the
information is kept by or for our care center. To request an amendment, your
request must be made in writing and submitted to Dr. Cheryl Moccio, D.M.D., 1
Indian Rd, Suite 7, Denville, NJ 07834, 973.625.4220. You must provide us with
a reason that supports your request for amendment. Our care center will deny
your request if you fail to submit your request (and the reason supporting your
request) in writing. Also, we may deny your request if you ask us to amend information
that is in our opinion: (a) accurate and complete; (b) not part of the IIHI
kept by or for the care center; (c) not part of the IIHI which you would be
permitted to inspect and copy; or (d) not created by our care center, unless
the individual or entity that created the information is not available to amend
the information.
5.
Accounting of Disclosures. All of our patients have the right to request an
“accounting of disclosures.” An “accounting of disclosures” is a list of
certain non-routine disclosures our care center has made of your IIHI for
non-treatment, non-payment or non-operations purposes. Use of your IIHI as part
of the routine patient care in our care center is not required to be
documented; for example, the doctor sharing information with the nurse; or the
billing department using your information to file your insurance claim. In
order to obtain an accounting of disclosures, you must submit your request in
writing to Dr. Cheryl Moccio, D.M.D., 1 Indian Rd, Suite 7, Denville, NJ 07834,
973.625.4220. All requests for an “accounting of disclosures” must state a time
period, which may not be longer than six (6) years from the date of disclosure
and may not include dates before April 14, 2003. The first list you request
within a 12-month period is free of charge, but our care center may charge you
for additional lists within the same 12-month period. Our care center will
notify you of the costs involved with additional requests, and you may withdraw
your request before you incur any costs.
6. Right to
a Paper Copy of This Notice. You are entitled to receive a paper copy of our
notice of privacy care centers. You may ask us to give you a copy of this
notice at any time. To obtain a paper copy of this notice, contact Dr. Cheryl
Moccio, D.M.D., 1 Indian Rd, Suite 7, Denville, NJ 07834, 973.625.4220
7. Right to
File a Complaint. If you believe your privacy rights have been violated, you
may file a complaint with our care center or with the Secretary of the
Department of Health and Human Services. To file a complaint with our care
center, contact Dr. Cheryl Moccio, D.M.D., 1 Indian Rd, Suite 7, Denville, NJ
07834, 973.625.4220. All complaints must be submitted in writing. You will not
be penalized for filing a complaint.
8. Right to
Provide an Authorization for Other Uses and Disclosures. Our office will obtain
your written authorization for uses and disclosures that are not identified by
this notice or permitted by applicable law. Any authorization you provide to us
regarding the use and disclosure of your IIHI may be revoked at any time in
writing. After you revoke your authorization, we will no longer use or disclose
your IIHI for the reasons described in the authorization. Please note we are
required to retain records of your care. Again, if you have any questions
regarding this notice or our health information privacy policies, please
contact the office of Dr. Cheryl Moccio, D.M.D., 1 Indian Rd, Suite 7,
Denville, NJ 07834, 973.625.4220.