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.
According to the Federal Law called HIPAA
(Healthcare Information Portability and Accountability Act), disclosures
of information about you for some purposes do not need special consent.
These disclosures are for the purpose of providing your medical care or
for billing your insurer. For example, a doctor may call another doctor
about your medical problems and discuss your condition without special
consent. We may contact your insurer about a claim for your care without
special consent. We may arrange for your care by a pharmacy without
special consent. We may discuss arrangements for your care at a hospital
without special consent.
There are some disclosures of your
private information that are required by law, such as reporting certain
diseases to public health agencies, reporting victims of abuse, and
disclosures for organ donation.
In addition, we may disclose private
health information to your family members relevant to their involvement
in your care or relevant to reimbursement issues.
In general, other disclosures of private
health information will be made only with your consent in writing, and
you have the right to revoke that consent.
You have certain rights to protect the
confidentiality of your health information:
You can request to have restrictions on
the use or disclosure of information about you for treatment, payment,
or health care operations purposes. However, we are not required to
agree with these restrictions, and we may decide not to accept the
responsibility for your care under these circumstances. In an emergency,
you will always receive care before adjudicating these issues.
You have the right to request and we have
the right to accommodate reasonable requests for you to receive
confidential information by alternative means or at alternative
locations. For example, you might wish to receive letters from us at an
address not your usual residence, and we would try to accommodate you.
You have the right to inspect and receive
a copy (for a fee) of your health information in this office. BAYSTATE
OB/GYN GROUP, INC. may deny access to records if there were a question
of endangerment to you or to others by that access.
You have the right to request an
amendment of your confidential information, but we have the right to
deny that request in certain circumstances. You cannot amend a record
that we did not create at BAYSTATE OB/GYN GROUP, INC.
You have a right to receive an accounting
of disclosures of your confidential information, but such a listing does
not have to be made in circumstances:
In general, if there is a request for use
of your health information, and there is any question about the impact
of HIPAA on that request, you will be asked for written consent for
release of that information first. We proactively intend to follow the
letter and spirit of the confidentiality law.
If you have a complaint about privacy of
your medical records, or you believe that your privacy rights have been
violated you may:
Complain to this practice in writing,
addressed to the "Practice Manager, BAYSTATE OB/GYN GROUP, INC., 2
Medical Center Drive, Springfield MA 01107.
Complain in writing to the Secretary of
Health and Human Services, 200 Independence Ave, Washington DC 20201.
The effective date of this policy is
April 14, 2003.
A detailed version of this notice is
available upon request.
