NOTICE OF PRIVACY PRACTICES                                                Become a Member

Rittenhouse Women’s Wellness Center
1632 Pine Street
Philadelphia, PA 19103

Effective Date of this Notice: May 19th, 2014

As required by the regulations created as with the passage of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

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.

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your protected health information (PHI). 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 privacy of your protected health information. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of the notice of privacy practices 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 PHI.
  • Your privacy rights in your PHI.
  • Our obligations concerning the use and disclosure of your PHI.

The terms of this notice apply to all records containing your PHI that are created or retained by our practice. 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 practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice 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:

Rittenhouse Women’s Wellness Center
1632 Pine Street
Philadelphia, PA 19103
215-735-7992
This email address is being protected from spambots. You need JavaScript enabled to view it.

C. WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your PHI.

1. Treatment. Our practice may use your PHI to treat you. For example, we may ask you to have laboratory tests (such as blood work, etc.), and we may use the results to help us reach a diagnosis. We might use your PHI to write a prescription for you, or we might disclose your PHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice — including, but not limited to, our doctors and nurses — may use or disclose your PHI to treat you or to assist others in your treatment. Additionally, we may disclose your PHI to others, who may assist in your care, such as your spouse, children or parents. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.

2. Payment. Our practice may use and disclose your PHI 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 PHI to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your PHI to bill you directly for services and items. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.

3. Appointment Reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment.

4. Treatment Options. Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.

5. Release of Information to Family/Friends. Our practice may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you.

6. Disclosures Required By Law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.

D. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your identifiable health information without an authorization from you:

1. Public Health Risks. Our practice may disclose your PHI 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 practice may disclose your PHI 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. Victims of Abuse, Neglect, or Domestic Violence. We may disclose your PHI to a government agency (including a social service or protective services agency) if we reasonably believe you to be the victim of abuse, neglect, or domestic violence, and the agency is authorized by law to receive such reports. We will only do so if you agree to the disclosure, or if we are expressly authorized by law to make the disclosure and either believe the disclosure to be necessary to prevent serious harm to you or other potential victims or if you are unable to agree because of incapacity and a law enforcement or other authorized public official represents that the PHI is not intended to be used against you, and an immediate enforcement activity depends upon the disclosure and would be materially and adversely affected by waiting until you are able to agree. We will inform you of such a disclosure, unless we believe doing so would place you at risk of serious harm, or if we are disclosing such information to a personal representative whom we believe to be responsible for the abuse, neglect, or other injury and that informing them would not be in your best interests.

4. Lawsuits and Similar Proceedings. Our practice may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI 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 ensure that you have been informed of the request or to obtain either an order protecting the information the party has requested or satisfactory assurances that you have been notified in accordance with federal regulations.

5. Law Enforcement. We may release PHI if asked to do so by a law enforcement official:

  • Regarding a crime victim with the victim’s permission, or 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.
  • As required by law, such as those requiring reports of certain types of wounds or physical injuries, or 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).

6. Serious Threats to Health or Safety. Our practice may use and disclose your PHI 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.

7. Military. Our practice may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

8. National Security. Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

9. Decedents. Our practice may disclose your PHI to a coroner or medical director for identification purposes or determining cause of death, as authorized by law, or to a funeral director as necessary for the funeral director to carry out his or her duty, consistent with applicable law.

10. Research. If our practice participates in research and obtains approval from an institutional review board or a privacy board, we may disclose your PHI for certain research purposes.

11. Workers’ Compensation. Our practice may disclose your PHI as authorized by law, and to the extent necessary to comply with laws relating to workers’ compensation.

E. YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding the PHI that we maintain about you:

1. Confidential Communications. You have the right to request that our practice 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 Rittenhouse Women’s Wellness Center, 1632 Pine Street, Philadelphia, PA 19103, This email address is being protected from spambots. You need JavaScript enabled to view it. specifying the requested method of contact, or the location where you wish to be contacted. Our practice 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 PHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI 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. We will, however, honor such a request where (1) the disclosure is made to a health insurer to carry out payment or health care operations and is not required by law, and (2) the information pertains solely to an item or service we provided to you, for which you pay us in full. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to Rittenhouse Women’s Wellness Center, 1632 Pine Street, Philadelphia, PA 19103, This email address is being protected from spambots. You need JavaScript enabled to view it. . Your request must describe in a clear and concise fashion:

(a) the information you wish restricted;
(b) whether you are requesting to limit our practice’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 PHI 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 Rittenhouse Women’s Wellness Center, 1632 Pine Street, Philadelphia, PA 19103, This email address is being protected from spambots. You need JavaScript enabled to view it. , in order to inspect and/or obtain a copy of your PHI. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice 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 practice. To request an amendment, your request must be made in writing and submitted to Rittenhouse Women’s Wellness Center, 1632 Pine Street, Philadelphia, PA 19103, This email address is being protected from spambots. You need JavaScript enabled to view it. . You must provide us with a reason that supports your request for amendment. Our practice 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 PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice, 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 nonroutine disclosures our practice has made of your PHI for non-treatment, non-payment or non-operations purposes. Use of your PHI as part of the routine patient care in our practice 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 Rittenhouse Women’s Wellness Center, 1632 Pine Street, Philadelphia, PA 19103, This email address is being protected from spambots. You need JavaScript enabled to view it. . 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 practice may charge you for additional lists within the same 12-month period. Our practice 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 practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Rittenhouse Women’s Wellness Center, 1632 Pine Street, Philadelphia, PA 19103, This email address is being protected from spambots. You need JavaScript enabled to view it. .

7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact Rittenhouse Women’s Wellness Center, 1632 Pine Street, Philadelphia, PA 19103, This email address is being protected from spambots. You need JavaScript enabled to view it. . 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 practice 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 PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI 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 Rittenhouse Women’s Wellness Center, 1632 Pine Street, Philadelphia, PA 19103, This email address is being protected from spambots. You need JavaScript enabled to view it. . Uses which require an authorization include certain uses or disclosures of psychotherapy notes; uses and disclosures made for marketing purposes; or, the sale of your protected health information.

 

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