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Patient Privacy
EFFECTIVE 1/03/2006

As required by the Privacy regulations Created as a results of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Our Commitment to Your Privacy
Our practice is dedicated to maintaining the privacy of your individually identifiable health information. 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 confidentially of health information that identifies you. We are required to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI. By federal and state law, we must follow the terms of the terms of the notice of privacy practice that we have in effect at the time. We realize that these laws are complicated, but we must provide the following important information:
     1. How we may use and disclose your IIHI
     2. Your privacy rights in your IIHI
     3. 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 practice. We reserve the right to revise or amend the Notice of Privacy Practice. Any revision or amendment to the notice will be effective for all your records that our practice had created or maintained in the past, and for all your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in a visible location at all times and you may request a copy at any time.
Treatment: Our practice may use your IIHI to treat you. For example, we may ask you to have laboratory 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 you’re your IIHI 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 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 spouse, children or parents. Finally, we may also disclose your IIHI to there health care providers for purposes related to your treatment.
Payment: Our practice 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.
Health Care Operations: Our practice 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 practice may use your IIHI to evaluate the quality of care your received from us, or to conduct cost-management and business planning activities for our practice.
Appointment Reminders: Our practice may use and disclose your IIHI to contact you and remind you of an appointment.
Treatment Options: Our practice may use and disclose your IIHI to contact you and remind you of an appointment.
Health-Related Benefits and Services: Our practice may use and disclose your IIHI to inform you of health-related benefits or services that may be of interest to you.
Release of Information to Family/Friends: Our practice 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.
Disclosures Required By Law: Our practice will use and disclose your IIHI when we are required to do so by federal, state or local law.

B. USE AND DISCLSURE 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 practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:
    1> Maintaining vital records, such as births and deaths
    2>Reporting child abuse or neglect
    3>notifying a person regarding potential exposure to a communicable disease
    4>Notifying a person regarding a potential risk of spreading or contracting a disease or condition
    5>Reporting reactions to drugs or problems with products or devices
    6>Notifying individuals if a product or device they may be using has been recalled
    7>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.
    8>Notifying your employer under limited circumstances related primarily to workplace injury or illness or         medical surveillance.


Health Oversight Activities. Our practice 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.

Lawsuit and similar Proceedings. Our practice 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.

Law Enforcement. We may release IIHI if asked to do so by 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 office

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)



o Serious Threats to Health or Safety. Our practice may use and disclose you IIHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the treat.

o Military. Our practice 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.

o National Security. Our practice may disclose you IIHI to federal officials for intelligence and national security activities authorized by law.

o Inmates. Our practice may disclose you IIHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of 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.

o Workers Compensation. Our practice may release your IIHI for workers compensation and similar programs.


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 our Privacy officer 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.

Request 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 case or disclosure of your IIHI, you must make your request in writing to our privacy officer. Your request must describe in a clear and concise fashion:


o (a)the information you wish restricted;

o (b)whether you are requesting to limit our practice’s use, disclosure or both; and

o (c)to whom you want the limits to apply.

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 our Privacy Officer, in order to inspect and/or obtain a copy of your request. Our practice may deny your request in 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.

Amendment. You may ask us to amend you 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 our Privacy Officer. You must provide us with a season 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 us in our opinion: (a) accurate and complete; (b)not part of the IIHI kept by or for the practice; (c) not part of the IIHI 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.

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 practice has made of your IIHI for non-treatment of operations purposes. Use of your IIHI as part of routine patient care in our practice is not required to be documented. For example, the doctor shares information with the nurse; or the billing department uses your information to file your insurance claim. In order to obtain an accounting of disclosures, you must submit your request in writing to our policy officer. All requests for an "accounting of disclosures" must state a time period, which may not be longer than (6) years from the date of disclosure and may not include dates before 1/3/05. The first list you request within a 12 month period is free of charge, but our practice may charge for additional lists within the same 12 month period. Our practice will notify you of the costs involved and you may withdraw your request before you incur any costs.

Rights to a paper Copy of this Notice. You are entitled to receive a paper copy of our notice 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 one of our receptionists.

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 Department of Health and Human Services. To file a complaint with our practice; contact the Office Manager, Privacy Officer. All complaints must be submitted in writing. You will no longer use or disclose your IIHI for the reasons described in the 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 our privacy officer:

Office Manager 
Care Cardiology Associates LLC
555 Iron Bridge Road, Suite 15 

Freehold, NJ 07728