NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

Hayden Health Group may record, transmit, or maintain, either on paper or electronically, personal information about you, your medical history and your healthcare treatment as part of providing you with healthcare services.

This Notice of Privacy Practices (“Notice”) describes how we may use and disclose such information, our obligations regarding the use and disclosure of your medical information, and your rights with respect to the use and disclosure of your medical information. This Notice is required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).

OVERVIEW

We are legally required to protect the privacy of information that identifies you or could be used to identify you, and relates to your past, present or future physical or mental health condition(s) or the provision of past, present, or future healthcare services (including payment for those services). This information is called “protected health information” or “PHI” for short.

We are legally required to follow the privacy practices that are described in this Notice. We reserve the right to change our privacy policies and the terms of this Notice at any time. Before any important policy change goes into effect, we will change this Notice.

We will post a copy of this Notice in a clearly visible location within our practice site for public viewing and on our website at www.haydenhealthgroup.com. You may also request a copy of this Notice at any time by contacting Hayden Health Group’s Privacy Officer at 781-836-5003.

USE AND DISCLOSURE OF YOUR PHI BY HAYDEN HEALTH GROUP

Hayden Health Group may use or disclose your PHI to carry out its responsibilities as a healthcare provider. Hayden Health Group may use or disclose your PHI without your written authorization for the following reasons:

  • •Treatment. Hayden Health Group may disclose PHI to provide your medical care. We may disclose PHI to our employees and others who are involved in providing your care at Hayden Health Group or other locations. For example, we may disclose PHI to other physicians or other health care providers; or we may share PHI with a pharmacist who needs it to dispense a prescription to you, or a laboratory that performs a test.
  • Payment. We may use and disclose PHI so that payment for the treatment and services you receive at Hayden Health Group or from other entities, such as an ambulance company, may be billed to and collected from you, or an insurance company or third party. We may also need to disclose this information to insurance companies to establish insurance eligibility benefits for you.
  • Healthcare Operations. “Healthcare operations” at Hayden Health Group include activities related to improving quality of care, staff training, medical education, and business management.
  • Appointment Reminders. We may use and disclose medical information to contact and remind you about appointments. If you do not answer, we may leave this information on your answering machine or in a message left with the person answering the phone.
  • Information about Healthcare Related Benefits and Treatment Alternatives. We may use and disclose medical information to contact you and inform you of treatment alternatives or other healthcare services or benefits that we offer.
  • Sign In Sheet. We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.
  • As Required By Law. We will disclose PHI when required to do so by federal or state law, including in response to a court or administrative order, subpoena, discovery request, warrant, summons or other lawful process. Hayden Health Group may also disclose PHI to law enforcement personnel or similar persons to avoid a serious threat to the health or safety of a person or the public.
  • To Avoid Harm. If we believe that there is substantial risk of physical harm to you or other persons due to your behavior or mental state, we may disclose PHI to other health care providers, police, courts, ambulance personnel, or others, in order to lessen that risk, to coordinate your health care, or to seek civil commitment;

In addition, Hayden Health Group may use your PHI without your written authorization under the following circumstances:

  • Emergency situations when your authorization cannot be reasonably obtained, including for disaster relief purposes;
  • To business associates (outside vendors or consultants that perform services on behalf of Hayden Health Group and are contractually required to appropriately safeguard your information);
  • To other healthcare facilities where Hayden Health Group physicians and healthcare professionals have privileges or to physicians from other healthcare facilities who see patients at Hayden Health Group;
  • With your agreement, to a family member, relative, close personal friend, or any other person you identify;
  • In connection with workers’ compensation claims;
  • To report abuse, neglect, or domestic violence as required by state of federal law;
  • For public health and health oversight activities, such as preventing or controlling disease or investigations; or
  • To coroners, medical examiners, or funeral directors as necessary to carry out their duties.

Certain actions, such as most uses of disclosures of psychotherapy notes, the use and disclosure of PHI for marketing purposes, and disclosures that constitute a sale of PHI, will be made only with your written permission (authorization). Other uses or disclosures of PHI that are not covered by this Notice or applicable laws also will be made only with your written permission.

Massachusetts provides special privacy protections for particularly sensitive conditions or illnesses such as HIV/AIDS, mental health, and substance abuse. Hayden Health Group will disclose such information only in a manner that is consistent with these laws.

You may revoke your permission at any time by writing to Hayden Health Group’s Privacy Officer at the address below. Once you revoke your permission, we will stop using or disclosing such information for the reasons covered by your written authorization. However, we cannot take back any disclosures made with your permission. We will retain our records of the care provided to you as required by law.

YOUR RIGHTS REGARDING YOUR PHI

Although your medical information is the property of Hayden Health Group, you have certain rights regarding your PHI, including the right to:

  • Inspect and Copy. With certain exceptions, you have the right to inspect or receive a copy of your medical information or both. We may charge a fee for these services. We may deny your request in certain limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by Hayden Health Group will review your request and our denial.
  • Request an Amendment. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend information that is kept by or for Hayden Health Group. We may deny your request if you ask us to amend information that (a) was not created by Hayden Health Group; (b) is not part of the medical information kept by or for Hayden Health Group; (c) is not medical information you are permitted to inspect or copy; or (d) is accurate and complete in the record.
  • Request an Accounting of Disclosures. You may request a list of the disclosures we have made of PHI that were for purposes other than treatment, payment, healthcare operations and certain other purposes, or disclosures made with your written authorization within the last six (6) years. You may be charged a fee in connection with this request.
  • Restrict or Limit Use or Disclosure. You may ask us to restrict or limit the use or disclosure of your PHI, including the disclosure of information to someone who is involved in your care or the payment for your care, like a family member or friend. Your request must state: (1) what information you want to limit; (2) whether you want to limit Hayden Health Group’s use, disclosure or both; and (3) to whom the limits apply, for example, disclosures to your spouse. We are not required to agree to your request, unless it relates to an item or service you paid for in full and out of pocket. In this case, you may request that we not share health information pertaining only to that product or service with your health plan for the purposes of carrying out payment or healthcare operations and we will comply with your request unless the information is needed to provide you emergency treatment or except as required by law.
  • Confidential Communications. Generally, we will use the address, telephone number and, in some cases, the email address you give us to contact you. You may ask us to communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
  • Notification in the Event of a Breach. Consistent with federal and state laws, we will notify you in the event unsecured PHI is used or disclosed by an unauthorized individual.

All requests must be submitted in writing to the address below. Your request must be specific and be signed by you or an authorized representative.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint by writing to the address below or by calling Hayden Health Group’s Privacy Officer at 781-836-5003. You may also file a complaint in writing with the Secretary of the U.S. Department of Health and Human Services in Washington, D.C. or through the regional office at J.F.K. Federal Building – Room 1874, Boston, MA 02203. The complaint must be filed within 180 days of the alleged violation. There will be no retaliation for filing a complaint.

CONTACT INFORMATION

If you have questions, would like to submit a written request, or need further assistance regarding this policy, please contact Hayden Health Group’s Privacy Officer at:

Privacy Officer
Hayden Health Group
99 Derby Street, Suite 200 Hingham, MA 02043

Telephone: 781-836-5003

EFFECTIVE DATE
This Notice of Privacy Practices is effective April 4, 2016