Your Rights
You have the right to:
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Get a copy of your paper or electronic medical record
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Correct your paper or electronic medical record
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Request confidential communication
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Ask us to limit the information we share
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Get a list of those with whom we’ve shared your information
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Get a copy of this privacy notice
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Choose someone to act for you
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File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
Our Uses and Disclosures
We may use and share your information as we:
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Treat you
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Run our organization
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Bill for your services
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Help with public health and safety issues
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Do research
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Comply with the law
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Respond to organ and tissue donation requests
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Work with a medical examiner or funeral director
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Address workers’ compensation, law
enforcement, and other government requests
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Respond to lawsuits and legal actions
Your Rights
When it comes to your health information, you have certain rights.
This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
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You can ask to see or get an electronic or paper copy of your medical record
and other health information we have about you. Ask us how to do this.
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We will provide a copy or a summary of your health information, usually within
30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
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You can ask us to correct health information about you that you think is
incorrect or incomplete. Ask us how to do this.
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We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
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You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a
different address.
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We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
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You can ask us not to use or share certain health information for treatment, payment, or our operations.
We are not required to agree to your request, and we may say “no” if it would affect your care.
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If you pay for a service or health care item out-of-pocket in full, you can ask
us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
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You can ask for a list (accounting) of the times we’ve shared your health
information for six years prior to the date you ask, who we shared it with, and why.
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We will include all the disclosures except for those about treatment, payment, and health care operations,
and certain other isclosures (such as any you asked us to make). We’ll provide one accounting a year for free
but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
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Get a copy of this privacy notice
You can ask for a paper copy
of this notice at any time, even
if you have agreed to receive
the notice electronically. We
will provide you with a paper
copy promptly. A copy of the
current Notice of Privacy
Practices will be prominently
displayed in our office at all
times and posted on our
website
Choose someone to act for you
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If you have given someone medical power of attorney or if someone is your legal guardian, that person
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can exercise your rights and make choices about your health information.
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We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
You may file a complaint with
us by notifying our Privacy
Officer of your complaint. We
will not retaliate against you for
filing a complaint. You may
contact our Privacy Officer for
further information about the
complaint process.
Your Choices
For certain health information, you can tell us your choices about what we share.
If you have a clear preference
for how we share your
information in the situations
described below, talk to us. Tell
us what you want us to do, and
we will follow your instructions.
In these cases, you have both
the right and choice to tell us to:
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Share information with your family, close friends, or others involved in your care.
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Share information in a disaster relief situation.
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Include your information in a hospital directory.
If you are not able to tell us
your preference, for example
if you are unconscious, we may
go ahead and share your
information if we believe it is in
your best interest. We may also
share your information when
needed to lessen a serious
and imminent threat to health
or safety.
In these cases we never share
your information unless you give
us written permission:
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Marketing purposes
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Sale of your information
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Most sharing of psychotherapy notes
In the case of fundraising:
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your
health information in the
following ways.
Treat you
We can use your health
information and share it with
other professionals who are
treating you.
Example: A doctor treating you
for an injury asks another
doctor about your overall
health condition.
Run our organization
We can use and share your
health information to run our
practice, improve your care,
and contact you when necessary.
Example: We use health
information about you to
manage your treatment and
services.
Bill for your services
We can use and share your
health information to bill and
get payment from health plans
or other entities.
Example: We give information
about you to your health
insurance plan so it will pay
for your services.
How else can we use or share
your health information?
We are allowed or required to
share your information in other
ways – usually in ways that
contribute to the public good,
such as public health and
research. We have to meet many conditions in the law
before we can share your
information for these purposes.
For more information see:
Help with public health and safety issues
We can share health information
about you for certain situations
such as:
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Preventing disease
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Helping with product recalls
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Reporting adverse reactions to medications
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Reporting suspected abuse, neglect, or domestic violence
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Preventing or reducing a serious threat to anyone’s health or safety
Do research
We can use or share your
information for health research.
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Comply with the law
We will share information
about you if state or federal
laws require it, including with
the Department of Health and
Human Services if it wants to
see that we’re complying with
federal privacy law.
Respond to organ and tissue donation requests
We can share health
information about you with
organ procurement
organizations.
Work with a medical examiner or funeral director
We can share health
information with a coroner,
medical examiner, or funeral
director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health
information about you:
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For workers’ compensation claims
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For law enforcement purposes or with a law enforcement official
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With health oversight agencies for activities authorized by law
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For special government functions such as military, national security and
presidential protective services
Respond to lawsuits and legal actions
We can share health
information about you in
response to a court or
administrative order, or in
response to a subpoena.
Our Responsibilities
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We are required by law to maintain the privacy and security of your protected
health information.
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We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
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We must follow the duties and privacy practices described in this notice and
give you a copy of it.
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We will not use or share your information other than as described here unless you tell us we can in writing.
If you tell us we can, you may change your mind at any time. Let us know in
writing if you change your mind.
For more information see: www.hhs.gov
Changes to the Terms of this Notice
We can change the terms
of this notice, and the changes
will apply to all information we
have about you. The new
notice will be available upon
request, in our office, and on
our website.
THIS NOTICE WAS
PUBLISHED AND BECAME
EFFECTIVE 10/11/2013.
For more information, please
contact your specific provider
below:
Ion of Bergen LLC - (877) 718-6777
Attn: Privacy Officer
736 Hwy 35 Suite D, Ocean, NJ 07712
Comfort Sleep Services - (877) 236-8494
Attn: Privacy Officer
736 Hwy 35 Suite A, Ocean, NJ 07712
Peak Respiratory - (800) 343-7325
Attn: Privacy Officer
120 Whitehorse Pike,
Haddon Heights, NJ 07712
OXYCARE - (410) 871-0887
224 Washington Heights Medical Center,
Westminster, MD 21157
Americoast Delaware, LLC. - (302) 945-8081
31507 Oak Orchard Rd, Ste 10,
Trading Post Plaza, Millsboro, DE 19966
Community Care of Harrisburg LLC
(717) 932-4849
689 York Town Rd, Lewisberry, PA 17339
Middlesex Homecare & Supplies
(860) 632-0393
160 West St Suite K
Cromwell CT 06416
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