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. THIS NOTICE IS EFFECTIVE: April 14, 2003.
USES AND DISCLOSURES OF HEALTH INFORMATIONWe use health information about you for treatment, to obtain payment for treatment, and for administrative purposes, such as to evaluate the quality of care you receive. We may contact you by mail or telephone to remind you about appointments, and to provide you with information about treatment alternatives or other health related services that may be of interest to you.
We may use or disclose identifiable health information about you without your authorization for reasons such as public health reporting, auditing purposes, or in emergency situations. We also may provide information when otherwise required to, such as law enforcement activities. In any other situation, we will ask you for your written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose health information, you can later revoke that authorization to stop any future uses and disclosures.
Our policies for using and disclosing heath information may change from time to time. If we make a significant change to our policies, we will change our notice and post the new notice in the waiting area. For more information about our privacy practices, contact the person below.
INDIVIDUAL RIGHTS
You have the right to request restrictions on how your health information is used or disclosed. We will try to accommodate your request, but are not legally required to. You have the right to receive confidential communications from us. For instance, you can request that we contact you at work instead of at home to remind you about appointments or provide you with test results. In most cases you have the right to look at or get a copy of health information about you. If you request copies, we will charge you $0.50 for each page. If you think information in your record is incorrect or that important information is missing, you have the right to request that we correct the record or add the missing information. We will try to accommodate your request, but we are not legally required to. You also have the right to receive a list of where we have disclosed health information about you for reasons other than treatment, payment, or administrative purposes or without your written authorization. You also have the right to receive a paper copy of this notice whenever you ask for one.
COMPLAINTS
If you think that your privacy rights have been violated, or you disagree with a decision we made about the use or access to your records, you may contact the person below. You may also send a written complaint to the U.S. Department of Health and Human Services, 200 Independent Ave, S.W. Washington D.C. 20201. Their telephone number is 202-619-0257 or Toll Free 877-696-6775.
OUR LEGAL DUTY
We are required by law to protect the privacy of your information, provide this notice about our information practices, and follow the information practices described in this notice. If you have any questions or complaints, please contact:
Privacy Officer Joseph Sabino D.C.
978-777-8734
39 Cross Street, Peabody, Suite 205, Massachusetts 01960, United States