Hampden County Physicians Associates

HAMPDEN COUNTY PHYSICIAN ASSOCIATES, LLC

               Director of Compliance and Quality
         Hampden County Physician Associates, LLC
                        354 Birnie Avenue
                    Springfield, MA  01107
                     Tel:  413-733-3470

                           Notice of Privacy Practices

                           Effective:  April 14, 2003

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 of privacy practices explains how Hampden County Physician Associates, LLC, (HCPA) its medical staff members, employees, may use and provide your Protected Health Information (PHI) to others for treatment, payment and health care “operations” as described below, and, for other purposes allowed or required by law. 

A copy of this policy is available at all Hampden County Physician Associates, LLC locations.

How we may use and disclose your medical information:

The following categories describe different ways that we use and share medical information.  Please note that each particular use or disclosure is not listed below.  However, the different ways in which we are permitted to use and share your medical information generally fall within one of the categories listed below:

Treatment.  Information obtained by a nurse, doctor or other member of your healthcare team will be recorded in your medical record and used as a basis for planning your care and treatment. In that way, your medical record serves as a means of communication and coordination among the many healthcare professionals who contribute to your care.  We may disclose information to people outside our practice who may be involved in your care, such as designated family members.  We may also disclose your PHI to providers or facilities that may be involved in your care after you leave our office or our care.  This would include, for example, when your primary care physician consults with a specialist regarding your condition or coordinates services you may need, such as lab work and x-rays. 

Payment.  HCPA may use and share your PHI to bill and collect payment for services delivered.  For example, if you have health insurance, we will need to give to the health plan or government agency (Medicare/Medicaid) information about the services you received so that your plan will pay us.  We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.  Co-payment is due at the time of your visit.

Healthcare Operations.  We may use and disclose your PHI in connection with our regular healthcare operations.  Healthcare operations include quality assessment and improvement activities, review of the competence or qualifications of our healthcare professionals, evaluating our clinical performance, and other business operations.  We may combine medical information about you with information from other hospitals to compare and identify areas where we can make improvements.

Appointment Reminders.  We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.  You will receive an appointment reminder call two (2) days in advance of your appointment; you must call 24 hours ahead to cancel an appointment to avoid a no-show fee of $25.00. 

Treatment Alternatives.  We may use and disclose your PHI to tell you about or recommend therapies, health care providers, settings of care or possible treatment options or alternatives that may interest you.

Health-Related Benefits and Services.   We may use and disclose your PHI to inform you about health-related products, benefits or services offered by HCPA that may interest you.

Fundraising Activities.  We may use PHI about you in order to contact you for fundraising activities supported by us.  Only your name, address and phone number and the date you received treatment or services from us would be used.

Individuals Involved in Your Care or Payment for Your Care.   Unless you object, we may disclose to one of your family members, to a relative, to a close personal friend or to any other person identified by you, protected health information directly relevant to the person’s involvement with your care or payment related to your care.  In addition, we may disclose protected health information about you to notify, identify or locate a member of your family, your personal representative, another person responsible for your care or certain disaster relief agencies of your location, general condition or death.  In the case of a communication barrier, we may disclose your PHI to an interpreter.

Emergencies/Disaster Relief.   We may use or disclose your PHI to a public or private agency (like the American Red Cross) for emergencies or disaster relief purposes.  Even if you object, we may still share information about you, if necessary for emergency circumstances.

Research/Stem Cell Research.   Under certain circumstances, we may use and disclose your PHI for research purposes.  For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition.  We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or, will be involved in your care.

As Required or Permitted by Law.   We will use and disclose medical information about you when required to do so by federal, state or local law.  We may use and disclose medical information about you when permitted by law to do so.  For example, as required by law, we may disclose health information to the following types of entities, including, but not limited to:

• Food and Drug Administration
• Public Health authorities charged with preventing or controlling disease, injury, disability
• Organ and Tissue Donation Organization
• Health Oversight Agencies
• Funeral Directors and Medical Examiners
• National Security and Intelligence Agencies

To Avert a Serious Threat to Health or Safety.   We may use and disclose PHI about you to help prevent a serious threat to the health or safety of you, the public or, another person.

For Public Health Activities.  We may use and disclose your PHI for public health activities, which may include the following:

• To prevent or control disease, injury or disability
• To report births and deaths
• To report child abuse or neglect
• To report reactions to medications or problems with products
• To notify you of recalls of products or medical devices that you may be using
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
• To notify the appropriate government authorities (or designee) if we believe a patient has been a victim of abuse, neglect or domestic violence

We will only make this disclosure if you agree, or, when we are required or authorized by law to do so

Judicial and Administrative Proceedings.   We may use and disclose PHI as required by a court or administrative order, or, in some instances pursuant to a subpoena, discovery request or other legal process 

Law Enforcement.   We may use and disclose your PHI to correctional or law enforcement officials when necessary or appropriate, including:

• In response to a court’s authority, including a court-issued order or search warrant
• About a death required to be reported to a medical examiner, including when we believe the death may be the result of criminal or other suspicious circumstances
• About criminal conduct at an HCPA office
• To report a crime, the location of the crime or victims, or the identity, description or location of the person who may have committed the crime

We have described in the bullet points above, those uses and disclosures of your PHI that we may make either as permitted or required by law or otherwise without your written authorization.  For other uses and disclosures of your medical information we must obtain your written authorization.  A written authorization request will, among other things, specify the purpose of the requested disclosure, the persons or class of persons to whom the information may be given and an expiration date for the authorization.  If you do provide a written authorization, you generally have the right to revoke it.

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YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION WE MAINTAIN ABOUT YOU

Right to Inspect and Copy.  Upon submission of a written request to us, you have the right to review or receive copies of your health information, with limited exceptions. You may obtain a form to request access by contacting the HCPA medical office where you are seen as a patient. If you request copies, we will charge you a reasonable cost-based fee. If you request that the copies be mailed, we may charge you for postage. If you request records in a non-photocopy alternative format, which we can accommodate, we will charge a reasonable cost based fee for providing you health information in that format.

Right to Amend Records.  We make every effort to maintain complete, accurate and up-to-date information about you and your health status. If you believe any information about you is incomplete or incorrect, you have the right to request that we amend your health information. Such requests must be made in writing and must explain why the information should be amended. We may be unable to comply with your request in certain circumstances. If you wish to make an amendment, please contact our Director of Compliance and Quality at the address below .

Right to an Accounting of Disclosures.  You have the right to request an “accounting report of certain disclosures.”  This is a list of the disclosures we made of your PHI.  We are not required to account for the following disclosures as stated by the law.  For example:  disclosures made for treatment, payment or in the process of our healthcare operation, disclosures authorized by you or made directly to you or others involved in your care, disclosures allowed by law when the use and disclosure relates to certain government functions or in other law enforcement custodial situations.  You request must be submitted in writing to our Director of Compliance and Quality at the address below, and, state a time period which may not be longer than six years and may not include dates before April 14, 2003.  Your request should indicate in what form you want the list (on paper or electronically).    The first list you request within a 12 month period will be free, however, for additional lists, we may charge you for the costs of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions.  You have the right to request that we place additional restrictions on our use or disclosure of your health information for treatment, payment and healthcare operations purposes. Depending on the circumstances of your request, we may or may not agree to those restrictions. If we do agree to your requested restrictions, we must abide by those restrictions except in emergency treatment situations. You have the right to request that we communicate with you about your PHI by alternative means or to alternative locations (e.g., at your place of business rather than at your home). Such requests must be made in writing, must specify the alternative means or location, and must provide satisfactory explanation on how payments will be handled under the alternative means or location you request.

Right to Request Confidential Communications.  You have the right to request that we 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 or by mail.   You must make your request in writing to the Director of Compliance and Quality at the address listed below.  We will not ask you the reason for your request and, we will accommodate all reasonable requests submitted in writing which must specify how or where you wish to be contacted.

Complaints.   If you believe your privacy rights have been violated, you may file a complaint directly with HCPA or with the Secretary of the US Department of Health and Human Services, Office of Civil Rights, Government Center, JF Kennedy Federal Building, Room 1875, Boston, MA, 02203,

Phone 617-565-1340, Fax 617-565-3809, TDD 617-565-1343.  

YOU WILL NOT BE PENALIZED FOR FILING A COMPLAINT and/or, There will be no retaliation for filing a complaint.

You may file your written complaint with our Director of Compliance and Quality at the address below.

If you want more information about our privacy practices or have questions or concerns, please contact us.

A copy of this policy is available at Hampden County Physician Associates, LLC locations.

Please direct any of your questions or complaints to:

Director of Compliance and Quality
Hampden County Physician Associates, LLC
354 Birnie Avenue
Springfield, MA  01107
Tel:  413-733-3470

Paper Copy of this Notice.   You have the right to obtain a paper copy of this notice at any time, which is also posted on our website at www.hampdencountyphysicians.com

Updated:    September 30, 2011