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

The confidentiality of your personal health information is very important to us. Your health information includes records that we create and obtain when we provide you care. It includes a record of your symptoms, examination and test results, diagnoses, treatment and referrals for further care. It also includes bills, insurance claims, or other payment information related to your care.

After reviewing this notice, if you need further information or want to contact us for any reason regarding the handling of your health information, please direct any communications to Lyle Crippen, Compliance Officer, 1615-B Piccard Drive, Rockville, MD 20850. (Phone) 240-449-3094; (Fax) 240-489-4415.

We are required by law to:

-Maintain the privacy of protected health information

-Give you this notice of our legal duties and privacy practices regarding your health information.

-Follow the terms of the Notice currently in effect

 

How we may use and disclose your health information:

The following are the ways that we may use and disclose your protected health information. Except for the purposes listed in this Notice or other limited purposes specifically permitted by applicable law, such as certain disclosures for law enforcement or national security purposes, we will use and disclose your health information only with your authorization. If we provide psychotherapy services to you, our use and disclosure of psychotherapy notes are subject to certain limitations unless we have your authorization. However, we may use and disclose psychotherapy notes without your authorization for, among other things, treatment, payment or health care operations (as described elsewhere in this notice) or to defend ourselves in a legal proceeding initiated by you.

Treatment: We may use and disclose your health information for your treatment and to provide you with treatment-related health care services. For example: we may disclose your health information to doctors, nurses, technicians, or other personnel, including people outside our office who are involved in your medical care and need the information to provide you with treatment. We may also share your health information with other healthcare providers, agencies or facilities involved in your care, to provide or coordinate the different treatments you need, such as prescriptions, DME equipment suppliers, hospice,home health or types of therapy. We may also disclosehealth information about you to people who maybe involved in your continuing care after you leaveour practice, such as other health care providers,transport companies, community agencies and family members.

Payment: We may use and disclose your health informationso that we may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received. For example: we may inform your insurance company that you received a certain type of treatment so that we might receive payment for providing that treatment.

Health Care Operations: We may use and disclose your health information for purposes relating to the proper operations of our practice, including to evaluate and improve our medical care and to operate and manage our office. For example: we may use and disclose information to a peer review organization or a health plan that is evaluating our care. We may use your health information to contact you about services that are available from us. We may also share information with other health care providers thathave a relationship with you for their treatment,payment or health care operations activities.

Appointment Reminders: We may use and disclose your health care information to contact you and remind you of your appointment. We may also tell you about treatment alternatives or health related benefits and services you could use.

Individuals Involved In Your Care or Payment for Your Care: When appropriate, we may share your health information with a person involved in, or paying for, your care (such as your family or a close friend). We may notify you family about your location or condition. Any such disclosure will be limited to information directly related to the person’s involvement in your care. If you are available, we will provide you an opportunity to object before disclosing any such information. If you are unavailable because,for example, you are incapacitated or because of someother emergency circumstance, we will use our professional judgement to determine whether such a disclosure is in your best interest.

Minors: If you are an unemancipated minor under Maryland law, there may be circumstances in which we disclose health information about you to a parent,guardian, or other person acting in loco parentis,in accordance with our legal and ethical responsibilities.

Parents: If you are a parent of a unemancipated minor,and/ or acting as the minor’s personal representative, we may disclose health information about your child to you under certain circumstances.For example, if we are legally required to obtain your consent as your child’s personal representative,in order for your child to receive care from us, we may disclose health information about your child to you. In some circumstances, we may not disclose health information about an unemancipated minor to you. For example, if your child is legally authorized to consent to treatment (without separate consent from you), consents to such treatment, and does not request that you be treated as his or her personal representative, we may not disclose health information about your child to you without your child’s written authorization. Similarly, if we determine,in our professional judgement, that it could be harmful to you or your child to disclose certain portionsof your child’s health information to you, we will notdisclose that information.

Disaster Relief: We may disclose health information about you to government entities or private organizations (such as the Red Cross) to assist in disaster relief efforts. If you are available, we will provide you an opportunity to object before disclosing any such information. If you are unavailable because, for example, you are incapacitated, we willuse our professional judgement to determine whether disclosure is in your best interest and is necessary to ensure an adequate response to the emergency circumstances.

As Required by Law: We will disclose your health informationwhen required to doso by law or by      applicable legal process, such as disclosures in lawsuitsin which we are a party or when we are served with legal process such as a subpoena in a lawsuitin which we are not a party.

 

To Avert a Serious Threat to Health or Safety: We may use and disclose your health information when necessary to prevent a serious threat to the health and safety of you, another person, or the public. Disclosures will be made only to someone who can help prevent or reduce the threat.

Business Associates: We may disclose your health information to our business associates that perform functions on our behalf or provide us with professional services. For example, we may use another company to perform billing services on our behalf. All our business associates are obligated to protect the privacy of your health information.

Worker’s Compensation: We may release your health information for worker’s compensation or similar programs that provide benefits for work-related injuries or illnesses.

Public Health Disclosures: We may disclose your health information for public health purposes. These purposes generally include the following: (1) preventing or controlling disease (such as cancer or tuberculosis), injury or disability; (2) reporting vital events such as births or deaths ; (3) reporting child abuse or neglect; (4) reporting adverse events or surveillance related to food, medications or defects; (5) reporting problems with products; (6) notifying a person who may have been exposed to disease or may be at risk for contracting or spreading a disease or condition; (7) notifying the appropriate government authority if we believe a patient has been the victim of abuse or neglect and make this disclosure as authorized or required by law; (8) notifying the coroner of a patient’s death; (9) notifying emergency response employees regarding possible exposure to HIV/AIDS, to the extent necessary to comply with state and federal law; (10) notifying multidisciplinary personnel teams relevant to the prevention , identification, management, or treatment of an abused child and the child’s parents or an abused elder or dependent adult.

Health Oversight Activities: We may disclose your health information to a health agency for activities authorized by law. These may include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

 

Judicial and Administrative Proceedings: If you are involved in a lawsuit or dispute, we may disclose your physical and mental health information in response to a court or administrative order. We may disclose your physical and mental health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement:We may release, as appropriate, your physical and mental health information to law enforcement: (1) pursuant to a subpoena by law enforcement; (2) as needed for the protection of others; or (3) if there is a court order, subpoena, or other legal process for the release of the information. Information may also be released to (1) law enforcement without their request to protect others whom you threaten to injure and to (2) persons who are in danger from a threat you have made.

CRISP (Chesapeake Regional Information System for our Patients):We have chosen to participate in CRISP, a regional health information exchange serving Maryland and DC. As permitted by law, your health information will be shared with this exchange in order to provide faster access, better coordination of care and assist providers and public health officials in making more informed decisions. You may “opt-out” and disable access to your health information available through CRISP by calling 1-877-952-7477 or completing and submitting an Opt-Out form to CRISP by mail, fax or through their website at www.crisphealth.org. Public health reporting and Controlled Dangerous Substances information, as part of the Maryland Prescription Drug Monitoring Program (PDMP), will still be available to providers.

Your Rights Regarding Your Physical and Mental Health Information: You have the right to inspect and/or receive a copy of your health information and billing records so long as it is included on records that we use to make treatment, payment or other decisions about you or your care. You do not have a right to access notes that are developed and maintained with regard to mental health services you receive (Psychotherapy Notes In order to access your health information, you need to send a written request to Bethesda Newtrition and Wellness Solutions. If you request a copy of the information, there will be a fee relating to the cost of copying your information and sending it to you. We may deny your request to inspect and/or to receive a copy in certain circumstances. Depending on the circumstances, you may have a right to appeal our decision.

Right to Amend:You have the right to request an amendment to your records by written request to Bethesda Newtrition and Wellness Solutions. We may or may not grant your request, but if we do not do so, you have a right to have us re-examine our denial.

Right to an Accounting of Disclosures:You have a right to an accounting of certain disclosures by written request to Bethesda Newtrition and Wellness Solutions. An accounting is a listing of information about the information disclosed, to whom it was disclosed, and related information.

Right to Request Restrictions:You have the right to request restriction or limitation on the health information used for treatment, payment or health care operations. You may request us to limit disclosure to someone involved in your care or in payment for your care (such as a spouse) by written request to Bethesda Newtrition and Wellness Solutions. We are not required to agree with your request except as specified in the next sentence, but we will make reasonable efforts to comply with requests that we deem reasonable. If you pay entirely out-of-pocket for an item or service that we provided, you have a right to request that we do not disclose your personal information relating to that service, unless required to do so by applicable law, to an insurance company for the insurance company’s payment or health care operations purposes. We are required to comply with your request restriction in this specific circumstance. Your written request for a restriction must specify the restriction requested and, in the case of a service that you paid for entirely out-of-pocket, what the service was and when it was provided. The request should be addressed to Bethesda Newtrition and Wellness Solutions.

Right to Request Confidential Communication: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. You can ask, for example, that we contact you only by mail or at work. Your written request must specify how or where you wish to be contacted and be addressed to Bethesda Newtrition and Wellness Solutions. We will accommodate all requests that we deem reasonable.

Questions or Complaints: If you have any questions about this Notice, please contact Bethesda Newtrition and Wellness Solutions. If you believe your privacy rights have been violated, you may file a complaint with Bethesda Newtrition and Wellness Solutions. To file a complaint with the Regional Manager of the Office for Civil Rights, U.S. Department of Health and Human services, write to 150 S. Independence Mall West, Suite 372, Public Ledger Building, Philadelphia, Pa 19106. (Phone) 215-861-4441, (Fax) 215-861-4431. To file a complaint with the Secretary of Health and Human Services (HHS), write to the Office For Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, Washington, D.C. 20201. (Phone) 800-368-1019 or (email) OCRprivacy@hhs.gov.

Other Uses Of Your Health Information: Other uses and disclosures of your health information not covered by this Notice will be made only with your authorization. If you provide us authorization to disclose such information about you, you make revoke that permission, in writing, at any time. If you revoke your permission, we will no longer disclose such information about you for the reasons covered by your written permission. You understand that we are unable to take back any disclosures we have already made with your permission, and that we will retain our records of the provided to you as required by law.

We may change this Notice and make it effective for medical information we already have about you as well as new information. The current Notice will be posted and available at all times. You have a right to request a paper copy of the current Notice and any visit or by written request to Bethesda Newtrition and Wellness Solutions, 1615-B Piccard Drive, Rockville, MD 20850. (Phone) 240-449-3094 (Fax) 240-489-4415.

I have received and reviewed a copy of the HIPAA Notice of Privacy Practices.