۰ͼ

۰ͼ, Inc.
205 Burlington Road, Bedford, MA 01730
781-862-3600

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 IT CAREFULLY.

We, at ۰ͼ, are dedicated to protecting the privacy of all people who seek services at The Center. We will protect the privacy of your health information and will not use or disclose your health information without your written permission, except as described in this Notice.

In accordance with state and federal laws, this Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out your plan of care, get paid for our services, administer ۰ͼ and for other purposes that are permitted or required by law.

This Notice also describes your rights with respect to your health information.

Throughout this Notice, we use the term “protected health information” or PHI. PHI is information about you that may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare services.

If we change our practices and this Notice, we will give you a revised Notice.

Using and Disclosing Your PHI without Your Authorization

We will use your information for your care and treatment. We will use and disclose your health information without your authorization to provide, coordinate and manage your care and treatment. For example, information about you will be recorded in your record and used to determine and carry out your plan of care. This information may be shared with others who are directly involved in your care and treatment. In addition, we may also disclose information to your case manager or others who are responsible for coordinating your care and treatment.

We will use your information for payment. For example, a bill may be sent to you, your insurance company or Medicare or Medicaid. The information on or accompanying the bill may include information that identifies you, as well as the treatment provided to you.

We will use your protected health information for the operation of The Center. We may use your PHI for quality improvement activities, for licensing purposes, and for service planning. For example, members of our quality improvement team may use information in your healthcare record to assess the care and outcomes in your case and others like it.

Other Uses or Discloses of Your PHI without Your Authorization:

* Emergency Situations: We may use or disclose your PHI without your authorization in an emergency treatment situation. For example, we may provide your health information to a paramedic who is transporting you in an ambulance. We may also give information about you to the staff of the hospital emergency department.

* Persons involved in your care or payment for your care: We may provide health information about you to someone who helps pay for your care. We may also use or disclose your health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. However, if you are physically present and have the capacity to make health care decisions, your health information may only be disclosed with your agreement to persons you designate to be involved in your care.

* To avert a serious threat to health or safety: We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Under these circumstances, we will only disclose health information to someone who is able to help prevent or lessen the threat.

* Victims of abuse, neglect, or domestic violence: We may disclose PHI about you to a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect, or domestic violence. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else or the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you.

* When a disclosure is required by federal, state or local law, judicial or administrative proceedings or law enforcement: For example, we may disclose your PHI for law enforcement purposes as required by law or in response to a valid subpoena. If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose health information about you 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.

* Food and Drug Administration (FDA): We may disclose to the FDA PHI relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

* Worker’s compensation: We may disclose your PHI to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.

* Public health and health oversight activities: As required by law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability. We may disclose your PHI to an oversight agency for activities authorized by law, including audits and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.

* Specific government functions: For example, if you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also disclose your PHI to authorized federal officials for national security purposes, such as protecting government officials and performing intelligence activities or investigation.

* Medical examiners and funeral directors: We may provide PHI to a medical examiner. Medical examiners are appointed by law to assist in identifying deceased persons and to determine the cause of death in certain circumstances. We may also disclose PHI to funeral directors as necessary to carry out their duties.

* Business associates: There are some services provided by The Center through contracts with business associates such as billing companies. When these services are contracted for, we may disclose your PHI to our business associates so that they can perform the job we have asked them to do. We require our business associates to appropriately safeguard your information.

* Personal communications: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

* Fundraising: We may contact you as part of a fundraising effort for The Center.

* Correctional institution: If you are or become an inmate of a correctional institution, we may disclose to the institution or its agents PHI necessary for your health and the health and safety of other individuals.

Your Written Authorization

Under any circumstances other than those listed above, we will request that you sign a written authorization before we use or disclose your PHI to anyone.

If you sign an authorization allowing us to disclose PHI about you in a specific situation, you can later revoke (cancel) the authorization in writing.

If you revoke (cancel) your authorization in writing, we will not disclose your PHI after we receive you cancellation, except for disclosures already made before we received your cancellation.

You Have a Right to:

* Request that we limit certain uses and disclosures of your information. You have the right to request that we limit how we use or disclose your PHI to carry out your plan of care, get paid for our services or administer our agency. (This is also referred to as “treatment, payment, or health care operations.”) You also have the right to request a restriction on the PHI we disclose about you to someone who is involved in your care or payment for your care, such as a family member or friend. We will grant all reasonable requests if it is possible to implement the restrictions in our agency practices. To request limitations or restrictions, you must send a written request to the director of the program where you are receiving services.

* See and get a copy of your information. You have the right to look at and to obtain a copy of PHI about you contained in your agency and billing records for as long as The Center maintains the information. To look at or receive a copy your PHI, please send a written request (Access to Records Request form) to the director of the program where you are receiving services. If you request a copy of the information, we may charge you a fee for the costs of the copying, mailing, or other supplies that are necessary to grant your request. Please be aware that the process may take up to 30 days to complete. We will grant all reasonable requests if it is possible to implement them in our agency practices. If you are denied the right to see or get a copy your PHI, you may request that the denial be reviewed.

*Correct or update your information. If you feel that PHI we have about you is incomplete or incorrect, you may request that we correct or update (amend) the information. You may request an amendment for as long as we maintain your health information. To request an amendment, you mustsend a written request (Request to Amend Record form) to the director of the program where you are receiving services. In addition, you must include the reasons for your request. We will grant all reasonable requests if it is possible to implement them in our agency practices. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may prepare a response to your statement, which we will provide to you.

* Receive a list of the disclosures of your information. You have the right to receive a list (“accounting”) of the disclosures we have made of your PHI. This is a listing of disclosures made by us or by others on your behalf. However, we are not required to include the following types of disclosures:

  1. Made for treatment;
  2. Made for billing or collection of payment for your treatment;
  3. Made directly to you, that you authorized, or those which were made to friends or family members involved in your care;
  4. Allowed by law when the use or disclosure relates to certain government functions or in other law enforcement custodial situations; and/or
  5. Made in the process of our health care operations.

To request an accounting, you must submit your request in writing (Request for Accounting form) to the director of the program where you are receiving services. Your request must state the time period, but may not be longer than six (6) years before your request (but not disclosures made prior to April 14, 2003). The first accounting you request within a 12-month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.

* Request communications of your information by alternative means or at alternative locations. For instance, you may request that we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of your PHI, you must submit your request in writing to the director of the program where you are receiving services. Your request must state how or when you would like to be contacted. We will accommodate all reasonable requests.

For More Information or to Report a Problem

If you have questions or would like additional information about The Center’s privacy practices, you may contact the Privacy Officer at ۰ͼ, 205 Burlington Road, Bedford.

If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer of The Center or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

 

This Notice is Effective as of January 17, 2017, revised February 17, 2022.