Accepting Insurance Plans & Self Pay
Accepting insurance plans in MA & RI and Self-Pay in all other states

NOTICE OF PRIVACY PRACTICES

YOUR INFORMATION. YOUR RIGHTS. OUR RESPONSIBILITIES.

This notice describes how clinical information about you may be used and disclosed and how you can get access to this information.

Please review it carefully.

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 clinical record
  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
  • We will provide a copy or summary within 30 days. A reasonable cost-based fee may apply.
Ask us to correct your medical record
  • You can ask us to correct health information you believe is incorrect or incomplete.
  • We may deny your request but will explain why in writing within 60 days.
Request confidential communications
  • You can ask us to contact you in a specific way or send mail to a different address.
  • We say “yes” to all reasonable requests.
Ask us to limit what we use or share
  • You can ask us not to use or share certain health information.
  • We are not required to agree if it affects your care.
  • If you pay out-of-pocket in full, you can ask us not to share information with your insurer.
Get a list of those with whom we’ve shared information
  • You can request an accounting of disclosures for the past six years.
  • One free request per year; additional requests may incur a fee.
Get a copy of this privacy notice
  • You can ask for a paper copy at any time.
Choose someone to act for you
  • A legal guardian or medical power of attorney may act on your behalf.
  • We will verify their authority before taking action.
File a complaint if you feel your rights are violated
  • You can contact us using the details provided.
  • You can also file a complaint with the U.S. Department of Health and Human Services.
  • We will not retaliate against you for filing a complaint.

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 CONTACT INFORMATION 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:
  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory
  • Contact you for fundraising efforts

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.

We never share your information unless you give us written permission when it comes to marketing purposes.

OUR USERS AND DISCLOUSURES

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.
Workers’ compensation
  • We may disclose your health information with workers’ compensation programs and other similar programs relating to work-related illnesses or injuries.

Example: We provide information about you to workers’ compensation so that you can continue to receive assistance for work-related illnesses or injuries.

Lawsuits and legal actions
  • We may share health information about you in response to a court or administrative order, or in response to a subpoena.

Example: We give information about you to the court when it is mandated by law.

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. 

OUR RESPONSIBILITIES

  • We are required by law to maintain the privacy and security of your protected health information.
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • 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 if you change your mind.

 

For more information see:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

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 and on our web site.

CONTACT INFORMATION

If you have specific questions about your rights or about this notice, you may contact us one of the following ways:

EMAIL:
info@mediex.health
CALL:
978-631-1071
WRITE:
Mediex Health PLLC
237A State Road
Dartmouth, MA 02747