PRIVACY
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.
This notice takes effect on June 16, 2006 and remains in effect until we replace it.
Our Pledge Regarding Medical Information
The privacy of your medical information is important to us. We understand that your medical information is personal and we are committed to protecting it. We create a record of the care and services you receive at H.E.R., LLC (Health Essentials by Robin). We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share medical information about you. We also describe your rights and certain duties we have regarding the use and disclosure of medical information.
Our Legal Duty
Law Requires Us to:
1. Keep your medical information private.
2. Give you this notice describing our legal duties, privacy practices, and your rights regarding this information.
3. Follow the terms of the notice that is now in effect.
We Have the Right to:
1. Change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law.
2. Make the changes in our privacy practices and the new terms of our notice effective for all medical information that we keep, including information previously created or received before that changes.
Notice of Change to Privacy Practices:
1. Before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.
Use and Disclosure of Your Medical Information
The following section describes different ways that we use and disclose medical information. Not every use or disclosure will be listed. However, we have listed all of the different ways we are permitted to use and disclose medical information. We will not use or disclose your medical information for any purpose not listed below, without your specific authorization. Any specific written authorization you provide may be revoked at any time by writing to us.
FOR TREATMENT: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other people taking care of you. We may also share medical information about your to your other health care providers to assist them in treating you.
ADDITIONAL USES AND DISCLOSURES: In addition to using and disclosing your medical information for treatment and payment, we may use and disclose medical information for the following purposes:
Notification: Medical information to notify or help notify: a family member, your personal representative or another person responsible for your care. We will share information about your location, general condition or death. If you are present we will get your permission if possible before we share, or give you the opportunity to refuse permission. In case of emergency, and if you are not able to give or refuse permission, we will share only the health information that is directly necessary for your health care, according to our professional judgment. We will also use our professional judgment to make decisions in your best interest about allowing someone to pick up medicine, medical supplies, x-ray or medical information for you.
Legal Compliance: We may disclose medical information to comply with applicable law. For example to respond to regulatory authorities responsible for oversight of government benefit programs or courts in the course of judicial or administrative proceedings: and to law enforcement officials during an investigation. We may also, as required by law disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect.
Victims of Abuse, Neglect, or Domestic Violence: We may disclose medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence or a possible victim of other crimes.
YOUR INDIVIDUAL RIGHTS
You Have a Right to:
1. Look at or get copies of your medical information. You may request that we provide copies in a format other than photocopies. We will use the format you request unless it is not practical for us to do so. You must make your request in writing. You may get the form to request access by using the contact information at the end of this notice. You may also request access by sending a letter to the contact person listed at the end of this notice. If you request copies, we will charge you $.10 for each page, and postage if you want the copies mailed to you. Contact us using the information listed at the end of this notice for full explanation of our fee structure.
2. Receive a list of all the times we or our business associated shared your medical information for purposes other than treatment, payment, and other specified exceptions.
3. Request that we place additional restrictions on our use or disclosure of your medical information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except in the case of an emergency).
4. Request that we communicate with you about your medical information by different means or to different locations. Your request must be made in writing to the contact person listed at the end of this notice.
5. Request that we change your medical information. We may deny your request if we did not create the information you want changed or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be added to the information that you wanted changed. If we accept your request to change the information, we will make reasonable efforts to tell others, including people you name, of the change and to include the changes in any future sharing of that information.
QUESTIONS AND COMPLAINTS
If you have and questions about this notice or if you think that we may have violated your privacy rights, please contact by phone or in writing:
Robin Howe, BSN RN
H.E.R., LLC
141 Turnpike Road, Suite 363
Rowley, MA 01969
Phone: 978-412-4266
You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint and we will not retaliate in any way if you choose to file a complaint. We can also furnish complaint forms to you at no cost.
Core Privacy
caring for the inner workings of your body
Robin Howe, BSN RN
Continence Nurse Specialist
