Drs. Rolle-Daya & Nagpaul  
     
     
Patient Privacy
Patient Privacy
April 14, 2003

Heike Rolle-Daya, M.D., F.A.A.P. Kanta Nagpaul, M.D., M.D., F.A.A.P. 3 Woodland Road, Suite 205 Stoneham, MA 02180

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.

A. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your medical information. In conducting our business, we will create records regarding your child(ren) or you (if 18 years or older), (also known as the patient ) and the treatment and services we provide. These records are our property. However, law requires us:

· To maintain the confidentially of the patient's medical information. · To provide you with this notice of our legal duties and privacy practices concerning the patient's medical information · To follow the terms of our notice of privacy practices in effect at the time.

To summarize, this notice provides you with the following important information.

· How we may use and disclose the patient's medical information. · The patient's privacy rights in the medical information. · Our obligations concerning the use and disclosure of the patient's medical information.

CHANGES TO THIS NOTICE

The terms of this notice apply to all records containing the patient's medical information that are created or retained by us. We reserve the right to revise, change, or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of the information that we already have about the patient, as well as any of the patient's medical information that we may receive, create, or maintain in the future. We will post a copy of our most current notice in our office in a prominent location, and you may request a copy of our most current notice during any visit to the practice. It is also available on our website.

B. HOW WE MAY USE AND DISCLOSE THE PATIENT'S MEDICAL INFORMATION

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

Treatment. We may use and disclose the patient's medical information to treat the patient. For example, we may ask the patient to undergo laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. Many of the people who work for our practice may use or disclose the patient's medical information in order to treat the patient or to assist others in such treatment. Additionally, we may disclose medical information to others that may assist in the patient's care, such as other doctors, therapists, nurses, etc.

April 14, 2003

Payment. We may use and disclose the patient's medical information in order to bill and collect payment for the services and items the patient may receive from us. For example, we may contact the health insurer to certify that the patient is eligible for benefits (and for what range of benefits), and we may provide the insurer with details regarding treatment to determine if the insurer will cover, or pay for, treatment. We also may use and disclose the medical information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use the patient's medical information to bill you directly for services and items.

Health Care Options. We may use and disclose the patient's medical information to operate our business. These uses and disclosures are important to ensure that the patient receives quality care and that our practice is well run. For example, we may use the patient's medical information to evaluate the quality of care received from us, or to conduct cost-management and business planning activities for our practice. Further, we may disclose the patient's information to doctors, nurses, medical students, and other personnel for review and learning purposes. We may disclose information to health care vendors for the patient to receive equipment or services.

Schools, Colleges, Camps, Employers and Insurance Companies (other than Health Insurance). We may use and disclose patient's medical information, with your authorization.

Appointments and Reminders. We may use and disclose the patient's medical information to remind you of appointments and to schedule appointments on your behalf with other providers.

Treatment Alternatives/Health-Related Benefits and Services. We may use and disclose the patient's medical information to inform you of treatment alternatives and/or health related benefits and services that may be of interest.

The following categories describe conditions in which we are REQUIRED BY LAW to use or disclose the patient's medical information:

a. Public Health Activities. We may disclose the patient's medical information for public health activities, including generally:

· To prevent or control disease, injury or disability; · To maintain vital records, such as births and deaths; · To report child abuse or neglect; · To notify a person regarding potential exposure to a communicable disease; · To notify a person regarding a potential risk for spreading or contracting a disease or condition; · To report reactions to drugs or problems with products or devices; · To notify individuals if a product or device they may be using has been recalled; · To notify appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information. · To notify your employer under limited circumstances, related primarily to workplace injury or illness or medical surveillance.

b. Abuse, Neglect, and Domestic Violence. We may disclose the patient's medical information to a government authority if we believe the patient is a victim of abuse, neglect or domestic violence. If we make such a disclosure, we will inform you of it, unless we think that informing you places the patient at risk of serious harm, or is not in the patient's best interest.

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c. Health Oversight Activities. We may disclose the patient's medical information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws, and the health care system in general.

d. Lawsuits and Similar Proceedings. We may use and disclose the patient's medical information in response to a court or administrative order, if the patient is involved in a lawsuit or similar proceeding. We also may disclose the patient's medical information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

e. Law Enforcement. We may release medical information if asked to do so by law enforcement officials:

· Regarding a crime victim in certain situations, if we are unable to obtains the person's agreement; · Concerning a death we believe might have resulted from criminal conduct; · Regarding criminal conduct at our offices; · In response to a warrant, summons, court order, subpoena or similar legal process; · To identify/locate a suspect, material witness, fugitive or missing person; and · In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator.

f. Coroners, Medical Examiners, and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may also release medical information to funeral directors as necessary to carry out their duties.

g. Serious Threats to Health or Safety. We may use and disclose the patient's medical information when necessary to reduce or prevent a serious threat to the patient's health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

C. YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION

You have the following rights regarding the medical information that we maintain about the patient.

Requesting Restrictions. You have the right to request a restriction in our use or disclose of the patient's medical information for treatment, payment, or health care operations. Additionally, you have the right to request that we limit our disclosure of the patient's medical information to individuals involved in the patient's care, such as family members and friends.

We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat the patient. In order to request a restriction in our use or disclosure of the patient's medical information, you must make your request in writing to our Privacy Officer. Your request must describe in a clear and concise fashion: (i) the information you wish restricted; (ii) whether you are requesting to limit our practice's use, disclosure or both; and (iii) to whom you want the limits to apply.

Confidential Communications. You have the right to request that we communicate with you about the patient's health and related issues in a particular manner, or at a certain location. For instance, you may ask that we contact you by mail, rather than by telephone or at home other than at work.

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In order to request a type of confidential communication, you must make a written request to our Privacy Officer specifying the requested method of contact, or the location where you wish to be contacted. We will accommodate reasonable requests. You do not need to give a reason for your request.

Inspection and Copies. You have the right to inspect and obtain a copy of the medical information that may be used to make decisions about the patient, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to or Privacy Officer in order to inspect and/or obtain a copy of the patient's medical information. We may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted not by the person that denied your request, but by another licensed health care professional chosen by us.

Amendment. You may ask us to amend the patient's medical information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by our practice. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. You must provide us with a reason that supports your request for amendment. We will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is:

· Accurate and complete · Not part of the medical information kept by the practice. · Not part of the medical information which you would be permitted to inspect and copy; or · Not created by our practice, unless the individual or entity that created the information is not available to amend the information.

Accounting of Disclosures. You have the right to request an accounting of disclosures. An accounting of disclosures is a list of certain disclosures the practice has made of the patient's medical information. In order to obtain an accounting of disclosures, you must submit your request in writing to our Security Officer. All requests for an accounting of disclosures must state a time period that may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. We will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

Right to a Paper/Written Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact our Privacy Officer. You can also view this notice on our website.

Right to File a Complaint. If you believe the patient's privacy rights have been violated, you may file a complaint within our organization or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact our Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Right to Provide an Authorization for Other Uses and Disclosures. We will obtain your written authorization for uses and disclosures that are not identified by this notice or are not permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of the patient's medical information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose the patient's medical information for the reasons described in the authorization. Of course, we are unable to take back any disclosures that we have already made with your permission. Please note that we are required to retain records of your care.

If you have any questions or concerns about our office's privacy practices, please contact our Privacy Officer.