RA Pain Services, P.A. (d/b/a ReclaimAbility Pain Services)
Notice of Privacy Practices
Effective August 1, 2005 (Most recent update January 2019)
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 describes the practices of ReclaimAbility Pain Services (“ReclaimAbility”) and the practices that will be followed by all of our ReclaimAbility workforce members who handle your medical information.
ReclaimAbility understands that medical information about you and your health is personal. We are committed to protecting it. We maintain our records and conduct our treatment environment with the goal of providing the highest level of protection for your medical information, while still providing you with the highest level of medical care. This notice applies to all of the records of your medical care which are received or created by ReclaimAbility.
Your other medical treatment providers (e.g. doctors, hospitals, home health agencies, etc.) may have different policies or notices regarding the use and disclosure of your medical information. This notice will tell you about the ways in which ReclaimAbility may use and disclose medical information about you. Your medical information, also referred to as “protected health information” is that information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health information and related health care services.
In this notice, we also describe your rights and certain obligations ReclaimAbility has regarding the use and disclosure of your protected health information. We are required by law to:
By becoming a patient at ReclaimAbility, you are giving consent for ReclaimAbility to use and share your protected health information for certain activities, including treatment, payment and other health care operations. Sometimes, you may hear these three activities referred to as “TPO.”
First of all, we may use and disclose protected health information about you so that ReclaimAbility and its medical professionals can treat you. For example, we may use your past medical information in order to diagnose your present condition or we may provide information regarding your medical condition to another doctor to whom we refer you for additional care. We may also use and disclose protected health information about you so that we may be paid for the medical treatment we provide you. For example, we will submit protected health information about you to your insurance company in order to receive payment for services we have provided. We may also use and disclose protected health information about you for ReclaimAbility health care operations, in other words, those other tasks that we need to perform to make sure that you are provided the highest quality of medical care. For example, we may use your protected health information to evaluate how we can better meet your needs or we may provide protected health information about you to an auditor who reviews our books so that we can keep our license to provide medical services in New Jersey.
Other uses and disclosures of your protected health information
The following uses and disclosure of your protected health information may be made without any additional authorization from you. Not every use or disclosure is listed, but all uses and disclosures made by ReclaimAbility are only those which are legally permitted:
Uses and disclosures for appointment reminders
We may use and disclose your medical information to contact you as a reminder that you have an appointment at the office. If you request that such communications be made confidentially, please contact our office in writing at the address of the practice you’ve been corresponding with. We will accommodate all reasonable requests.
Uses and disclosures to others involved in your healthcare
We may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person’s involvement in your medical care. If you are unable to agree or object to this disclosure, we may disclose such information as necessary if we determine that it is in your best interests based on our professional judgment. We may also use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for decisions regarding your care, location, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Uses and disclosures in emergency situations
We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician will attempt to obtain your acknowledgment of this Notice as soon as reasonably practical after the delivery of treatment.
Uses and disclosures for health-related benefits or services
From time to time, ReclaimAbility may use and disclosure protected health information to tell you about certain health-related benefits or services that may be of interest to you.
Uses and disclosures required by law
We will use or disclose protected health information about you when required to do so by federal, state, or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if the law requires us to do so, of any such uses or disclosures. We must make disclosures to you when required by the Secretary of the Department of Health and Human Services or other governmental agencies having jurisdiction to investigate or determine our compliance with the law.
Uses and disclosures related to communicable diseases
We may disclose your protected health information, if authorized by law, for public health and safety reasons, such as to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Disclosures for health oversight activities
We may disclose protected health information to a health oversight agency for activities authorized by law. These activities include audits, investigations, and inspections. These activities are necessary for the government to monitor the health care system, the delivery of healthcare, government benefit programs, other government regulatory programs and civil rights laws.
Disclosures of abuse or neglect
We may disclose your protected health information to a public health authority authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to a governmental entity or agency authorized to receive such information. In such cases, the disclosure will only be made in accordance with applicable laws.
Disclosures to the food and drug administration
We may disclose your protected health information to a person or company required by the Food and Drug Administration (FDA) to report adverse events, product defects, or other problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements; or to conduct post-market surveillance, as required.
Disclosures for lawsuits and disputes
If you are involved in a lawsuit or a dispute, we may disclose protected health information about you in response to a court order or administrative order. We may also be required to disclose protected health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.
Disclosures to law enforcement
We may release protected health information if asked to do so by a law enforcement official, in response to a court order, subpoena, warrant, summons, or similar process. Other related disclosures may include disclosures relating to individuals who are Armed Forces personnel, to national security and intelligence agencies, as well as disclosures to authorized federal officials for the protection of the President of the United States or other authorized persons or foreign heads of state.
Disclosures to coroners, funeral directors, and organ donation
We may disclose protected health information about you to a coroner or medical examiner for identification purposes, determining cause of death, or for the coroner or medical examiner to perform other duties required by law. We may also disclose protected health information about you to a funeral director in order to permit the funeral director to carry out legal duties and may do so if death is reasonably anticipated. Your protected health information may also be disclosed for certain organ or tissue donations to which you have agreed.
Disclosures for research
We may disclose your protected health information to researchers when their research has been approved and protocols have been established to ensure the privacy of your information. We may also disclose a limited set of your information, as allowed under the law, for research purposes.
Disclosures related to criminal activity
We may disclose your protected health information, consistent with applicable laws, if we believe that the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public or if it is necessary for law enforcement authorities to identify or apprehend an individual.
Disclosures for Workers’ Compensation
We may release protected health information about you for Workers’ Compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Right to inspect and obtain a copy
You have the right to inspect and to obtain a copy of protected health information that may be used to make decisions about your medical care. Usually this right includes both your medical and billing records. You must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request. Your request to inspect and copy your information may only be denied in very limited circumstances and you have a right to request that any such denial be reviewed.
Right to request restrictions
You have the right to request that we restrict the use and disclosure of your protected health information for treatment, payment and health care operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to our Mount Laurel location. In your request, you must tell us:
Right to confidential communications
You also have the right to request to receive private health information communications (such as appointment confirmations) by alternative means or at alternative locations. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to our Mount Laurel location. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to amend
If you feel that the protected health information we have about you is incorrect or incomplete, you have the right to request that your protected health information be amended. Only the health care entity (e.g., doctor, hospital, clinic, etc.) that created your protected health information is responsible for amending it. For more information regarding the procedures for submitting such a request, contact our Mount Laurel location. We may say “No” but, if so, we would tell you why in writing within 60 days.
Right to an accounting of disclosures
You have a right to an accounting of disclosures of your protected health information for purposes other than treatment, payment, or health care operations by ReclaimAbility or any of the people or companies who perform treatment, payment, or health care operations on our behalf. To request the list of disclosures we made of protected health information about you, you must submit a request in writing to our Mount Laurel location. Your request must state a time period which may not be longer than six (6) years prior to the date of your request and may not include dates before August 1, 2005. Your request should indicate the form in which you want the list (for example, on paper or electronically). You will be charged our reasonable cost-based fee (for photocopying, postage, etc., if applicable).
Someone acting for you
If you have given medical power-of-attorney to someone else or someone else is your legal guardian, after they accurately show their status to us, we may give your protected health information to that person.
Right to a paper copy of this notice
You have the right to a paper copy of this Notice. You may ask us to give you a copy of this notice at any time.
You may obtain a copy of this Notice at our website: www.rapaindocs.com.
To obtain a paper copy of this Notice, contact 1-855-727-2465.
To learn more about these procedures, or to make any of these requests, you should contact our Office Manager at 1-855-727-2465.
Changes to this notice
ReclaimAbility reserves the right to change this notice. We reserve the right to make the revised or changed Notice effective for protected health information we already have about you, as well as any information we create or receive in the future. We will post a copy of the current Notice on our ReclaimAbility website. The Notice will contain, in the top right-hand corner, the effective date.
If you believe your privacy rights have been violated and/or that ReclaimAbility has not followed this policy, you may file a complaint with ReclaimAbility’s Manager or with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Ave, S.W., Washington, DC 20201, 1-877-696-6775 or www.hhs.gov/ocr/privacy/hipaa/complaints.
To file a complaint with ReclaimAbility, contact the Office Manager at our Mount Laurel location. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other uses and disclosures of your protected health information not covered by this notice or the laws that apply to ReclaimAbility will be made only with your written permission (“authorization”). If you provide us permission to use or disclose protected health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose protected health information about you for the reasons covered by your authorization. You understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain our records of the medical treatment or other services that we have provided to you.
If you have any questions regarding this notice, please contact the Office Manager at ReclaimAbility.