Notice of Privacy Practices

Murray H. Seltzer, M.D., P.A.
200 South Orange Avenue
P.O. Box 1845
Livingston, New Jersey 07039

Murray H. Seltzer, M.D., P.A., Notice of Privacy Practices Effective April 14, 2003

1. 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.
   
   

2. We have a legal duty to safeguard your protected health information (PHI).
   We are legally required by The Health Insurance Portability and Accountability Act of 1996 (HIPAA) to protect the privacy of your health information. We call this information "protected health information", or "PHI" for short, and it includes information that can be used to identify you that we've created or received about your past, present, or future health condition, the provision of health care to you, or the payment for this health care. We must provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this notice. However, we reserve the right to change the terms of this notice and our privacy policies
   at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice in the main reception area. You can also request a copy of this notice from the contact person list in Section V at any time and can view a copy of this notice on our Web site at: www.seltzerbreastsurgery.com.
   
   

3. How we may use and disclose your protected health information.
   We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your specific authorization. Below, we describe the different categories of uses and disclosures.

1. Uses and Disclosures Which Do Not Require Your Authorization.
   We may use and disclose your PHI without your authorization for the following reasons:

1. For treatment: We may disclose your PHI to hospitals, physicians, nurses, and other health care personnel who provide you with health care services or are involved in your care. For example, if you're being treated for a knee injury, we may disclose your PHI to a x-ray technician in order to coordinate your care.
   
   

2. To obtain payment for treatment: We may use and disclose your PHI in order to bill and collect payment for you for the treatment and services provided to you. For example, we may provide portions of your PHI to your health plan for payment for these health care services we provided to you.
   
   

3. For health care operations: We may disclose your PHI in order to operate this practice. For example, we may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you. We may also disclose only when necessary limited, required PHI to third party business associates including accountants, attorneys, consultants, who perform billing, collections, consulting, or transaction and code sets, for this practice.
   
   

4. When a disclosure is required by federal, state, or local law, judicial or administrative proceedings, or law enforcement, your PHI may also be provided. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot or other wounds; or when ordered in a judicial of administrative proceeding.
   
   

5. For public health activities: For example, we report information about deaths and various diseases to government officials in charge of collecting this information. Also, if applicable, we will report information to the cancer registry affiliated with Saint Barnabas Medical Center and/or another registry where you received treatment in the past. We provide coroners, medical examiners, and funeral directors necessary information relating to an individual's death.
   
   

6. For health oversight activities: For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.
   
   

7. For purposes of organ donation: We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.
   
   

8. For research or teaching purposes. In certain circumstances we may provide anonymous PHI in order to conduct medical research.
   
   

9. To avoid harm: In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.
   
   

10. For specific government functions: We may disclose PHI of military personnel and veterans in certain situations. As we may disclose PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations.
    
    

11. For workers' compensation in order to comply with workers' compensation laws.
    
    

12. Appointment reminders and health-related benefits or services: We may use PHI to provide appointment reminders or give you information about treatment alternatives, or other health care services or benefits we offer. As a rule, appointment reminders are generally sent by mail. Occasionally, there may be a need to reschedule an appointment (inclement weather, change in office schedule, etc.). The information listed on your signed confidentiality sheet will be used to notify you. If time permits, you will be contacted by mail.

2. Use and Disclosure Where You to Have the Opportunity to Object:

1. Disclosures to family, friends, or others: We will provide your PHI to a family member, friend, or other person that you have named and authorized in writing and who is involved in your care or the payment for your health care. This information must be specifically designated on your signed confidentiality sheet.
   
   

2. All Other Uses and Disclosures Require Your Prior Written Authorization: In any other situation not described above, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures to the extent that we haven't taken any action relying on the authorization.
   
   

3. Incidental Uses and Disclosures: Incidental uses and disclosures of information may occur. An incidental use or disclosure is a secondary use or disclosure that cannot reasonably be prevented, is limited in nature, and that occurs as a by-product of an otherwise permitted use or disclosure. However, such incidental uses or disclosures are permitted only to the extent that we have applied reasonable safeguards and do not disclose any more of your PHI than is necessary to accomplish the permitted use or disclosure. For example, disclosures about a patient at a nursing station that might be overheard by personnel not involved in the patient's care would be permitted.

4. What Right You have Regarding your PHI: You have the following rights with respect to your PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.
   
   

2. The Right to Choose How We Send PHI to You. You have the right to ask that we send information to you to an alternate address (work rather than home) or by alternate means (fax rather than regular mail). This office prefers regular mail to ensure that your PHI is protected. This office does not have the ability to send PHI via internet. If you request that PHI be faxed to you or your authorized designee, this authorization will release this office from sharing your PHI with a potential receipt by an unauthorized designee.
   
   

3. The Right to See and Get a Copy of Your PHI. In most cases, you have the right to look at or get a copy of your PHI that we have, but you must make the request in writing. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed. If you request a copy of your PHI, we will charge you
   $1.00 for each page.
   
   

4. The Right to Get a List of the Disclosures We have Made. You have the right to get a list of instances in which we have disclosed your PHI. The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or health care operations, directly to you, or to anyone you previously authorized in writing, or in our facility directory. The list also won't include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or before April 14, 2003. We will respond within 60 days of receiving your request. The list we will give you will include disclosures made starting with April 14, 2003. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. We will provide the list to you at no charge, but if you make more that one request in the same year, we will charge you $1.00 per page for each additional request.
   
   

5. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. We will respond within 60 days of receiving your request in writing. You must provide the request and your reason for the request in writing. We may deny your request in writing if the PHI is (i.) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don't file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI.
   
   

6. The Right to Get this Notice from the WebSite. You have the right to view a copy of this notice from the WebSite. You also have the right to request a paper copy of this notice. See Section V.

5. Person to Contact for information about this notice or to complain about our privacy practices.

If you have any questions about this notice or any complaints about our privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact, Sharon L. Capuano, CMM, Office Manager, Privacy Officer, P.O. Box 1845, Livingston, New Jersey 07039. If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a
complaint with the person listed in Section V. You also may send a written complaint to the Secretary of the Department of Health and Human Services, 200 Independence Avenue, S.W., Room 615F, Washington, DC 20201. We will take no retaliatory action against you if you file a complaint about our privacy practices.