Notice of Privacy Practices

PRIVATE PSYCHIATRIC CARE OF New Jersey, L.L.C.

MARIBEL ABBATE, M.D.  

Effective Date: December 1st, 2018  

WHAT IS THIS NOTICE FOR? This Notice of Privacy Practices (Notice) describes how Private Psychiatric Care of New Jersey, L.L.C., Maribel Abbate, M.D. (“PPCNJ”) may use and disclose your medical information that we maintain and how you can get access to this information.  This Notice applies to all services that are provided to you by PPCNJ and Maribel Abbate, M.D. 

WHY DO YOU NEED THIS NOTICE? The Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act, places certain obligations upon us with regard to how we may use and disclose your protected health information (PHI). Your PHI includes medical information about you such as your medical record and the care and services you have received. We are committed to maintaining the privacy of your PHI. When we need to use or disclose it, we will comply with the full terms of this Notice. Anytime we are permitted to or required to share your PHI with others, we only provide the minimum amount of data necessary to respond to the need or request. 

WHEN CAN WE USE/DISCLOSE YOUR PHI? PPCNJ respects your privacy.  We understand that your personal health information is sensitive.  We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.  The law protects the privacy of the health information we create and obtain in providing your symptoms, test results, diagnoses, and treatment, health information from other providers, and billing and payment information relating to these services.  Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations.  There are certain uses and disclosures of your PHI that we may undertake without your written or other authorization. These uses and disclosures may be for purposes such as to provide you with treatment, obtain payment for services we have provided, and other health care operations. Some examples include: PHI made known to your relatives, close friends, or caregivers, public health activities and officials, reporting of abuse or neglect as may be required by law, health oversight activities, judicial and administrative proceedings, law enforcement officials, workers’ compensation, and other individuals and activities as set forth in this Notice. 

WE MUST OBTAIN YOUR WRITTEN AUTHORIZATION FOR ANY USE OR DISCLOSURE NOT SET FORTH IN THIS NOTICE. You may revoke this authorization AT ANY TIME. In addition to obtaining your written authorization for uses or disclosures not described in this Notice, we generally will need to seek your written authorization prior to disclosing the following information: 

• HIV/AIDS related information 

• Sexually transmitted disease information 

• Tuberculosis information 

• Psychotherapy notes 

• Mental health information 

• Drug & alcohol information 

• Genetic information 

WHAT RIGHTS DO YOU HAVE FOR YOUR PHI? You have the right to ask us to limit certain uses and disclosures of your PHI. We will consider ALL requests but may not be required to agree to your requested limitations (except as otherwise set forth in further detail in the Notice of Privacy Practices). You also have the right to inspect and receive (for a reasonable, cost-based fee) copies of your PHI, the right to request a change or amendment be made to your PHI, the right to be notified of a breach of your unsecured PHI, the right to an accounting (a list) of certain disclosures of your PHI, and the right to revoke any authorization you may have made to the extent we have not yet relied upon it. You also have the right to receive a paper copy of this Notice at any time. 

CAN WE CHANGE THIS NOTICE? We may change this Notice at any time. The revised Notice will apply to all PHI that we maintain. However, if we do change this Notice, we will only make changes to the extent permitted by law. We will also make the revised Notice available to you by posting it in a place where all individuals seeking services from us will be able to read the Notice. This Notice will be on our website as well at http://www.privatepsychiatriccare.com. You may obtain the new Notice in hard copy as well from our Privacy Officer, who can be reached at (973) 847-2120. 

ADDITIONAL INFORMATION/COMPLAINTS. You may contact our Privacy Officer if you wish any additional information or have questions concerning this Notice or your PHI. If you feel that your privacy rights have been violated, you may also contact the Privacy Officer or file a written complaint with the Office for Civil Rights of the U.S. Department of Health and Human Services. We will NOT retaliate against you if you file a complaint with us or the Office for Civil Rights. 

THE ABOVE IS ONLY A SUMMARY OF THE RIGHTS AND OBLIGATIONS WITHIN THIS NOTICE. PLEASE READ CAREFULLY THE ENTIRE NOTICE THAT FOLLOWS.
WE WELCOME ANY QUESTIONS YOU MAY HAVE. 

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. 

I. WHO WE ARE 

This Notice describes the privacy practices of Private Psychiatric Care of New Jersey, L.L.C. (“PPCNJ”), and Maribel Abbate, M.D. This Notice applies to all services that are provided to you at PPCNJ. 

II. WHY YOU NEED THIS NOTICE 

We are committed to maintaining the privacy of your protected health information (“PHI”). Your PHI includes medical information about you such as your medical record and the care and services that you have received from us. We need this information to provide you with the appropriate level of care and also to comply with certain legal obligations we may have. 

The Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act, places certain obligations upon us with regard to your PHI and requires that we keep confidential any medical information that identifies you. We take this obligation seriously and when we need to use or disclose your PHI, we will comply with the full terms of this Notice. Anytime we are permitted to or required to share your PHI with others, we only provide the minimum amount of data necessary to respond to the need or request. 

III. USES AND DISCLOSURES OF YOUR PHI THAT DO NOT REQUIRE YOUR AUTHORIZATION 

We are permitted by law to use and disclose your PHI without your written or other form of authorization under certain circumstances as described below. This means that we do not have to ask you before we use or disclose your PHI for purposes such as to provide you with treatment, seek payment for our services, or for health care operations. We may also use or disclose your PHI without asking you for other activities or to state and/or federal officials. 

• Treatment, Payment and Health Care Operations. 

• Treatment - We may use and disclose your PHI in order to provide you with medical treatment or services. Your PHI may be used or disclosed to doctors, nurses, employees and other personnel who may be involved in your care. Your PHI may also be disclosed to individuals outside of our office only for purposes of treatment and health care operations.
  

• Payment – We may use and disclose your PHI in order for us to obtain payment for the medical treatment or services they provide you with. We can provide you with a receipt for reimbursement of payment from your insurance company.  This receipt may include your diagnosis code and service rendered.

• Health Care Operations – We may use and disclose your PHI for our internal health care operations, such as administration, planning, quality improvement, and other activities that help us provide you with quality care. For example, your PHI may be used to help us evaluate our doctors, nurses and employees, or to help us provide them with education and training. Your PHI may also be disclosed to and used by our administrative staff to help us coordinate your care and respond to any concerns you may have. In addition, your PHI may be provided to our accountants, attorneys, and other consultants in order to make sure we’re complying with the laws that affect us. We may also use and disclose your PHI in order to provide you with reminders of appointments you have scheduled with our doctors or other health care professionals. 

• Treatment Alternatives, Health-related Benefits and Services. We may use and disclose your PHI to communicate with you regarding treatment options and alternatives or make recommendations that may be of interest to you.
  

• Other Healthcare Providers. We may disclose your PHI to other health care professionals where it may be required by them to treat you, to obtain payment for the services they provided you with or their own health care operations.
  

• Disclosures to Relatives, Close Friends, Caregivers. We may disclose your PHI to family members and relatives, close friends, caregivers or other individuals that you may identify so long as we:
  • Obtain your agreement;
  • Provide you with the opportunity to object to the disclosure and you do not object; or 

• We reasonably infer that you would not object to the disclosure.
  If you are not present or, due to your incapacity or an emergency, you are unable to agree or object to a use or disclosure, we may exercise our professional judgment in order to determine whether such use or disclosure would be in your best interests. Where we would disclose information to a family member, other relatives, or a close friend, we would disclose only that information we believe is directly relevant to his or her involvement with your care or payment related to your care. We will also disclose your PHI in order to notify or assist with notifying such persons of your location, general condition or death. You may at any time request that we do NOT disclose your PHI to any of these individuals.
  

•  Public Health Activities. We may disclose your PHI for certain public health activities as required by law, including: 

  • to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; 

  • to report births and deaths; 

  • to report child abuse to public health authorities or other government authorities authorized by law to
    receive such reports; 

• to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration, such as reactions to medications; 

• to notify you and other patients of any product or medication recalls that may affect you; 

• to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and 

• to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance. 

• 
  USES AND DISCLOSURES OF YOUR PHI THAT REQUIRE YOUR WRITTEN AUTHORIZATION 

In general, we will need your specific written authorization on our HIPAA Authorization Form to use or disclose your PHI for any purpose other than those listed above in Section III. For example, in order for us to send your information to your life insurance company, you would need to sign our HIPAA Authorization Form and tell us what information you would like sent. 

We will seek your specific written authorization for at least the following information unless the use or disclosure would be otherwise permitted or required by law as described above: 

• HIV/AIDS information. In most cases, we will NOT release any of your HIV/AIDS related information unless your authorization expressly states that we may do so. There are certain purposes, however, for which we may be permitted to release your HIV/AIDS information without obtaining your express authorization. For example, we may release information regarding your HIV/AIDS status to your insurance company or HMO for purposes of receiving payment for services we provided you with. We may also release information regarding HIV/AIDS status of yourself and other patients where the information has been “de-identified” (meaning, the information cannot be used in any way to identify you). Other instances where we may use or disclose HIV/AIDS information without your express authorization include: 

  • For your diagnosis and treatment; 

  • For scientific research; 

  • For management audits, financial audits or program evaluation; 

  • For medical education; 

  • For disease prevention and control, when permitted by the New Jersey Department of Health 

  • To comply with certain court orders; and 

  • When otherwise required by law, to the New Jersey Department of Health or another entity.
    

• Sexually transmitted disease information. We must obtain your specific written authorization prior to disclosing any information that would identify you as having or being suspected of having a sexually transmitted disease. We may use and disclose information related to sexually transmitted diseases without obtaining your authorization only where permitted by law, including to the New Jersey Department of Health, to your physician or a health authority, or to a prosecuting officer or court if you are being prosecuted under New Jersey law. Where necessary, your physician or a health authority may further disclose such information to protect your health and welfare, or the health and welfare of your family or the public.
  

• Tuberculosis Information. We must obtain your specific written authorization prior to disclosing any information that would identify you as having or being suspected of having tuberculosis (TB). We may use and disclose information related to TB without obtaining your authorization where authorized by law, such as for research purposes, to the Department of Health, where the Commissioner determines that the disclosure may be necessary to enforce public health laws or protect the health or life of a known individual or otherwise authorized by a court order.
  

• Psychotherapy notes. We must obtain your specific written authorization prior to disclosing any psychotherapy notes that may be protected by law. Notes recorded (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or group, joint, or family counseling session and that are separated from the rest of the individual’s medical record.  Psychotherapy notes excludes medication prescription and monitoring, counseling session start and stop times, the modalities and frequencies of treatment furnished, results of clinical tests, and the summary of the following items:  diagnosis, functional status, the treatment plan, symptoms, prognosis, and progress to date.  An authorization to use or disclose psychotherapy notes is required except if used by the originator of the notes for treatment, to a person or persons reasonably able to prevent or lessen the threat (including the target of a threat), if the originator believes in good faith the the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public; if the notes are to be used in the course of training students, trainees or practitioners in mental health; to defend a legal action or any other legal proceeding brought forth by the patient; when used by a medical examiner or coroner; for health oversight activities of the originator; or when required by law.
  

• Mental health information. We must obtain your specific written authorization prior to disclosing certain mental health information where required by New Jersey law. There may be cases where you see a mental health provider in a primary care setting and collaborative care is provided by the mental health provider and your primary care physician. In these situations, the mental health provider is not operating as a psychotherapist, and your mental health information may be stored within your primary care notes, where they may be offered less protection under HIPAA.
  

• Drug and alcohol information. We must obtain your specific written authorization prior to disclosing information related to drug and alcohol treatment or rehabilitation under certain circumstances such as where you received drug or alcohol treatment at a federally funded treatment facility or program.
  

• Genetic information. We must obtain your specific written authorization prior to obtaining or retaining your genetic information, or using or disclosing your genetic information for treatment, payment or health care operations purposes. For example, before conducting any genetic testing, we will ask for your written authorization to conduct such testing. We may use or disclose your genetic information, or the genetic information of your child, without your written authorization only where it would be permitted by law, such as for paternity tests for court proceedings, anonymous research, newborn screening requirements, identifying a body, for the purposes of criminal investigations or otherwise authorized by a court order.
  

• Information related to treatment of a minor in special circumstances. If you are a minor who sought certain types of treatment from us (to which treatment you were able to consent on your own behalf), such as treatment related to your pregnancy or treatment related to your child, or a sexually transmitted disease, we must obtain your specific written authorization prior to disclosing any of your PHI related to such treatment to another person, including your parent(s) or guardian(s), unless we would otherwise be permitted by law to do so.
  

• 
  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 disclosure 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 within a physician’s office that might be overheard by persons not involved in your care would be permitted.
  BUSINESS ASSOCIATES.
  We may engage certain persons to perform certain of our functions on our behalf and we may disclose certain health information to these persons. For example, we may share certain PHI with our computer consultant in order to facilitate our healthcare operations. We will require our business associates to enter into an agreement to keep your PHI confidential and to abide by certain terms and conditions. 

YOUR RIGHTS REGARDING YOUR PHI 

• Right to Inspect/Copy PHI. You have the right to inspect and request copies of your PHI that we maintain. However, under limited circumstances, you may be denied access to a portion of your records. For example, if your doctor believes that certain information contained within your medical record could be harmful to you, we would not release that information to you. Please contact the office if you would like to inspect or request copies of your PHI from us and we will respond in most circumstances within two (2) weeks. We may charge you a reasonable fee for paper copies of your PHI or the amount of our reasonable labor costs for a copy of your PHI in an electronic format. We may also charge you for the costs of electronic media if you request that we provide you with your electronic records on such media.
  

• Right to Confidential Communications. You have the right to make a reasonable written request to receive your PHI by alternative and reasonable means of communication or at alternative reasonable locations (for example, sending information to your work address rather than your home address).
  

• Right to Request Additional Restrictions. You have the right to request restrictions be placed on our use and disclosure of your PHI, such as: 

  • For treatment, payment and health care operations, 

  • To individuals involved in your care or payment related to your care, or 

  • To notify or assist individuals locate you or obtain information about your condition.
    However, although we will carefully consider all requests for additional restrictions on how we will use or disclose your PHI, we are not required to grant your request unless your request relates solely to disclosure of your PHI to a health plan or other payor for the sole purpose of payment or health care operations for a health care item or service that you have paid us for in full and out-of-pocket. Requests for restrictions must be in writing. Please contact the Privacy Officer if you wish to request a restriction.
    If we accept your request for a restriction, we will put any limits in writing and abide by them except in emergency situations. Under certain circumstances, we may terminate our agreement to a restriction.
    

• Right to Request Amendment. You may request that we amend, or change, your PHI that we maintain by contacting the Privacy Officer. We will comply with your request unless: 

  • We believe the information is accurate and complete; 

  • We maintain the information you have asked us to change but we did not create or author it, for example,
    your medical records from another doctor were brought to us and incorporated into your medical records
    with our doctors; 

  • The information is not part of the designated record set or otherwise unavailable for inspection.
    

Requests for amendments must be in writing. Please contact the Privacy Officer if you wish to request an additional restriction on a use/disclosure of your PHI. We will generally respond to your request in writing within thirty (30) days from receipt. 

• Right to Revoke Authorization. You may at any time revoke your authorization, whether it was given verbally or in writing. You will generally be required to revoke your authorization in writing by contacting our Privacy Officer. Any revocation will be granted except to the extent we may have taken action in reliance upon your authorization.
  

• Right to Accounting of Disclosures. You may request an accounting of certain disclosures we have made of your PHI within the period of six (6) years from the date of your request for the accounting. The list will not include uses or disclosures made for purposes of treatment, payment, or health care operations, those made pursuant to your written authorization, or those made directly to you or your family. The first accounting you request within a period of twelve (12) months is free. Any subsequently requested accountings may result in a reasonable charge for the accounting statement.
  To the extent that we maintain your PHI in electronic format, we will account all disclosures including those made for treatment, payment and health care operations. Should you request such an accounting of your electronic PHI, the list will include the disclosures made in the last three (3) years.
  Please contact the Privacy Officer if you wish to request an accounting of disclosures. We will generally respond to
  your request in writing within thirty (30) days from receipt of the request.
  

• Right to Receive Paper Copy of NPP. You may at any time request a paper copy of this Notice, even if you previously
  agreed to receive this Notice by email or other electronic format. Please contact the Privacy Officer to obtain a paper copy of this Notice.
  

• Right to be Notified Following a Breach of Unsecured PHI. We must notify you if your unsecured PHI is acquired, accessed, used, or disclosed in a manner not permitted under HIPAA that “compromises the security or privacy of the PHI.”
  

1. VIII. MEDICATION HISTORY SERVICE
   We work with Dosespot who delivers medication history information when you have an office visit at PPCNJ. Dosespot accesses the information securely from community pharmacies and patient medication claims history from payers and pharmacy benefit managers. PPCNJ will obtain this information for treatment purposes, as prescribers who can access critically important information on their patient’s current and past medications are better informed about potential medication issues with their patients and can use this information to improve safety and quality. If you would like to opt out of this service and would NOT like your medication history provided to SMG, please send a private message to Dr. Abbate through the Luminello portal.
   

2. INFORMATION REGARDING THE LENGTH AND DURATION OF THIS NOTICE 

This Notice is effective as of December 1st, 2018. We may change this notice at any time. Changes to this Notice will apply to all PHI that we maintain. However, if we do change this Notice, we will only make changes to the extent permitted by law. We will also make the revised Notice available to you by posting it in a place where all individuals seeking services from us will be able to read the Notice as well as on our website at http://www.summitmedicalgroup.com/. You may obtain the new Notice in hard copy as well from our Privacy Officer. 

X. COMPLAINTS/ADDITIONAL INFORMATION 

You may contact our Privacy Officer at any time if you wish to obtain any additional information or have questions concerning this Notice or your PHI. If you feel that your privacy rights have been or may have been violated, you may also contact our Privacy Officer OR file a written complaint with the Secretary of the U.S. Department of Health and Human Services. We will NOT retaliate against you if you file a complaint with us or the Department of Health and Human Services. If you wish to file a written complaint with the Department of Health and Human Services, please contact the Privacy Officer and we will provide you with the contact information or you may call the U.S. Office for Civil Rights at (866) 627-7748 or (866) 788-4989 TTY.  You can also visit www.hhs.gov/ocr/privacy/hipaa/complaints.

XI. OUR CONTACT INFORMATION 

You may contact us with any concerns or for additional information regarding our privacy practices by calling or writing the Privacy Office at: PPCNJ, Maribel Abbate, M.D. 300 Main St., #508, Madison, NJ 07940 ; (973) 847-2120 

Acknowledgment of Receipt of HIPAA NPP 

I hereby acknowledge that I have received PPCNJ LLC’s HIPAA Notice of Privacy Practices as of the date of the first service delivery, or as soon are reasonably practicable in the event that I received emergency treatment. 

Print Your Name: ___________________________

Signature: ________________________________ Date: ____________