HIPAA Notice of Privacy Practices

Our Commitment to Your Privacy

Spine & Pain CT is committed to protecting the privacy of your health information. We are required by law to maintain the privacy of your protected health information (PHI), provide you with this notice of our legal duties and privacy practices, and follow the terms of this notice.

How We May Use and Disclose Your Health Information

For Treatment

We may use your health information to provide you with medical treatment or services. We may disclose your health information to doctors, nurses, technicians, or other personnel involved in your care. For example, we may share your information with a specialist to whom you have been referred.

For Payment

We may use and disclose your health information to bill and collect payment for your treatment and services. For example, we may send your health information to your insurance company to get paid for services we provided to you.

For Healthcare Operations

We may use and disclose your health information for our healthcare operations, including quality assessment, staff training, licensing, and other administrative activities.

Other Uses and Disclosures

We may also use or disclose your health information for the following purposes:

• Appointment Reminders: To contact you about appointments and treatment options
• Business Associates: To contractors who perform services for us and agree to protect your information
• As Required by Law: To comply with federal, state, or local laws
• Public Health: To public health authorities for disease prevention and control
• Health Oversight: To health oversight agencies for audits and investigations
• Legal Proceedings: In response to court orders or subpoenas
• Law Enforcement: For law enforcement purposes as required by law
• To Avert Serious Threat: To prevent serious threats to health or safety
• Workers' Compensation: For workers' compensation claims

Uses Requiring Your Authorization

Other uses and disclosures of your health information not covered by this notice or by law will be made only with your written authorization. You may revoke your authorization at any time in writing, except to the extent that we have already taken action in reliance on your authorization.

We will obtain your authorization before using your health information for:

• Marketing purposes
• Sale of your health information
• Most uses of psychotherapy notes

Your Rights Regarding Your Health Information

Right to Inspect and Copy

You have the right to inspect and obtain a copy of your health information. To request access, submit a written request to our Privacy Officer. We may charge a reasonable fee for copying and mailing.

Right to Amend

If you believe your health information is incorrect or incomplete, you may request an amendment. Submit a written request explaining why the information should be amended. We may deny your request under certain circumstances.

Right to an Accounting of Disclosures

You have the right to request a list of disclosures we have made of your health information, except for disclosures for treatment, payment, or healthcare operations.

Right to Request Restrictions

You have the right to request restrictions on how we use or disclose your health information. We are not required to agree to your request, except for restrictions on disclosures to health plans for services you paid for in full out-of-pocket.

Right to Request Confidential Communications

You have the right to request that we communicate with you in a certain way or at a certain location. For example, you may ask that we contact you only at work or by mail.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice at any time, even if you have agreed to receive it electronically.

Our Responsibilities

We are required to:

• Maintain the privacy of your protected health information
• Provide you with this notice of our legal duties and privacy practices
• Follow the terms of the notice currently in effect
• Notify you if there is a breach of your unsecured health information

Changes to This Notice

We reserve the right to change this notice and make the new provisions effective for all health information we maintain. If we make significant changes, we will post the revised notice in our office and on our website.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

Contact Information

For more information about this notice or to exercise your rights, contact our Privacy Officer:

Privacy Officer
Spine & Pain CT
2880 Old Dixwell Avenue
Hamden, CT 06518
Phone: (203) 535-0206
Fax: (203) 535-0207

To file a complaint with the U.S. Department of Health and Human Services:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll-free: 1-877-696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints/