THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION, (IIHI)

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties and your rights concerning your health information. We must follow the privacy practices that are described in this notice while it is in effect. This Notice takes effect 4/14/03 and will remain in effect until we replace it.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon request.

You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

USES AND DISCLOSURES OF YOUR HEALTH INFORMATION

The following categories describe the different ways in which we may use and disclose IIHI.

TREATMENT: We may use or disclose your health information to a physician or other healthcare provider required for your treatment. For example, IIHI may be disclosed when ordering a lab test or in providing a prescription. Additionally, we may disclose your IIHI to others who may assist in your care, such as a spouse, children or parents.

PAYMENT: We may use or disclose your health information for the purpose of allowing us to secure payment for the healthcare services provided to you. For example, we may inform your health insurance company of your diagnosis and treatment in order to assist the insurer in processing our claim for the healthcare services provided to you.

HEALTHCARE OPERATIONS: Our practice may use and disclose your IIHI to operate our business. As an example, we may use your IIHI to evaluate the quality of care you received from us, or to conduct cost management and business planning activities for our practice. We may disclose your IIHI to other healthcare providers and entities to assist in their healthcare operations.

APPOINTMENT REMINDERS: We may use you IIHI to contact you to remind you of an appointment. For example, we may send postcards, letters, leave a message on your answering machine or voicemail, or leave a message with your family regarding an appointment.

TREATMENT OPTIONS: Our practice may use and disclose your IIHI to inform you of potential treatment options or alternatives.

YOUR AUTHORIZATION: In addition to our use of your health information for treatment, payment or healthcare options, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use to disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this Notice.

TO YOUR FAMILY AND FRIENDS: We must disclose your health information to you, as described in the Patient Rights section of this Notice. We may disclose your health information to a family member, friend or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so.

PERSONS INVOLVED IN CARE: We may use or disclose health information to notify a family member, your personal representative or another person responsible for your care, of your locations, your general condition, or death. If you are present, then prior to use or disclosure of your health information, we will provide you with an opportunity to object to. such uses or disclosures. In the event of your incapacity or emergency circumstances,, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person's involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, x-rays or other similar forms of health information.

MARKETING HEALTH RELATED SERVICES: We will not use your health information for marketing communications without your written authorization.

REQUIRED BY LAW: We may disclose your health information when we are required to do so by federal or state law.

USE AND DISCLOSURE OF IIHI IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

PUBLIC HEALTH RISKS: Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information. For example, we may release IIHI when reporting reactions to drugs of problems with products or devices.

HEALTH OVERSIGHT ACTIVITIES: Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations necessary for the government to monitor government programs, compliances with civil rights laws and healthcare system in general.

LAWSUITS AND SIMILAR PROCEEDINGS: Our practice may use and disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceedings. We also may disclose your IIHI 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.

LAW ENFORCEMENT: We may release IIHI if asked to do so by a law enforcement official, such as to report an injury inflicted in connection with a criminal act.

DECEASED PATIENTS: Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.

ORGAN AND TISSUE DONATIONS: Our practice may release your IIHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

RESEARCH: We may disclose information to researchers whose protocols ensure the privacy of your health information. If the research involves treatment, we will obtain your written permission.

ABUSE OR NEGLECT: We may disclose your health information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your health information to the extent necessary to avert a serious threat to your health or safety or the health or safety of others.

MILITARY: Our practice may disclose your IIHI if you are a member of the U. S. or foreign military forces (including veterans) if required by the appropriate: authorities.

NATIONAL SECURITY: We may disclose to military authorities the health information of Armed Forces personnel under certain circumstances. We may disclose to authorize federal officials health information required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institutions or law enforcement officials having lawful custody of protected health information of inmate or patient under certain circumstances.

INMATES: Our practice may disclose your IIHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of law enforcement official.

WORKERS COMPENSATION: Our practice may release your IIHI for workers' compensation and similar programs.

YOUR RIGHTS REGARDING YOUR IIHI

You have the following rights regarding the IIHI that we maintain about you:

1. Confidential Communications: You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than at work. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions: You have the right to request a restriction on certain uses and disclosures of your information as provided by Federal law (45 CFR 164.222). Additionally, you have the right to request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment for your care, such as family members.
3. Inspection and Copies: You have the right to inspect and obtain a copy of your health record there may be a reasonable copying charge as provided under Federal law(45 CFR 164.524).
4. Amendment: You may ask us to amend your health information if you believe it is incorrect or incomplete as provided by Federal law (45 CFR 164.526). You must provide us with a reason that supports your request for amendment in writing.
5. Accounting of Disclosures: All of our patients have the right to obtain an accounting of disclosures of your health information, except routine disclosures for treatment, payment, health care operations, and certain other disclosures, as provided by Federal law (45 CFR 164,328). All requests for an "accounting of disclosures" must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003.
6. Right to a Paper Copy of This Notice: You are entitled to receive a paper copy of our notice of privacy practice.
7. Right to Provide an Authorization for Other Uses and Disclosures: Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for reasons described in authorization.

QUESTIONS AND COMPLAINTS

If you want more information about our privacy practices or have questions or concerns, please contact us.

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of the Notice. You also may submit a written complaint to: U.S. Department of Health and Human Services, Office of Civil Rights, 200 Independence Ave. S.W., Washington D.C. 20201.

We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

If you have any questions regarding this notice of our health information privacy policies or wish to make a request regarding Your Rights Regarding your IIHI please contact:

Effective Date of this notice 4/14/2003
Revised 1/9/2007

The Urology Center of Southern New Hampshire
17 Riverside Street
Suite # 201
Nashua, NH 03062
Tel: 603.594.0800
Fax: 603.886.0445
view map