Privacy Policy
Everis Medi Spa
James N. Romanelli, MD, PC
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
NOTICE OF PRIVACY POLICY
Effective November 27, 2007
The following is the privacy policy (“Privacy Policy”) of James N. Romanelli, MD, PC (“Covered “Entity”) as described in the Health Insurance Portability and Accountability Act of 1996 and regulations promulgated thereunder, commonly known as HIPAA. HIPAA requires Covered Entity by law to maintain the privacy of your personal health information and to provide you with notice of Covered Entity’s legal duties and privacy policies with respect to your personal health information. We are required by law to abide by the terms of this Privacy Notice.
Your Personal Health Information
We collect personal health information from you through treatment, payment and
related healthcare operations, the application and enrollment process, and/or
healthcare providers or health plans, or through other means, as applicable.
Your personal health information that is protected by law broadly includes any
information, oral, written or recorded, that is created or received by certain
health care entities, including health care providers, such as physicians and
hospitals, as well as, health insurance companies or plans. The law specifically
protects health information that contains data, such as your name, address,
social security number, and others, that could be used to identify you as the
individual patient who is associated with that health information.
Uses or Disclosures of Your Personal Health Information
Generally, we may not use or disclose your personal health information without
your permission. Further, once your permission has been obtained, we must use
or disclose your personal health information in accordance with the specific
terms that permission. The following are the circumstances under which we are
permitted by law to use or disclose your personal health information.
Without Your Consent
Without your consent, we may use or disclose your personal health information
in order to provide you with services and the treatment you require or request,
or to collect payment for those services, and to conduct other related health
care operations otherwise permitted or required by law. Also, we are permitted
to disclose your personal health information within and among our workforce
in order to accomplish these same purposes. However, even with your permission,
we are still required to limit such uses or disclosures to the minimal amount
of personal health information that is reasonably required to provide those
services or complete those activities.
Examples of treatment activities include: (a) the provision, coordination,
or management of health care and related services by health care providers;
(b) consultation between health care providers relating to a patient; or (c)
the referral of a patient for health care from one health care provider to another.
Examples of payment activities include: (a) billing and collection
activities and related data processing; (b) actions by a health plan or insurer
to obtain premiums or to determine or fulfill its responsibilities for coverage
and provision of benefits under its health plan or insurance agreement, determinations
of eligibility or coverage, adjudication or subrogation of health benefit claims;
(c) medical necessity and appropriateness of care reviews, utilization review
activities; and (d) disclosure to consumer reporting agencies of information
relating to collection of premiums or reimbursement.
Examples of health care operations include:
(a) development of clinical guidelines; (b) contacting patients with information
about treatment alternatives or communications in connection with case management
or care coordination; (c) reviewing the qualifications of and training health
care professionals; (d) underwriting and premium rating; (e) medical review,
legal services, and auditing functions; and (f) general administrative activities
such as customer service and data analysis.
As Required By Law
We may use or disclose your personal health information to the extent that such
use or disclosure is required by law and the use or disclosure complies with
and is limited to the relevant requirements of such law. Examples of instances
in which we are required to disclose your personal health information include:
(a) public health activities including, preventing or controlling disease or
other injury, public health surveillance or investigations, reporting adverse
events with respect to food or dietary supplements or product defects or problems
to the Food and Drug Administration, medical surveillance of the workplace or
to evaluate whether the individual has a work-related illness or injury in order
to comply with Federal or state law; (b) disclosures regarding victims of abuse,
neglect, or domestic violence including, reporting to social service or protective
services agencies; (c) health oversight activities including, audits, civil,
administrative, or criminal investigations, inspections, licensure or disciplinary
actions, or civil, administrative, or criminal proceedings or actions, or other
activities necessary for appropriate oversight of government benefit programs;
(d) judicial and administrative proceedings in response to an order of a court
or administrative tribunal, a warrant, subpoena, discovery request, or other
lawful process; (e) law enforcement purposes for the purpose of identifying
or locating a suspect, fugitive, material witness, or missing person, or reporting
crimes in emergencies, or reporting a death; (f) disclosures about decedents
for purposes of cadaveric donation of organs, eyes or tissue; (g) for research
purposes under certain conditions; (h) to avert a serious threat to health or
safety; (i) military and veterans activities; (j) national security and intelligence
activities, protective services of the President and others; (k) medical suitability
determinations by entities that are components of the Department of State; (l)
correctional institutions and other law enforcement custodial situations; (m)
covered entities that are government programs providing public benefits, and
for workers’ compensation.
All Other Situations, With Your Specific Authorization
Except as otherwise permitted or required, as described above, we may not use
or disclose your personal health information without your written authorization.
Further, we are required to use or disclose your personal health information
consistent with the terms of your authorization. You may revoke your authorization
to use or disclose any personal health information at any time, except to the
extent that we have taken action in reliance on such authorization, or, if you
provided the authorization as a condition of obtaining insurance coverage, other
law provides the insurer with the right to contest a claim under the policy.
Miscellaneous Activities, Notice
We may contact you to provide appointment reminders or information about treatment
alternatives or other health-related benefits and services that may be of interest
to you. We may contact you to raise funds for Covered Entity. If we are a group
health plan or health insurance issuer or HMO with respect to a group health
plan, we may disclose your personal health information to be sponsor of the
plan.
Your Rights With Respect to Your Personal Health Information
Under HIPAA, you have certain rights with respect to your personal health information.
The following is a brief overview of your rights and our duties with respect
to enforcing those rights.
Right To Request Restrictions On Use Or Disclosure
You have the right to request restrictions on certain uses and disclosures of
your personal health information about yourself. You may request restrictions
on the following uses or disclosures: to carry out treatment, payment, or healthcare
operations; (b) disclosures to family members, relatives, or close personal
friends of personal health information directly relevant to your care or payment
related to your health care, or your location, general condition, or death;
(c) instances in which you are not present or your permission cannot practicably
be obtained due to your incapacity or an emergency circumstance; (d) permitting
other persons to act on your behalf to pick up filled prescriptions, medical
supplies, X-rays, or other similar forms of personal health information; or
(e) disclosure to a public or private entity authorized by law or by its charter
to assist in disaster relief efforts. While we are not required to agree to
any requested restriction, if we agree to a restriction, we are bound not to
use or disclose your personal healthcare information in violation of such restriction,
except in certain emergency situations. We will not accept a request to restrict
uses or disclosures that are otherwise required by law.
(version 4/14/2003)
Right To Receive Confidential Communications
You have the right to receive confidential communications of your personal health
information. We may require written requests. We may condition the provision
of confidential communications on you providing us with information as to how
payment will be handled and specification of an alternative address or other
method of contact. We may require that a request contain a statement that disclosure
of all or a part of the information to which the request pertains could endanger
you. We may not require you to provide an explanation of the basis for your
request as a condition of providing communications to you on a confidential
basis. We must permit you to request and must accommodate reasonable requests
by you to receive communications of personal health information from us by alternative
means or at alternative locations. If we are a health care plan, we must permit
you to request and must accommodate reasonable requests by you to receive communications
of personal health information from us by alternative means or at alternative
locations if you clearly state that the disclosure of all or part of that information
could endanger you.
Right To Inspect And Copy Your Personal Health Information
Your designated record set is a group of records we maintain that includes Medical
records and billing records about you, or enrollment, payment, claims adjudication,
and case or medical management records systems, as applicable. You have the
right of access in order to inspect and obtain a copy your personal health information
contained in your designated record set, except for (a) psychotherapy notes,
(b) information complied in reasonable anticipation of, or for use in, a civil,
criminal, or administrative action or proceeding, and (c) health information
maintained by us to the extent to which the provision of access to you would
be prohibited by law. We may require written requests. We must provide you with
access to your personal health information in the form or format requested by
you, if it is readily producible in such form or format, or, if not, in a readable
hard copy form or such other form or format. We may provide you with a summary
of the personal health information requested, in lieu of providing access to
the personal health information or may provide an explanation of the personal
health information to which access has been provided, if you agree in advance
to such a summary or explanation and agree to the fees imposed for such summary
or explanation. We will provide you with access as requested in a timely manner,
including arranging with you a convenient time and place to inspect or obtain
copies of your personal health information or mailing a copy to you at your
request. We will discuss the scope, format, and other aspects of your request
for access as necessary to facilitate timely access. If you request a copy of
your personal health information or agree to a summary or explanation of such
information, we may charge a reasonable cost-based fee for copying, postage,
if you request a mailing, and the costs of preparing an explanation or summary
as agreed upon in advance. We reserve the right to deny you access to and copies
of certain personal health information as permitted or required by law. We will
reasonably attempt to accommodate any request for personal health information
by, to the extent possible, giving you access to other personal health information
after excluding the information as to which we have a ground to deny access.
Upon denial of a request for access or request for information, we will provide
you with a written denial specifying the legal basis for denial, a statement
of your rights, and a description of how you may file a complaint with us. If
we do not maintain the information that is the subject of your request for access
but we know where the requested information is maintained, we will inform you
of where to direct your request for access.
Right To Amend Your Personal Health Information
You have the right to request that we amend your personal health information
or a record about you contained in your designated record set, for as long as
the designated record set is maintained by us. We have the right to deny your
request for amendment, if: (a) we determine that the information or record that
is the subject of the request was not created by us, unless you provide a reasonable
basis to believe that the originator of the information is no longer available
to act on the requested amendment, (b) the information is not part of your designated
record set maintained by us, (c) the information is prohibited from inspection
by law, or (d) the information is accurate and complete. We may require that
you submit written requests and provide a reason to support the requested amendment.
If we deny your request, we will provide you with a written denial stating the
basis of the denial, your right to submit a written statement disagreeing with
the denial, and a description of how you may file a complaint with us or the
Secretary of the U.S. Department of Health and Human Services (“DHHS”).
This denial will also include a notice that if you do not submit a statement
of disagreement, you may request that we include your request for amendment
and the denial with any future disclosures of your personal health information
that is the subject of the requested amendment. Copies of all requests, denials,
and statements of disagreement will be included in your designated record set.
If we accept your request for amendment, we will make reasonable efforts to
inform and provide the amendment within a reasonable time to persons identified
by you as having received personal health information of yours prior to amendment
and persons that we know have the personal health information that is the subject
of the amendment and that may have relied, or could foreseeably rely, on such
information to your detriment. All requests for amendment shall be sent to:
James N. Romanelli, MD, PC, 110 East Main Street, Suite 6, Huntington, New York,
11743.
Right To Receive An Accounting Of Disclosures Of Your Personal Health Information
Beginning April 14, 2003, you have the right to receive a written accounting
of all disclosures of your personal health information that we have made within
the six (6) year period immediately preceding the date on which the accounting
is requested. You may request an accounting of disclosures for a period of time
less than six (6) years from the date of the request. Such disclosures will
include the date of each disclosure, the name and, if known, the address of
the entity or person who received the information, a brief description of the
information disclosed, and a brief statement of the purpose and basis of the
disclosure or, in lieu of such statement, a copy of your written authorization
or written request for disclosure pertaining to such information. We are not
required to provide accountings of disclosures for the following purposes: (a)
treatment, payment, and healthcare operations, (b) disclosures pursuant to your
authorization, (c) disclosures to you, (d) for a facility directory or to persons
involved in your care, (e) for national security or intelligence purposes, (f)
to correctional institutions, and (g) with respect to disclosures occurring
prior to 4/14/03. We reserve our right to temporarily suspend your right to
receive an accounting of disclosures to health oversight agencies or law enforcement
officials, as required by law. We will provide the first accounting to you in
any twelve (12) month period without charge, but will impose a reasonable cost-based
fee for responding to each subsequent request for accounting within that same
twelve (12) month period. All requests for an accounting shall be sent to: James
N. Romanelli, MD, PC, 110 East Main Street, Suite 6, Huntington, New York ,
11743.
Complaints
You may file a complaint with us and with the Secretary of DHHS if you believe
that your privacy rights have been violated. You may submit your complaint in
writing by mail or electronically to our privacy officer,: James N. Romanelli,
MD at, 110 East Main Street, Suite 6, Huntington, New York , 11743, 631-424-3600. A complaint must name the entity that is the subject of the complaint and describe
the acts or omissions believed to be in violation of the applicable requirements
of HIPAA or this Privacy Policy. A complaint must be received by us or filed
with the Secretary of DHHS within 180 days of when you knew or should have known
that the act or omission complained of occurred. You will not be retaliated
against for filing any complaint.
Amendments to this Privacy Policy
We reserve the right to revise or amend this Privacy Policy at any time. These
revisions or amendments may be made effective for all personal health information
we maintain even if created or received prior to the effective date of the revision
or amendment. We will provide you with notice of any revisions or amendments
to this Privacy Policy, or changes in the law affecting this Privacy Notice,
by mail or electronically within 60 days of the effective date of such revision,
amendment, or change.
On-going Access to Privacy Policy
We will provide you with a copy of the most recent version of this Privacy Policy
at any time upon your written request sent to: James N. Romanelli, MD, 110 East
Main Street, Suite 6, Huntington, New York, 11743, or at the following website
address: www.jrcs.com
For any other requests or for further information regarding the privacy of your
personal health information, and for information regarding the filing of a complaint
with us, please contact our privacy officer James N. Romanelli, MD, 110 East
Main Street, Suite 6, Huntington, New York , 11743, 631-424-3600.
(Version 4/14/2003)
