HealthWise Medical Associates, LLP

Privacy Practices

This notice describes how information about you may be used and disclosed and how you can gain access to this information. Please review it carefully.

NOTICE OF PRIVACY PRACTICES-HEALTHWISE MEDICAL ASSOC., LLP

1. HealthWise Medical Associates, LLP, may use and disclose your protected health information (PHI) for treatment, payment and healthcare operations. Information for treatment includes, but is not limited to, requested preschool, life insurance or sports physicals, referral to nursing homes, foster care homes, home health agencies and/or referral to other providers for treatment. Payment examples include, but are not limited to, insurance companies for claims including coordination of benefits with other insurers and collection agencies. Healthcare operations include, but are not limited to, internal quality control and assurance including auditing of records.


2. HealthWise Medical Associates, LLP, originates and maintains health records describing your health history, symptoms, examination and test results, diagnoses, treatment, and any plans for future care of treatment. This information also serves as:


• A basis for planning your care and treatment
• A means of communication among the many health professionals who contribute to your care
• A source of information for applying your diagnosis and surgical information to your bill
• A means by which a third party payer can verify that services billed were actually provided
• And a tool for routine healthcare operations such as assessing quality and reviewing the competence of healthcare professionals.


3. HealthWise Medical Associates, LLP, is permitted or required to use or disclose your protected health information (PHI) without your written consent or authorization in certain circumstances. Two examples of such are for public health requirements or court orders.


4. HealthWise Medical Associates, LLP, is permitted to use and disclose your protected health information (PHI) as part of a sale, merger, or acquisition.


5. HealthWise Medical Associates, LLP, is permitted to disclose your protected health information (PHI) to another provider without obtaining authorization when the other provider requires the information for purposes of treatment, payment, or health care operations. This permission is extended only when the information applies to a relationship that has existed or exists between you and the provider.


6. HealthWise Medical Associates, LLP, is permitted to disclose your protected health information (PHI) to another covered entity without authorization when the information being disclosed is needed by the entity receiving the information for the purpose of fraud and abuse detection or compliance, and the information relates to a relationship between you and the entity receiving the information.


7. HealthWise Medical Associates, LLP, is permitted to disclose your protected health information (PHI) in instances that may occur as part of the educational and training activities of our practices.


8. HealthWise Medical Associates, LLP, will not make any other use or disclosure of your protected health information (PHI) without your written authorization. Such authorization may be revoked at any time. Revocation must be written.


9. You have the right to inspect, copy and amend your protected health information (PHI). You have the right to request restrictions on the use of your PHI. HealthWise is not required to agree to a requested restriction. You have the right to receive confidential communications of protected health information (PHI). You have a right to an accounting of the disclosure of your protected health information (PHI) for other than treatment, payment and healthcare operations.


10. HealthWise Medical Associates, LLP, may, at times, contact you to provide appointment reminders or information regarding treatment alternatives or other health-related benefits and services that may be of interest to you without your written authorization.


11. HealthWise Medical Associates, LLP, will abide by the terms of this notice or the notice currently in effect at the time of the disclosure.


12. HealthWise Medical Associates, LLP, is legally obligated to maintain the privacy of protected health information (PHI) and provide you with a “Notice of Privacy Practices”.


13. HealthWise Medical Associates, LLP, reserves the right to change the terms of its notice and to make new notice provisions effective for all protected health information (PHI) that it maintains.


14. HealthWise Medical Associates, LLP, will make available to you any revisions of its Notice of Privacy Practices via their Website http://www.healthwisema.com. Revisions will also be posted at all HealthWise Medical Associates, LLP, practice sites. You will be notified at the time of your next visit or at your last known address if there is a need to use or disclose any protected health information (PHI). Copies may also be obtained at any time at our offices.


15. You may file a complaint to the Practice and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. To file a complaint with the practice, please contact the Privacy Officer at the following address and/or phone number: Compliance/Privacy Officer, 29 Naek Road, Suite 5, Vernon, CT 06066, 860-872-2289 X14 or the Corporate Compliance Contact at 860-646-1974 or you may contact the Compliance/Privacy Officer or Corporate Compliance Contact anonymously via our Website http://www.healthwisema.com. All complaints will be addressed and the results will be reported to the Compliance Committee. To file a complaint with the Secretary of the Department of Health & Human Services write to: U.S. Department of Health & Human Services, Office of Civil Rights, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201.


16. It is HealthWise Medical Associates, LLP, policy that no retaliatory action will be made against any individual who submits or conveys a complaint of suspected or actual non-compliance of the privacy standards.


17. The title and telephone number of a person in the office to contact for further information Chief Operating Officer/Compliance Officer, 860-872-2289 X14.


18. The effective date: April 13, 2003