1. Introduction: In 1996, the Federal Government established uniform privacy and security standards to protect patients’ medical information. The standard is known as the Health Insurance Portability and Accountability Act (HIPAA). This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services.  Where applicable, this Notice references New Hampshire state law as well.

  2. Your Health Information Rights: While the actual records we maintain about you belong to us, the information contained in our records belongs to you.  Under the Federal Privacy Rules you have the right to:
    • Request a restriction on certain uses and disclosures of your information.  Note, however, that we are not required to agree to a restriction that you may request.  If we believe it is in your best interest to permit use and disclosure of your health information, we will notify you that your request for restriction will not be honored.  If we agree to the requested restriction, we may not use or disclose your health information in violation of that restriction unless it is needed to provide emergency treatment.
    • Obtain a paper copy of this Notice of Privacy Practices upon request.
    • Inspect and obtain a copy of your medical records at any time. The Federal Rule does not include the right of access for certain types of information. Provided your information falls within the right to access category, we may restrict access in certain specific situations, such as when we believe that access could cause harm to you, or another.  You may, however, be given the right to have the denial reviewed by a licensed health care professional for a second opinion.
    • Amend your health record.
    • Obtain an accounting of certain disclosures of your health information.
    • Receive confidential communications of your health information by alternative means or alternative locations.
    • Revoke your authorization at any time in writing, but only to the extent we have not already used or disclosed your protected health information in reliance on your authorization.

  3. Our Responsibilities: New England Pediatric Services, LLC is required to:
    • Maintain the privacy of your health information.
    • Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
    • Abide by the terms of this notice.
    • Notify you if we are unable to agree to a requested restriction.
    • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

  4. Uses and Disclosures of Patient Information: Your protected health information may be used or disclosed by New England Pediatric Services, LLC, Without Your Written Authorization, for the following purposes. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by New England Pediatric Services, LLC.
    • Treatment: New England Pediatric Services, LLC will use and disclose your protected health information to provide, coordinate, or manage your care, including your health care and any related services. This includes the coordination of management of your health care with third parties as needed to provide treatment to you.
    • Payment: New England Pediatric Services, LLC will use and disclose your protected health information, as needed, to obtain payment for services that we provide to you.  This may include certain activities that your health plan may undertake before it approves or pays for the services we recommend for you.  For example, some health plans must make a determination that you are eligible for reimbursement for particular services before we can provide them to you and we must provide them with protected health information to enable them to make such a determination.
    • Healthcare Operations: New England Pediatric Services, LLC will use and disclose your protected health information, as needed, in order to support our own business activities. These activities include, but are not limited to, quality assessment activities, training and supervision of personnel, including staff members and private contractors, licensing, certification and conducting or arranging for other business activities.
    • Business Associates: We will share your protected health information with third party “business associates” that perform various activities that are essential to the operations of our organization. Whenever we have an arrangement between our organization and a business associate, we will limit the amount of protected health information that we provide to the minimum necessary to accomplish the particular task and we will have a written contract that contains terms that will protect the privacy of your protected health information.
    • Emergency: We may use and disclose your protected health information by using our best judgment and determining it to be in your best interest, if you are incapacitated, in an emergency situation, or not available.
    • Communications with Family Members: We may rely on your informal permission to disclose to family members, relatives, or friends, who you have identified, your protected health information, relevant to that person’s involvement in your care.  Additionally, we may rely on your informal permission for the purposes of notifying family members, personal representatives, and others responsible for your care, of  your location, general condition, or death.
    • Appointment Reminders, etc: We may use and disclose your protected health information, as necessary, to provide you with appointment reminders.

  5. Uses and Disclosures Not Requiring Your Authorization (Public Interest): The Federal privacy rules provide that New England Pediatric Services, LLC may use or disclose your protected health information without your authorization for public interest purposes in the following circumstances:
    • As Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by state or federal law, including by statute, regulations and court orders. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
    • Workers Compensation: We may disclose your protected health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs providing benefits for work-related injuries or illnesses.
    • Public Health Activities: As required by law, we may disclose your protected health information to public health authorities authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, as well as to public health or other government authorities authorized to receive reports of child abuse and neglect.  When notification is authorized by law, we may also disclose the protected health information of those who may have contracted, or have been exposed to a communicable disease.  We may also disclose to the Food and Drug Administration (FDA) protected health information relating to FDA regulated products or activities for reporting adverse events, product recalls, tracking of products, and post marketing surveillance information.  We may also disclose to employers the protected health information of their employees, for information concerning a work-related illness or injury, or workplace related medical surveillance, provided such information is needed by the employer to comply with the Occupational Safety and Health Administration (OSHA), the Mine Safety and Health Administration (MHSA), or similar state law.
    • Cadaveric Organ, Eye, or Tissue Donation: We may use or disclose your protected health information to facilitate the donation and transplantation of cadaveric organs, eyes and tissue.
    • Research: We may disclose your protected health information for research purposes without authorization, provided that the research has been approved by an institutional review board that has reviewed the research proposal and the researchers have established protocols to ensure the privacy of your protected health information.
    • Serious Threat to Health or Safety: We may disclose your protected health information when we believe it is necessary to prevent, or lessen a serious and imminent threat to a person or to the public, when the disclosure is made to someone we believe can prevent the threat or lessen the threat. We may also disclose your protected health information to law enforcement, provided the information is needed to identify or apprehend an escapee or a violent criminal.
    • Essential Government Functions: We may disclose your protected health information for certain essential government functions.  For example, should you be an inmate of a correctional institution, we may disclose to the institution your protected health information necessary for your health and the health and safety of other individuals.  We may also disclose your protected health information for determining your eligibility for, or enrolling you in certain government benefit programs. We may also disclose your protected health information for such purposes as assuring proper execution of a military mission, for lawful intelligence, counterintelligence and other essential national security activities.
    • Law Enforcement Purposes: We may disclose your protected health information for law enforcement purposes as required by law, including court orders, court-ordered warrants, subpoenas and administrative requests. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or locate a suspect, fugitive, material witness, or missing person.  We may disclose your protected health information, if requested by a law enforcement official, for information regarding a victim or suspected victim of a crime.  We may disclose your protected health information to alert law enforcement of a person’s death, provided that we suspect that criminal activity caused the death.  We may disclose your protected health information if we believe that it constitutes evidence of criminal conduct that occurred on our premises.  We may also disclose your protected health information in a medical emergency not occurring on our premises, when it is necessary to inform law enforcement about the commission and nature of a crime, the location of a crime or of the crime victims and the perpetrator of the crime.
    • Victims of Abuse, Neglect or Domestic Violence: We may also disclose your protected health information if we are required by applicable state law to report suspected child abuse or neglect or abuse of incapacitated adults or an injury that we believe may have been the result of an illegal act.
    • Judicial or Administrative Proceedings: We may disclose your protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal and in response to a subpoena, or other lawful process.
    • Relating to Decedents: We may disclose your protected health information regarding your death to coroners, medical examiners or funeral directors, to identify a deceased person, determine the cause of death and to perform other functions as authorized by law.
    • Health Oversight Activities: We may disclose your protected health information to health oversight agencies, for legally authorized health oversight activities. Such activities may include audits and investigations for oversight of the health care system and governmental benefit programs.

  6. Uses and Disclosures of Protected Health Information Based upon Your Written Authorization: Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described in this Notice.
    • You may request that we use or disclose all or part of your protected health information.  Use and disclosure may be authorized to specified individuals or other recipients for a defined purpose over a particular timeframe.  Authorizations will be required to disclose sensitive protected health information/records/reports/test results including HIV/AIDS, Hepatitis, Mental Health Disorders, Sexually Transmitted Diseases, Genetic Disorders, Domestic Violence, Drug Abuse, Alcohol Abuse, and Other Substance Abuse (unless an emergency situation exists). While most authorizations must be in writing, in certain circumstances, we will accept oral authorizations to the extent permitted by New Hampshire or Federal law.  The minimum necessary amount of your protected health information will be disclosed to comply with your authorization.
    • Fundraising & Marketing: We must obtain your written authorization prior to using your protected health information to send you any marketing materials, such as information about treatment alternatives, or other health-related benefits.  We may also contact you for fundraising activities. In accordance with New Hampshire State Law, you may choose to opt out of receiving any fundraising communications. Any fundraising communication addressed to you will contain instructions describing how you may opt out of receiving such communications in the future.  Protected health information for marketing or fundraising shall not be disclosed by voice mail, an unattended facsimile, or through other methods of communication that are not secure.
    • Psychotherapy Notes: We must obtain your written authorization to use or disclose psychotherapy notes.  However, we may use the psychotherapy notes for treatment, without your authorization, provided those notes originated with us.  We may also use the notes without your authorization, for our own training, to defend ourselves in a legal proceeding brought by you, for the Department of Health and Human Services to investigate or determine our compliance with the Privacy Rules, to avert serious, imminent threat to public health safety and to a health oversight agency for lawful oversight of the originator of the psychotherapy notes, for lawful activities of a coroner, or medical examiner, as required by law.

  7. Confidentiality of Client Information: New England Pediatric Services, LLC will attempt in all cases to preserve the confidentiality of all oral and written protected health information.  This includes, but not limited toprogress information at the end of treatment sessions, written information and electronic transmission of information to physicians, insurance companies, state and federal entities and law enforcement agencies in the interest of public safety. New England Pediatric Services, LLC will not be held responsible in the event of natural disaster, theft, or burglary of their physical or electronic property, having taken reasonable precautions.

  8. Unauthorized Disclosure: In accordance with New Hampshire law, in the event of a use or disclosure of protected health information that is allowed under Federal law, but not permitted by New Hampshire law, we shall promptly notify you of the disclosure, in writing.

  9. For More Information or to Report complaints: If you wish to exercise any of your rights, or if you have any questions and would like additional information, you may contact our Privacy Officer either in writing or by phone at (603) 296-5241.  If you believe that your privacy rights have been violated, you may file a formal, written complaint with our Privacy Officer, or with the Secretary of the United States Department of Health & Human Services, Office of Civil Rights. New England Pediatric Services, LLC will not retaliate against you if you file a complaint.New England Pediatric Services, LLC reserves the right to change our practices and to make new provisions effective for all the protected health information we maintain.  To obtain the most recent notice, please summit a request in writing to New England Pediatric Services, LLC.  We will not use or disclose your health information without your authorization, except as described in this notice.