Privacy Policy

Albany Saratoga Center for Pain Management (“ASCPM”) is required by the Health Insurance Portability and Accountability Act of 1996, and the Health Information Technology for Economic and Clinical Health Act (found in Title XIII of the American Recovery and Reinvestment Act of 2009) (collectively referred to as “HIPAA”), as amended from time to time, to maintain the privacy of individually identifiable patient health information—“protected health information.” We are also required to provide patients with a Notice of Privacy Practices regarding protected health information. We will only use or disclose your protected health information as permitted or required by applicable state and federal law. This Notice applies to your protected health information under our control, including the medical records generated by us.

“Protected health information” is any information we create, receive, maintain or transmit that relates to your past, present, or future health care, condition, or treatment, and that identifies you or can be used to identify you. This includes both medical and identification information. Protected health information includes information that is written and information that is stored in computers, as well as other information (e.g., information that is disclosed verbally). Protected health information that is disclosed in accordance with federal law may be redisclosed and is no longer protected under the HIPAA Privacy Rule.

Typically, we will use or disclose your protected health information for the following purposes:

• Treatment: We may use and disclose protected health information in the provision, coordination, or management of your health care, including consultations between health care providers regarding your care and referrals for health care from one health care provider to another.
• Payment: We may use and disclose protected health information to obtain reimbursement for the health care provided to you, including determinations of eligibility and coverage and other utilization review activities.
• Healthcare Operations: We may use and disclose protected health information to support functions of our practice related to treatment and payment, such as quality assurance activities, case management, receiving and responding to patient complaints, physician reviews, compliance programs, audits, business planning, development, management and administrative activities.
• For Treatment, Payment and Health Care Operations of Other Covered Entities: We may disclose your protected health information to other covered entities or licensed health care providers for use in their treatment of you, so they may obtain payment for care provided to you, or for their health care operations that relate to you.
• Appointment Reminders: We may use and disclose protected health information to contact you to provide appointment reminders.
• Treatment Alternatives: We may use and disclose protected health information to tell you about or recommend possible treatment alternatives or other health related benefits and services that may be of interest to you.
• Business Associates: There may be some services provided in our organization through contracts with Business Associates. Examples include billing companies which we may use to help us operate our organization. When these services are contracted, we may disclose some or all of your health information to our Business Associate so that they can perform the job we have asked them to do. To protect your health information, however, we require the Business Associate to appropriately safeguard your information.
• To You: We may disclose information to you or, if you lack capacity, to someone authorized to act for you.
• Individuals Involved in Your Care or Payment for Your Care: Unless you object, we may disclose your protected health information to your family or friends or any other individual identified by you as someone you want involved in your care or for the payment for your care. We will only disclose the protected health information directly relevant to their involvement in your care or payment. We may also disclose your protected health information to notify a person responsible for your care (or to identify such person) of your location, general condition or death.

Less typically, we may use or disclose your protected health information in special situations and to the extent permitted by federal and/or state laws, such as the following:

• Required by Law: We may use or disclose your protected health information when we are required by law to do so, such as to comply with a court order.
• Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for purposes such as controlling disease, injury or disability.
• Health Oversight Activities: We may disclose protected health information to federal or state agencies that oversee our activities.
• To Your Employer in Certain Instances: We may share specific protected health information with your employer if we provide health care to you at your employer’s request: (1) to conduct an evaluation relating to medical surveillance of the workplace; or (2) to evaluate whether you have a work-related illness or injury. You will be provided notice that your protected health information will be disclosed to your employer at the time the health care is provided, and the information disclosed will be limited to findings concerning a work-related illness or injury or a workplace-related medical surveillance.
• Product Monitoring, Repair and Recall: We may disclose your information to a person or company that is required by the Food and Drug Administration to report or track product defects or problems, to repair, replace, recall or enable lookbacks on defective or dangerous products, or monitor product performance.
• Abuse or Neglect: We may disclose protected health information to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
• Coroners, Medical Examiners, and Funeral Directors: We may disclose protected health information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also release protected health information about patients to funeral directors as necessary to carry out their duties.
• Medical Research: We may use and disclose your protected health information in a permitted manner to medical researchers who request it for approved medical research projects. Researchers are required to safeguard all protected health information they receive.
• Serious Threats: As permitted by applicable law and standards of ethical conduct, we may use and disclose protected health information if we, in good faith, believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
• Specialized Government Functions: We may use or disclose protected health information for specialized governmental functions, such as disclosing information about a member of the armed services to the military to assure the proper execution of a military mission, or disclosing information about inmates to a correctional facility for security, continued health care or safety or other important purposes.
• Worker’s Compensation: We may release protected health information about you for programs that provide benefits for work related injuries or illness.
• Fundraising: We may use and may also disclose some of your protected health information for certain fundraising activities that we undertake on our own behalf. All fundraising communications include the ability to opt-out.

The following uses and disclosures of protected health information require your authorization:

• Most uses and disclosures of psychotherapy notes.
• Most uses and disclosures for marketing purposes.
• Disclosures that constitute a sale of your protected health information. We, of course, will never sell your protected health information.

Other uses and disclosures of protected health information not covered by this Notice will be made only with your written authorization.

There are state and federal laws that are stricter than HIPAA. This includes laws that apply to HIV-related information, drug/alcohol abuse information and genetic information. For example, under New York law, confidential HIV-related information can only be shared with persons allowed to have it by law, or persons you have allowed to have it by signing a specific authorization form. We will follow these stricter state law requirements for HIV-related information because they are more protective than the requirements under HIPAA.

You have rights with respect to the information contained in your medical record. You have the right to:

• Receive a copy of this Notice of Privacy Practices from us upon enrollment or upon request.
• Inspect and obtain a copy of the protected health information contained in your medical and billing records as long as we maintain the record. If we maintain or use electronic health records, you will also have the right to obtain a copy or forward a copy of your electronic health record to a third party. We may charge a reasonable, cost-based fee for any copy. However, under federal and state law, you may not inspect or obtain a copy of the following records: information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to that protected health information. In some circumstances, you may have a right to have this decision reviewed.
• Request restrictions on our uses and disclosures of your protected health information for the purposes of treatment, payment and health care operations functions or to prohibit such disclosure. This includes your right to request that we not disclose your health information to a health plan for payment or health care operations if you have paid in full and out of pocket for the services provided. We will consider your request but are not required to agree to the requested restrictions.
• Request to receive confidential communications of protected health information from us by alternative means or at an alternative location. We will accommodate reasonable requests, but we may ask you how payment will be handled or for the specification of an alternative address or other method for contact.
• Request an amendment to your protected health information. This means that if you believe our records are incorrect or incomplete, you may request an amendment of protected health information about you in our records. However, we may deny your request for an amendment, if we determine that the protected health 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 protected health information is no longer available to act on the requested amendment;
  • is not part of your medical or billing records;
  • is not available for inspection as set forth above; or
  • is accurate and complete.

  In any event, any agreed upon amendment will be included as an addition to, and not a replacement of, already existing records.

• Receive an accounting of disclosures of protected health information made by us to individuals or entities other than to you. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices. It excludes disclosures:
  • we have made to you or your legally authorized representative;
  • made with your authorization;
  • for a facility directory;
  • to family members or friends involved in your care or for notification purposes as provided by law;
  • about inmates to correctional institutions or law enforcement officials as provided by law; or
  • that occurred prior to the date of compliance with privacy standards (April 14, 2003).
• Revoke your authorization to use or disclose health information except to the extent that we have already acted in reliance on your authorization, or if the authorization was received as a condition of obtaining insurance coverage and other applicable law provides the insurer that received the authorization with the right to contest a claim under the policy.
• Receive notification if affected by a breach of unsecured PHI.
• To complain. If you believe we have violated your rights, you may file a complaint using the Patient Privacy Complaint Form, or by contacting our Privacy Officer in writing or by telephone. You may also file a formal complaint with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

We will abide by the terms of this Notice, currently in effect. We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain.

Your health information will not be used or disclosed without your written authorization, except as described in this Notice. Except as noted above, you may revoke your authorization in writing at any time.

If you have questions about this Notice or would like additional information, you may contact our Privacy Officer, at the telephone or address below. If you believe that your privacy rights have been violated, you have the right to file a complaint with the Privacy Officer at ASCPM. You may also file a complaint with the Secretary of the Department of Health and Human Services, which complaint must be in writing, describe the acts or omissions that you believe violate your privacy rights, and be filed within 180 days of when you knew or should have known that the act or omission occurred. We will take no retaliatory action against you if you make such complaints.

The contact information for both the Privacy Officer at ASCPM and the Secretary of the Department of Health and Human Services is provided on the following page.

This notice will be prominently posted in the office where registration occurs. You will be provided with a hard copy of this notice at the time we first deliver services to you. Thereafter, you may obtain a copy of this notice upon request. Additionally, the notice will be maintained on our Web site (if applicable Web site exists) for downloading.

If our information practices change, a revised notice will be prominently posted in our facilities and on our website, and will be available upon request.