Privacy Practices

 

TARIQ S. SIDDIQI, M.D.
NOTICE OF PRIVACY PRACTICES
EFFECTIVE DATE APRIL 14, 2003

THIS NOTICE DESCRIBES HOW PERSONAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices is provided to you pursuant to the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations (“HIPAA”).
It is designed to tell you how we may, under federal law, use or disclose your Protected Health Information.

WHO AND WHAT IS COVERED BY THIS NOTICE?

This Notice of Privacy Practices covers all staff and subcontractors employed by Dr. Siddiqi.  This Notice applies to all Protected Health Information maintained by Dr. Siddiqi. Your medical records are referred to as Protected Health Information.

HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION.   

Federal and State Law Implications:

HIPAA is a federal law, which places limitations on the types of uses and disclosures health care providers and others may make of Protected Health Information.  At times, State or other regulations may be more stringent than HIPAA.  Our office will abide by the most stringent of the regulations as they pertain to Protected Health Information.

Uses and Disclosures under HIPAA:

  1. WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION FOR PURPOSES OF TREATMENT, PAYMENT OR HEALTHCARE OPERATIONS WITHOUT OBTAINING YOUR AUTHORIZATION. EXAMPLES WOULD BE:

The billing department will access Protected Health Information and send relevant information to insurance companies and third party payers so that payment can be made for the services provided.

    1. Protected Health Information will be provided to third party “business associates” that perform various activities and services (e.g., billing, transcription) on behalf of Dr. Siddiqi.  In such situations, Dr. Siddiqi will have a written contract in place that restricts the ability of the business associate to use or disclose your Protected Health Information in accordance with HIPAA requirements.
  1. PROCTECTED HEALTH INFORMATION WILL ALSO BE USED WITHOUT PRIOR AUTHORIZATION UNDER THE FOLLOWING CIRCUMSTANCES:
    1. As required by Law – Protected Health Information will be used and disclosed, to the extent that law requires such use or disclosure. Some examples would be: communicable disease reporting, incidence of cancer, seizures, gunshots, abuse, product recalls, and product failures.  Examples of just a few of the authorities / agencies to which Protected Health Information may be disclosed include: New Jersey Department of Health and Senior Services, the Division of Motor Vehicles, Local and / or State Police, the Medical Examiner and County Prosecutor, the Drug Enforcement Administration, the Ombudsman, the Office of Civil Rights, the Centers for Medicare and Medicaid Services and or Peer Review Organizations.
    2. For Public Health Purposes – Protected Health Information will be provided to local, state or federal public health authorities, as required by law to prevent or control disease, injury or disability; report domestic violence; report to the Food and Drug Administration problems with products and reactions to medications; and report disease or infection exposure.
    3. For Health Oversight Activities - Protected Health Information will be used and disclosed to health agencies during the course of audits, investigations, surveys, accreditation, certification and other proceedings.
    4. To Law Enforcement Personnel – Protected Health Information will be used and disclosed to law enforcement officials to identify or locate a suspect, fugitive, material witness or missing person, or, in some cases, to comply with a court order or subpoena and for other law enforcement purposes.
    5. For Public Safety – Protected Health Information will be used and disclosed in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
    6. For Worker’s Compensation – Protected Health Information may be used and disclosed as necessary to comply with worker’s compensation laws.
    7. To Aid Specialized Government Functions Protected Health Information may be used and disclosed for military or national security purposes.  Protected Health Information of patients who are Armed Forces personnel may be used and disclosed:
      1. for activities deemed necessary by appropriate military command authorities.
      2. for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits.
      3. to a foreign military authority if you are a member of that foreign military service.

Protected Health Information may be used and disclosed to authorized federal officials for conducting national security and intelligence activities.

REQUIRED USES AND DISCLOSURES:

Under the law, disclosures must be made to you, upon your request (unless medically contraindicated) and when required by the Secretary of the Department of Health and Human Services to investigate or determine compliance  with HIPAA regulations.

FOR ALL OTHER CIRCUMSTANCES, WE MAY ONLY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION AFTER YOU HAVE SIGNED AN AUTHORIZATION: 

If you authorize us to use or disclose your Protected Health Information for another purpose, you may revoke your authorization in writing at any time.

WE MAY ALSO USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION FOR THE FOLLOWING PURPOSES: 

Appointment Reminders – To contact you with appointment reminders or to provide information on other treatments or health-related benefits and services that may be of interest to you.

YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION

  1. You have the right to request restrictions on the uses and disclosures of your Protected Health Information.  This means you may ask us not to use or disclose any part of your Protected Health Information for treatment, payment or healthcare operations.  You may also request that any part of your Protected Health Information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Joint Notice.  Your request must be in writing, be addressed to the Privacy Officer and state the specific restrictions requested and to whom you want the restrictions to apply.  However, we are not required to comply with your request.
  2. You have the right to request your Protected Health Information through confidential means.  However, we may condition this accommodation by asking you for information as to how payment will be handled or a specification of an alternative address or other method of contact.  We will not request an explanation from you as to the basis for the request.  Your request must be in writing, be addressed to the Privacy Officer and state the specific alternate means or location.
  3. You have the right to inspect your Protected Health Information.  You may also obtain a copy of your Protected Health Information (unless medically contraindicated).  Our office will charge a reasonable fee for the copy of your Protected Health Information that is contained in Dr Siddiqi’s designated record set for you.  A “designated record set” is the HIPAA term for medical and billing records and any other records that our office uses for making health care decisions about you.  You have a right to request that we amend the Protected Health Information contained in your designated set if you believe it is incorrect or incomplete.  However, we are not required to make such amendments. If we deny a request, we will provide you with information about our denial and explain how you can disagree with the denial by filing a statement of disagreement with us.  We may then prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.  All of these documents will be placed in the appropriate part of your designated record set.
  4. You may have a right to receive an accounting of disclosures of your Protected Health Information made by us, except that we do not have to account for disclosures: made prior to April 14, 2003; authorized by you; made for treatment, payment, health care operations; provided in response to an Authorization; made in order to notify and communicate with family; for certain government functions, and / or disclosures provided to you, to name a few.  The right to receive an accounting is subject to exceptions, restrictions and limitations.
  5. You have a right to a copy of this Joint Notice of Privacy Practices upon request.
  6. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact the Privacy Officer at our office.

OUR DUTIES TO YOU

  1. We are required by law to maintain the privacy of your Protected Health Information and to provide you with a copy of this Notice.
  2. We are also required to abide by the terms of this Notice.
  3. We reserve the right to amend this Notice at any time in the future and to make the new Notice provisions applicable to all your Protected Health Information  - even if it was created prior to the change in the Notice.  If such amendment is made, we will immediately display the revised Notice in our office. We will also provide you with a copy, at any time, upon request.

** YOU WILL BE ASKED TO SIGN AN ACKNOWLEDGEMENT THAT YOU HAVE RECEIVED THIS “NOTICE OF PRIVACY PRACTICES” NOTICE.

You may contact us about our privacy practices by calling the Privacy Officer at: 856-751-6600

DISCLAIMER: Information provided on this website is for educational purposes only, and is not a substitute for advise you would receive from a qualified medical professional familiar with your specific medical history.

Contact

Sheppard Office Park
900 Sheppard Road
Voorhees, NJ 08043
Phone: 856-751-6600
Fax: 856-751-5556

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