Effective date 4-14-03

Raritan Valley Psychiatric Care, P.C.

NOTICE OF PRIVACY ACT
This notice describes how health information about you as a patient of this practice may be used and disclosed, and how you can get access to your Protected Health Information (PHI).

PLEASE REVIEW THIS NOTICE CAREFULLY

OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your Private Health Information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of the health information that identifies you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI. By federal and state law, we must follow the terms of this notice of privacy practices that we have in effect at the time.

We realize these laws are complicated, but we must provide you the following important information:
•	How we may use and disclose your PHI
•	Your privacy rights of your PHI
•	Our obligations concerning the use and disclosure of your PHI.
The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, present or future, Our practice will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.

If you have questions about this notice, please contact our Privacy Officer at 732-469-7899.

WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) IN THE
FOLLOWING WAYS
The following categories describe the different ways in which we may use and disclose your PHI.
1. Treatment. Our practice may use PHI to treat you. For Example, we may ask you to have lab tests (such as blood or urine), and we may use the results to help us reach a diagnosis. We might use your PHI in order to write or call a pharmacy with a prescription for you. We may also disclose your PHI to others who may assist in your care, such as your spouse, children or parents.
2. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services you may have received from us. For example, we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. Also, we may use your PHI to bill you directly for services.
3. Healthcare Operations. Our practice may use and disclose your PHI to operate our business. Examples of this would be to evaluate the quality of care you receive from us or to conduct business planning activities.
4. Appointment Reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment.
5. Disclosures Required By Law. Our practice will use and disclose your PHI when we are required to do so by federal, state and local law.
USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in which we may use or disclose your PHI:
1. Public Health Risks. Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purposes of:
•	maintaining vital records, such as births and deaths
•	reporting child abuse or neglect
•	preventing or controlling disease, injury or disability
•	notification of exposure to a communicable disease

•	notification of potential risk of spreading or contracting a disease
•	reporting reactions to drugs or problems with products or devices
•	notification of product or device recalls
•	notification of government agencies regarding the potential abuse or neglect of an adult patient
•	Notification of employers under limited circumstances related to workplace injury or illness.

2. Health Oversight Activities. Our practice may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include investigations, audits, civil and criminal procedures.
3. Lawsuits and Similar Proceedings. Our practice may use and disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena or other lawful process.
4. Law Enforcement. We may release PHI if asked to do so by a law enforcement official regarding a crime victim, death from criminal conduct, or in response to a warrant.
5. Deceased Patients. Our practice may release PHI to a medical examiner, coroner or funeral director to perform their jobs. We may also release information to organizations regarding organ donation if you are a donor.
6. Serious Threats to Health or Safety. Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your or another individual health and safety.
7. National Security. Our practice may disclose your PHI to federal official for intelligence and national security activities authorized by law
8. Workers’ Compensation. Our practice may release your PHI for workers’ compensation and similar programs.

YOUR RIGHTS REGARDING YOUR PHI
       You have the following rights regarding the PHI that we maintain about you:
1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request specifying the requested method of contact, or location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for you request.
2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or healthcare operations. You have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family and friends. We are not required to agree to your request. However, if we do agree, we are bound by our agreement except when otherwise required by law or emergencies. This request must be made in writing.
3. Inspection and Copies. You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records. You must submit your request in writing in order to do this. Our practice will charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our office may deny you request, however you may request a review of denial.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete. To request an amendment must be made in writing. Our practice also has the right to deny your request.
5. Accounting of Disclosures. You have a right to request an accounting of disclosure. This is a list of certain non-routine disclosures our practice has made of your PHI for non treatment purposes. Use of PHI for routine patient care is not required to be documented. You may obtain an accounting of disclosure in writing to our office. All requests must state a time period, which may be no longer than 6 years from the date of disclosure and may not include dates prior to April 14, 2003. The first request is free of charge, but our practice may charge you for additional lists.
6. Right to a Paper Copy of this Notice. You are entitled to receive a paper copy of our notice of privacy practices.
7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice. You may revoke your authorization at any time.

Again, if you have any questions regarding this notice or our health information privacy policies, please contact our Privacy Office at 732-469-7899.