Notice of Privacy Practices

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


We are committed to maintaining the privacy of your protected health information(PHI) which includes information about your health condition and the care and treatment you receive from us. The creation of a record detailing the care and services you receive helps us to provide you with quality health care. This notice details how your PHI may be used and disclosed to third parties. This notice also details your rights regarding your PHI. The privacy of PHI in patient files will be protected when the files are taken to and from this office by placing the files in a box or briefcase and kept within the custody of the doctor or employee of the office authorized to remove the files from the office. It may be necessary to take patient files to a facility where a patient is confined or to a patient's home where the patient is to be examined or treated.

NO CONSENT REQUIRED

We may use and/or disclose your PHI for the purposes of:

(a) Treatment - In order to provide you with the health care you require, we will provide your PHI to those health care professionals, whether on our staff or not, directly involved in your care so that they may understand your health condition and needs. For example, a physician treating you for a condition or disease may need to know the results of your latest physical examination or X-rays performed in this office.

(b) Payment - In order to get paid for services rendered to you, we will provide your PHI, directly or through a billing service, to appropriate third party payors, pursuant to their billing and payment requirements. For example, we may need to provide Medicare with information about health care services that you received from us so that we can be properly reimbursed. We may also need to tell your insurance plan about treatment that you are going to receive so that it can determine whether or not they will cover the treatment expense.

(c) Health Care Operations - In order for us to operate in accordance with applicable law and insurance requirements and in order for us to continue to provide quality and efficient care, it may be necessary for us to compile, use and/or disclose your PHI. For example, we may use your PHI in order to evaluate the performance of the office's personnel in providing care to you.

We may also use and/or disclose your PHI, without a written consent from you, in the following additional instances:

(a) De-identified Information - Information that does not identify you and, even without your name, cannot be used to identify you.

(b) Business Associate - To a business associate if this practice obtains satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI. A business associate is an entity that assists this office in undertaking some essential function, such as a billing company that assists this office in submitting claims for payment to insurance companies or other payers.

(c) Personal Representative - To a person who, under applicable law, has the authority to represent you in making decisions related to your health care.

(d) Emergency Situations - For the purpose of obtaining or rendering emergency treatment to you provided that we attempt to obtain your consent as soon as possible; or to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinationg your care with such entities in an emergency situation.

(e) Communication Barriers - If, due to substantial communication barriers or inability to communicate, we have been unable to obtain your consent and we determine, in the exercise of our professional judgment, that your consent to receive treatment is clearly inferred from the circumstances.

(f) Public Health Activities - Such activities include, for example, information collected by a public health authority, as authorized by law, to prevent or control disease and that does not identify you and, even without your name, cannot be used to identify you.

(g) Abuse, Neglect or Domestic Violence - To a government authority if this office is required by law to make such disclosure, we will do so if we believe that the disclosure is necessary to prevent serious harm.

(h) Health Oversight Activities - Such activities, which must be required by law, involve government agencies and may include, for example, criminal investigations, disciplinary actions, or general oversight activities relating to the community's health care system.

(i) Judicial and Administrative Proceeding - For example, we may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.

(j) Law Enforcement Purposes - In certain instances, your PHI may have to be disclosed to a law enforcement official. For example, your PHI may be the subject of a grand jury subpoena. Or, we may disclose your PHI if we believe that your death was the result of criminal conduct.

(k) Coroner or Medical Examiner - We may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death.

(l) Organ, Eye or Tissue Donation - If you are an organ donor, we may disclose your PHI to the entity to whom you have agreed to donate your organs.

(m) Research - If we are involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI and that does not identify you and, even without your name, cannot be used to identify you.

(n) Avert a Threat to Health or Safety - We may disclose your PHI if we believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.

(o) Workers' Compensation - If you are involved in a Workers' Compensation claim, we may be required to disclose your PHI to an individual or entity that is part of the Workers' Compensation system.

APPOINTMENT REMINDER

We may, from time to time, contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. The following appointment reminders are used by this office: a postcard mailed to you at the address provided by you; and/or telephoning you on any of the phone numbers you provided to us and/or leaving a message on your answering machine or with the individual answering the phone.

FAMILY/FRIENDS

We may disclose to an immediate family member, other relative, a close personal friend, or any other person identified by you, your PHI directly relevant to such person's involvement with your care or the payment for your care. We may also use or disclose your PHI to notify or assist in the notification(including identifying or locating) a family member, a personal representative, or another person responsible for your care, of your location, general condition or death. However, in both cases, the following conditions will apply: (a) If you are present at or prior to the use or disclosure of your PHI, we may use or disclose your PHI if you agree, or if we can reasonably infer from the circumstances, based on the exercise of our professional judgment, that you do not object to the use or disclosure, or (b) If you are not present, we will, in the exercise of our professional judgment, determine whether the use or disclosure is in your best interests and, if so, disclose only the PHI that is directly relevant to the person's involvement with your care.

AUTHORIZATION

Uses and/or disclosures, other than those described above, will be made only with your written authorization.

YOUR RIGHTS

You have the right to:

(a) Revoke any authorization and/or consent, in writing, at any time and to request a revocation, you must submit a written request to this office's Compliance Officer.

(b) Request restrictions on certain use and/or disclosure of your PHI as provided by law, however, this office is not obligated to agree to any requested restrictions. To request restrictions, you must submit a written request to this office's Compliance Officer. In your written request you must inform this office what information you want to limit, whether you want to limit the office's use or disclosure, or both, and to whom you want the limits to apply. If we agree to your request, we will comply unless the information is needed in order to provide you with emergency treatment.

(c) Receive confidential communications or PHI by alternative means or at alternative locations. You must make your request in writing to the office's Compliance Officer. We will accommodate all reasonable requests.

(d) Inspect and obtain a copy of your PHI as provided by law. To inspect and copy your PHI, you must submit a written request to this office's Compliance Officer. We can charge you a fee for the cost of copying, mailing or other supplies associated with your request.

(e) Amend your PHI as provided by law. To request an amendment, you must submit a written request to this office's Compliance Officer. You must provide a reason that supports your request. We may deny your request if it is not in writing, if you do not provide a reason in support of your request, if the information to be amended was not created by this office(unless the individual or entity that created the information is no longer available), if the information is not part of your PHI maintained by this office, if the information is not part of the information you would be permitted to inspect and copy, and/or if the information is accurate and complete. If you disagree with this office's denial, you will have the right to submit a written statement of disagreement.

(f) Receive an accounting of disclosures of your PHI as provided by law. The request should indicate in what form you want the list(such as paper or electronic copy).

(g) Receive a paper copy of this Privacy Notice from this office upon request to the office's Compliance Officer.

(h) Complain to this office or to the Office of Civil Rights, U.S. Dept. of Health and Human Services, 200 Independence Ave., S.W., Room 509F, HHH Building, Washington, DC 20201, (202)619-0257, email: ocrmail@hhs.gov, if you believe your privacy rights have been violated. To file a complaint with this office, you must contact the office's Compliance Officer. All complaints must be in writing.

(i) To obtain more information on, or have your questions about your rights answered, you may contact this office's Compliance Officer, Dorothy H. Krempin, at (973)822-1317 or via email at dr.stiso@usa.net.

PRACTICE'S REQUIREMENTS

This office:

(a) Is required by federal law to maintain the privacy of your PHI and to provide you with this Privacy Notice detailing our legal duties and privacy practices with respect to your PHI.

(b) Is required to abide by the terms of this Privacy Notice.

(c) Reserves the right to change the terms of this Privacy Notice and to make the new Privacy Notice provisions effective for all of your PHI that it maintains.

(d) Will distribute any revised Privacy Notice to you prior to implementation.

(e) Will not retaliate against you for filing a complaint.

EFFECTIVE DATE

This notice is in effect as of April 14, 2003.