Visiting Physician Services
23 Main Street, Suite D1
Holmdel, NJ  07733
732-571-1000
 
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
 
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive by our medical staff. We need this record to provide you with quality of care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Visiting Physician Services (VPS).
 
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
 
To Provide Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you within our organization, such as your attending physician and other healthcare professionals or other personnel who are involved in your care. For example, obtaining personal health information for our clinicians prior to treating you. VPS also may disclose your health care information to individuals outside of the organization involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.
 
To Obtain Payment. We may use and disclose medical information about you so that the treatment and services you receive by VPS may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about a treatment you received by us so your health plan will pay us or reimburse you for the treatment provided.
 
To Conduct Health Care Operations. We may use and disclose medical information about you in order to aid the organization and ensure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many patients to decide what additional services VPS should offer and what services are not needed. We may disclose information to doctors, nurses, technicians, and other non-health care professionals for review and learning purposes.
 
Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
 
Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may interest you.
 
For Appointment Reminders. VPS may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.
 
Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following: Worker's Compensation. We may release medical information about you for worker's compensation or similar programs. These programs provide benefits for work-related injuries or illness.
 
Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
 
In Connection with Judicial and Administrative Proceedings. The organization may disclose your health information in the course of any judicial or administrative processing in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when VPS makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
 
Law Enforcement. We may release medical information if asked to do so by a law enforcement official:
Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of VPS to funeral directors as necessary to carry out their duties.
 
National Security and Intelligence Activities. We may release medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of states or conduct special investigations.
 
For Research. VPS may, under very select circumstances, use your health information for research. Before we disclose any of your health information for such research purposes, the project will be subject to an extensive approval process.
 
You have the following rights regarding medical information we maintain about you:
 
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
 
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to our Office Manager. If you request a copy of information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.
 
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the organization.
 
To request an amendment, your request must be made in writing and submitted to our Office Manager. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not made in writing or does not include a reason to support the request. In addition, if you ask us to amend information that: Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures. This is a list of the disclosures we made of medical information about you.
 
To request this list or accounting of disclosures, you must submit your request in writing to the Office Manager. Your request must state a time period, which may not be longer than six years, and may not include dates before April 14, 2003. The organization will provide the first accounting you request during any 12 month period at no charge. For additional lists, we may charge you for the costs involved and you may choose to withdraw or modify your request at that time, before any costs are incurred.
 
Right to Request Restrictions. You have the right to request a restriction or limitation in the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care, like a family member or friend. For example, you could ask that we not use or disclose information about a procedure that you had.
 
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
 
To request restrictions, you must make your request in writing to our Office Manager.
 
In your request, you must tell us: Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you may ask that VPS only conduct communications regarding your health information privately, without family members present.
 
To request confidential communications, you must make your request in writing to our Office Manager. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
 
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice at any time, even if you have agreed to receive this notice electronically.
 
To obtain a paper copy of this notice contact our Office Manager at 732-571-1000.
 
Complaints. If you believe your privacy rights have been violated, you may file a complaint with the organization. Any complaints to VPS should be addressed to: the Office Manager, 23 Main Street, Suite D1, Holmdel, NJ  07733.
 
You will not be penalized for filing a complaint.
 
Changes to This Notice. We reserve the right to change this notice. We reserve the right to make the revised or changes notice effective for medical information that we already have about you as well as any information we receive in the future. If the organization changes this notice, we will provide a copy of the revised notice.
 
Effective Date. This notice is effective April 14, 2003.
 
Other Uses of Medical Information. Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission to use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to resend any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
 
If you have any questions regarding this notice, please contact our Office Manager:
 
Visiting Physician Services
23 Main Street, Suite D1
Holmdel, NJ  07733
732-571-1000
Notice of Privacy Practices, VPS 4/2003