At MassResearch we promise to keep your Personal Health Information (PHI) private. It will never be shared or sold to anyone. The information below outlines how we can and cannot use your PHI. If you have any questions or concerns, please contact firstname.lastname@example.org
Notice of Privacy Practices
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.
If you have any questions about this notice, please contact
MassResearch, LLC 42 Weston Street. Waltham, MA 02453.
This notice describes the practices of:
” MassResearch, LLC
” Any health care professional authorized to enter information into your medical chart or record.
” All departments and units of MassResearch.
” Any member of a volunteer group we allow to help you while you a part of the research project.
” All employees, staff and other research personnel.
This notice describes the ways in which we may use and disclose your medical information. It also describes your rights and certain obligations we have regarding the use and disclosure of your medical information.
We are required by law to:
” ensure that medical information that identifies you is kept private;
” give you this notice of our legal duties and privacy practices with respect to medical information about you; and
” follow the terms of the notice that is currently in effect.
Understanding Your Health Record/Information
Each time you visit a hospital, physician, research facility, or other healthcare provider, a record of your visit is made. This record typically contains your symptoms, medical history, examination, test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
” basis for planning your care and treatment
” means of communication among the many health professionals who contribute to your care
” legal document describing the care you received
” means by which you or a third-party payer can verify that services billed were actually provided
” a tool in educating health professionals
” a source of data for medical research
” a source of information for public health officials charged with improving the health of the nation
” a source of data for facility planning and marketing
” a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to:
” ensure its accuracy
” better understand who, what, when, where, and why others may access your health information
” make more informed decisions when authorizing disclosure to others HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The following describes different ways that we are permitted to use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
” For Treatment. We may use your medical information to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel at MassResearch, LLC and outside medical providers such as a hospital which is involved in caring for and following your progress. For example, different departments of a hospital may share medical information about you in order to coordinate the different services/treatments you need, such as prescriptions, lab work, and x-rays. We may also disclose medical information about you to people who may be involved in your medical care after you leave MassResearch, LLC, such as a person you have designated, home health services, clergy, or others who provide services that are part of your care.
” For Payment. We may use and disclose your medical information so that MassResearch, LLC may correctly pay for any medical services or treatments you receive outside of MassResearch, LLC.
” For Health Care Operations. We may use and disclose your medical information for research/clinical operations. These uses and disclosures are necessary to run MassResearch, LLC and make sure that all of our volunteers receive quality care. We may combine medical information about many research volunteers to decide if certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other personnel for review and learning purposes. We may remove information that identifies you from this set of medical information so others may use it to study research and research practice without learning who the specific volunteers are i.e., Arthritis Foundation, American Diabetes Association. We may also combine the medical information we have with medical information from other research facilities to compare how we are doing and see where we can make improvements in the care and services we offer.
” Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at MassResearch, LLC.
” Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options, medical research, 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 be of interest to you.
” Research. We may disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research.
” As Required By Law. We will disclose your medical information when required to do so by federal, state or local law.
” To Avert a Serious Threat to Health or Safety. We may use and disclose your medical information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would be only to someone able to help prevent the threat.
” Special Situations – We may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
” Organ and Tissue Donation. If you are a potential organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transplantation.
” Military and Veterans. If you are a member of the armed forces, we may release your medical information as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
” Workers’ Compensation. We may release your medical information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
” Public Health Risks. We may disclose your medical information for public health activities. These activities generally include the following:
” to prevent or control disease, injury or disability;
” to report births and deaths;
” to report child abuse and/or neglect;
” to report reactions to medications or problems with products;
” to notify people of recalls of products they may be using;
” to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
” to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will make this disclosure only if you agree or when required or authorized by law.
” Health Oversight Activities. We may disclose your medical information to a health oversight agency for activities authorized by law. These oversight activities include, 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.
” Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your medical information in response to a court or administrative order. We may also disclose your medical information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but we will do so only if efforts have been made to tell you about the request or to obtain a court order protecting the information requested.
” Law Enforcement. We may release your medical information if asked to do so by a law enforcement official in accordance with applicable laws:
” In response to a court order, subpoena, warrant, summons or similar process;
” To identify or locate a suspect, fugitive, material witness, or missing person;
” About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
” About a death we believe may be the result of criminal conduct;
” About criminal conduct at MassResearch, LLC; and
” In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
” 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 research volunteers to funeral directors or designees as necessary to carry out their duties.
” National Security and Intelligence Activities. We may release your medical information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
” Protective Services for the President and Others. We may disclose your medical information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
” Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights regarding medical information we maintain about you:
” Right to Inspect and Obtain a Copy. You have the right to inspect and obtain a copy of your medical information that may be used to make decisions about your care. This request usually includes medical and billing records but does not include psychotherapy notes. In such case we would refer you to your attending physician.
To inspect and obtain a copy of your medical information that may be used to make decisions about you, you must submit your request in writing to the Health Information , MassResearch 3 Hope Ave. Waltham, MA 02453. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and obtain a copy in certain very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the MassResearch, LLC will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
” Right to Amend. If you think that the 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 MassResearch, LLC. Your request for an amendment will become a legal part of your medical record, to be sent out in addition to the rest of the record whenever a request for copies is received. No part of the original documentation can legally be destroyed.
To request an amendment, your request must be made in writing and submitted to the Health Information , MassResearch, LLC 3 Hope Ave. Waltham, MA 02453. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend information that:
” Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
” Is not part of the medical information kept by or for MassResearch, LLC;
” Is accurate and complete.
” Right to Request an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosures we may have made of your medical information without your authorization and the release was not part of treatment, payment and healthcare operations.
To request this list or accounting of disclosures, you must submit your request in writing to the Health Information , MassResearch, LLC, 3 Hope Ave. Waltham, and MA 02453. 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 first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost 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 on the medical information we use or disclose about you concerning your research relationship with us.
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 or the payment for your research participation, such as a family member or friend.
We are not required to agree to your request for restrictions. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to the Health Information , MassResearch, LLC, 42 Weston St. Waltham, MA 02453. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
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 can ask that we contact you only at work or by mail.
To request confidential communications, you must make your request in writing to Health Information, MassResearch, LLC 3 Hope Ave. Waltham, MA 02453. We will not ask you the reason for your request. We will attempt to 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. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website, www.massresearch.com. To obtain a paper copy of this notice, please contact the Health Information, MassResearch, LLC, 3 Hope Ave. Waltham, MA 02453
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice at MassResearch, LLC. The notice will contain on the first page, in the top right-hand comer, the effective date. In addition, each time you volunteer with us, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with MassResearch, LLC or with the Secretary of the Department of Health and Human Services. To file a complaint with MassResearch, LLC, contact Health Information , MassResearch, LLC, 42 Weston Street Waltham MA 02453. All complaints must be submitted in writing.
You will not be penalized for filing a complaint. 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, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back 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.