Notice of Privacy Practices
NOTICE OF PRIVACY PRACTICES OF OPHELIA MEDICAL GROUP
THIS NOTICE DESCRIBES:
- HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
- YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
- HOW TO FILE A COMPLAINT CONCERNING A VIOLATION OF THE PRIVACY OR SECURITY OF YOUR HEALTH INFORMATION, OR OF YOUR RIGHTS CONCERNING YOUR INFORMATION
YOU HAVE A RIGHT TO A COPY OF THIS NOTICE (IN PAPER OR ELECTRONIC FORM) AND TO DISCUSS IT WITH OPHELIA MEDICAL GROUP’S PRIVACY OFFICER AT COMPLIANCE@OPHELIA.COM OR (215) 585-2144 IF YOU HAVE ANY QUESTIONS.
Effective Date: July 26, 2024
Ophelia Medical Group FL, P.A., Ophelia Medical Group CA, P.C., Ophelia Medical Group NJ, P.C., and any other member of its affiliated covered entity (collectively, “Ophelia Medical Group,” “we” or “our”) are required by law to maintain the privacy of your health information in accordance with federal and state law. In particular, we protect the privacy and security of your substance use disorder patient records in accordance with 42 U.S.C. § 290dd–2 and 42 C.F.R. Part 2, the Confidentiality of Substance Use Disorder Patient Records (“Part 2”), applicable state law, and the Health Insurance Portability and Accountability Act and its implementing regulations (“HIPAA”). This Notice of Privacy Practices (“Notice”) outlines our legal duties and privacy practices with respect to health information. We are required by law to maintain the privacy of records, provide you with notice of our legal duties and privacy practices with respect to records, and to notify you following a breach of your unsecured records.
We will abide by the terms of the Notice currently in effect. We reserve the right to make changes to this Notice as permitted by law. We reserve the right to make the new Notice provisions effective for all records and health information we currently maintain, as well as any records and health information we receive in the future. If we make material or important changes to our privacy practices, we will promptly revise our Notice. Each version of the Notice will have an effective date listed on the first page. If we change this Notice, you can access the revised Notice on our website (https://ophelia.com/notice-of-privacy-practices).
You have the right to file a complaint if you believe your privacy rights have been violated. If you would like to file a complaint about our privacy practices, you can do so by contacting the Ophelia Medical Group Privacy Officer by mail at
Ophelia Medical Group
Attn: Privacy Officer
228 Park Ave S, Suite 15314
New York, NY 10003,
by telephone at (215) 585-2144, or
by email at compliance@ophelia.com.
You also have the right to complain to the Secretary of the United States Department of Health and Human Services. You will not be penalized or otherwise retaliated against for filing a complaint.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION:
We will obtain your written consent to use and disclose your health information unless we are permitted to use or disclose your information without your consent under applicable law. The following categories describe the ways that we may use and disclose your health information without your written consent under Part 2. To the extent applicable state law is even more restrictive than Part 2 on how we use and disclose any of your health information, we comply with more restrictive state law.
Within Our Organization. Ophelia Medical Group personnel who have a need for your information in connection with their duties that arise out of the provision of diagnosis, treatment, or referral for treatment may use and share your information. In addition, we may share your information with the entity that has direct administrative control over our substance use disorder program.
Emergency Treatment. In the event of a bona fide medical emergency in which your prior consent cannot be obtained, we may disclose your identifying information to medical personnel.
Business Associates/Qualified Service Organizations. We may disclose your information to third party “business associates” and “qualified service organizations” that perform various services on our behalf, such as transcription, billing, and collection services, and who agree to protect the privacy of your health information.
Audits. We may disclose your health information to entities who are legally permitted to perform audits of our facilities, such as government regulators. Those entities are required to maintain the privacy of your information.
Legal Proceedings. We may disclose your health information pursuant to court orders that meet the requirements of applicable law. Records, or testimony relaying the content of such records, shall not be used or disclosed in any civil, administrative, criminal, or legislative proceedings against you unless based on specific written consent or a court order. Records shall only be used or disclosed based on a court order after you or the record holder is provided notice and an opportunity to be heard, where required by law. A court order authorizing use or disclosure must be accompanied by a subpoena or other similar legal mandate compelling disclosure before the record is used or disclosed.
Reporting Crimes on Our Premises or Against Our Personnel. We may disclose a patient’s commission (or threatened commission) of a crime on our premises or against our personnel to a law enforcement agency or official. We are permitted to disclose information regarding the circumstances of such an incident, including the suspect’s name, address, last known whereabouts, and status as a patient in our program.
Reporting Child Abuse or Neglect. We may report incidents of suspected child abuse and neglect to the appropriate state or local authorities.
Deceased Persons. We may disclose information relating to the cause of death of a patient under laws requiring the collection of death or other vital statistics or permitting inquiry into the cause of death.
Research. Under certain circumstances, we may disclose your health information to researchers who are conducting a specific research project. Your identifying information will never be published without your written consent.
FDA Reporting. We may disclose patient identifying information to medical personnel of the Food and Drug Administration (“FDA”) who assert a reason to believe that the health of any individual may be threatened by an error in the manufacture, labeling, or sale of a product under FDA jurisdiction, and that the information will be used for the exclusive purpose of notifying patients or their physicians of potential dangers.
De-identified Information. We may disclose your de-identified information as permitted by law, including for public health purposes.
OTHER USES AND DISCLOSURES:
Use or disclosure of your health information for any purpose other than those listed above requires your written consent. Some examples include:
- Psychotherapy/Substance Use Disorder Counseling Notes: We will not use and disclose your psychotherapy/substance use disorder counseling notes without your written consent except as otherwise permitted by law.
- Release of Your Presence in Treatment: We will not disclose your presence in treatment to individuals who may contact Ophelia Medical Group unless you have provided your written consent permitting the release.
- Marketing: We will not use or disclose your health information for marketing purposes without your written consent except as otherwise permitted by law.
- Sale of Your Health Information: We will not sell your health information without your written consent except as otherwise permitted by law.
You may provide a single consent for all future uses or disclosures for treatment, payment, and health care operations purposes. Records that are disclosed to a Part 2 program, covered entity, or business associate pursuant to your written consent for treatment, payment, and health care operations may be further disclosed by that Part 2 program, covered entity, or business associate, without your written consent, to the extent HIPAA permits such disclosure.
If you change your mind after consenting to the use or disclosure of your health information, you may withdraw your permission by revoking the consent in writing. However, your decision to revoke the consent will not affect or undo any use or disclosure of your health information that occurred before you notified us of your decision, or any actions that we have taken based upon your consent. To revoke a consent, please notify us by mail at
Ophelia Medical Group
Attn: Privacy Officer
228 Park Ave S, Suite 15314
New York, NY 10003
by telephone at (215) 585-2144,
or by email at compliance@ophelia.com.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION:
This section describes your rights regarding the health information we maintain about you. All requests or communications to exercise your rights discussed below must be submitted in writing to
Ophelia Medical Group
Attn: Privacy Officer
228 Park Ave S, Suite 15314
New York, NY 10003
or by emailing compliance@ophelia.com.
Right to Inspect and Copy. You have the right to inspect and receive a copy of your health information, excluding your psychotherapy/substance use disorder counseling notes. We may charge you a fee as authorized by law to meet your request. You may request access to your health information in a certain electronic form and format, if readily producible, or, if not readily producible, in a mutually agreeable electronic form and format. Further, you may request in writing that we transmit such a copy to any person or entity you designate. Your written, signed request must clearly identify such designated person or entity and where you would like us to send the copy. We may deny your request to inspect and copy in limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed by a licensed health care professional chosen by us. 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 Request Confidential Communications. You have the right to request that we communicate your health information to you in a certain manner or at a certain location. For example, you may wish to receive information through a written letter sent to a private address. We will grant reasonable requests. We will not ask you the reason for your request.
Right to Amend. You have a right to request that we amend or correct your health information that you believe is incorrect or incomplete. For example, if your date of birth is incorrect, you may request that the information be corrected. To request a correction or amendment to your health information, you must make your request in writing and provide a reason for your request. You have the right to request an amendment for as long as the information is kept by or for us. Under certain circumstances we may deny your request. If your request is denied, we will provide you with information about our denial and how you can file a written statement of disagreement with us that will become part of your medical record.
Right to an Accounting of Disclosures. You have the right to request an accounting of certain disclosures we make of your health information. This includes disclosures made with your consent, disclosures for treatment, payment, and health care operations through an electronic health record, and disclosures by an intermediary, in the three years prior to your request. You will not be charged for this accounting, unless you request more than one accounting per year, in which case we may charge you a reasonable cost-based fee for providing the additional accounting(s). We will notify you of the costs involved and give you an opportunity to withdraw or modify your request before any costs have been incurred.
Right to Request Restrictions. You have the right to request restrictions on how your health information is used or disclosed for treatment, payment, or health care operations activities, including when you have signed a consent for these disclosures. However, we are not required to agree to your requested restriction, unless that restriction is regarding disclosure of health information to your health insurance company and: (1) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (2) the health information pertains solely to a health care item or service for which you or another person (other than your health insurance company) paid for in full.
Right to a Copy of This Notice. You have the right to receive a paper or electronic copy of this Notice at any time upon request. A paper copy of this Notice can be obtained at any time from our website at https://ophelia.com/notice-of-privacy-practices.
Right to Discuss This Notice. You have the right to discuss this Notice with us. Please contact us at the contact information listed below.
CONTACT INFORMATION:
If you have questions or concerns about your privacy rights, or the information contained in this Notice, please contact the Ophelia Medical Group Privacy Officer by mail at Ophelia Medical Group, Attn: Privacy Officer, 228 Park Ave S, Suite 15314, New York, NY 10003, by telephone at (215) 585-2144, or by email at compliance@ophelia.com.
