Clinic Privacy Notice
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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.
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our website at womentowomenhealthcarecenter.com, by calling the office at 207-846-6163 and requesting that a revised copy be sent to you in the mail or requesting one from a member of our front office staff.
Understanding Your Health Record — Information
Each time you visit a healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and 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
tool in educating heath professionals
source of data for medical research
source of information for public health officials charged with improving the health of the nation
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
Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:
request a restriction on certain uses and disclosures of your information
obtain a paper copy of the notice of information practices upon request
inspect and obtain a copy of your health record
amend your health record
obtain an accounting of disclosures of your health information
requst communications of your health information by alternative means or at alternative locations
revoke your authorization to use or disclose health information except to the extent that action has already been taken
Our Responsibilities
This organization is required to:
maintain the privacy of your health information
provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
abide by the terms of this notice
notify you if we are unable to agree to a requested restriction
accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
We will not use or disclose your health information without your authorization, except as described in this notice.
If you believe your privacy rights have been violated, you can file a complaint with our Privacy Office or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. You may contact our Privacy Officer, Donna Poulin, at (207) 846-6163 or by e-mail at donna@womentowomen.com for further information about the complaint process.
Examples of Disclosures for Treatment and Payment
Will use your health information for treatment. For example, Information obtained by a therapist or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. We may provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you.
Business associates: There are some services provided in our organization through contacts with business associates. Examples include our billing service and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition. Communication with family – Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.
Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Marketing: We may 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.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
If you have any questions about this notice please contact our Privacy Officer:
Marcelle Pick
170 Route 1 Suite 110
Falmouth, ME 04105
Ph: 207-846-6163
Fax: 207-846-6167
www.womentowomenhealthcarecenter.com
This notice was published and became effective on April 14, 2003.
We invite you to become our patient
Over the past 25 years our practitioners have helped thousands of women restore their health and well-being.
We often detect underlying imbalances that conventional practitioners miss. Over the years we have developed a specialization resolving the symptoms of:
Adrenal Imbalance
Thyroid Imbalance
Depression or Anxiety
Menopause and Perimenopause
PMS
Digestive Problems
We invite you to book an appointment now by calling 1-800-540-5906. If you cannot make the trip to Maine, we offer phone consultations both for new patients and for follow-up care with patients that live far away.
To book an appointment at either the clinic or via the phone, please call us toll free at 1-800-540-5906 now.
