Alex M. Mercado, M.D.

Internal Medicine

191 Rt. 206

Flanders, NJ 07836

(973) 584-0045

NOTICE OF PRIVACY POLICIES AND PRACTICES FOR

Alex M. Mercado, M.D., L.L.C.

 Dear Patient:

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

Please review it carefully. 

INTRODUCTION

We are committed to treating and using protected health information about you responsibly. This notice describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This notice is effective April 14, 2003 and applies to all protected health information as defined by federal regulations.

UNDERSTANDING YOUR MEDICAL RECORD/HEALTH INFORMATION

Each time you visit our office a record of your visit is made. Typically, this record contains information about your visit including your examination, diagnosis, test results, treatment as well as other pertinent healthcare data. This information, often referred to as your health or medical record, serves as a:

	Basis for planning your care and treatment
	Means of communication with other health professionals involved in your care
	Legal document outlining and describing the care you received
	A tool that you, or another payer (your insurance company) will use to verify that services billed were actually provided
	An educational tool for medical health providers
	A source for possible medical research
	Basis for public health officials who might use this information to assess and / or improve state as well as national healthcare standards
	A source of data for planning and/or marketing
	A tool that we can reference to ensure the highest quality of care and patient satisfaction

Understanding what is in your record and how your health information is used helps you to ensure it’s accuracy, determine what entities have access to your health information, and make and informed decision when authorizing the disclosure of this information to other individuals.

YOUR RIGHTS

You have certain rights under the federal privacy standards. These include

	The right to request restriction on the use and disclosure of your protected health information
	The right to receive confidential communications concerning your medical condition and treatment
	The right to inspect and copy your protected health information
	The right to amend or submit corrections to your protected health information
	The right to receive an accounting of how and to who your protected health information had been disclosed
	The right to receive a printed copy of this notice

OUR RESPONSIBILITIES

Alex M. Mercado, M.D., L.L.C. is required to:

	Maintain the privacy of your health information
	Provide you with this 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 regarding communication of health information via alternative means and locations

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will b applied to all protected health information that we maintain. We will not use or disclose your health information without your authorization, except as described in this notice. We will also discontinue to use or disclose your health information after we have receive a written revocation of the authorization according to procedures included in the authorization.

HOW WE MAY USE AND / OR DISCLOSE YOUR HEALTH INFORMATION

We will use your health information for treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluation your health, diagnosing medical conditions and providing treatment. For example, results of laboratory test and procedure will be available in your medal record to all health professionals who may provide treatment or who may be consulted by staff members.

We will use your information for payment. Your health plan may request and receive information on dates of service, the services provided and the medical condition being treated in order to pay for the service rendered to you.

We will use you information for regular health operations. Your health information may be used as necessary to support the day to day activities and management of Alex M. Mercado, M.D., L.L.C.. For example: information o the services you received may be used to support budgeting, financial reporting and activities to evaluate and promote quality care.

Business Associates. In some instances, we have contracted separate entities to provide services for us. These “associates” require your health information in order to accomplish the tasks that we ask them to provide. Some example of these “business associates” might be a billing service, collection agency, answering service and a computer software / hardware provider.

Communication With the Family. Due to the nature of our field, we will use our best judgment when disclosing health information to a family member, other relatives, or any other person that is involved in your care or that you have authorized to receive this information. Please inform the practice when you do not wish a family member or other individual to have authorization to receive your information.

Research / Teaching / Training. We may use your information for the purpose of research, teaching and training.

Healthcare Oversight. Federal law requires us to release your information to an appropriate health oversight agency, public health authority or attorney, or other federal / state appointee if there are circumstances that require us to do so.

Public Health Reporting. Your health information may be disclosed to public health agencies as required by law.

Law Enforcement. Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting.

Appointment Reminders. The practice may use your information to remind you about upcoming appointments. Typically, appointment reminders are sent by mail on a postcard or a brief specific message may be left on you answering machine. If you don’t approve of these methods or if you prefer alternative methods (i.e. mail) please inform the practice.

Other Uses and Disclosures. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have complaints, questions or would like additional information regarding this notice or the privacy practices of Alex M. Mercado, M.D., L.L.C. please contact the practice’s Privacy Official at:

                                    Ms. Linda Rossi, M.A.

                                    C/o Alex M. Mercado, M.D., L.L.C.

                                    191 Route 206

                                    Flanders, NJ 07836

                                    Tel: (973) 584-0045

If you believe that your privacy rights have been violated, please contact the aforementioned practice Privacy Official or you may file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint with either the practice’s Privacy Official or with the Office for Civil Rights. The address for the Office for Civil Rights is listed below:

Office for Civil Rights

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Room 509F, HHH Building

Washington, D.C. 20201

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