NEWARK RADIATION ONCOLOGY PRIVACY STATEMENT 

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 is a formal notification, as required by the government concerning the privacy of this practice. This practice has an obligation to maintain all medical information in the strictest of confidence. Our practice cannot release information without your written consent, including medical records, conversations, reminder calls, test results and other confidential issues. Patient information about health care is identified as “PHI” or protected health information. This new policy requires that you, the patient, identify at the time of registration with us specific information about release of information. You can change this information at any time with either written notification or verbal notification, followed up in writing.

•  Your protected health information (PHI) is a part of your medical care, and can be used or disclosed as follows:

For your treatment in this practice and other locations under our immediate care for your needs. This may include medical assessment, diagnostic testing and procedures. This includes coordination with other physicians involved with your care, referrals, and related care needs such as home care agencies, hospice, or spiritual support needed by you during the course of your care.

For obtaining payment for treatment with your identified health care program. This would include any documentation related to this care, including history forms, progress notes, test results and procedure notes. This would include eligibility verification, prior authorization and claim submission.

For operations of this practice, such as enrolling with insurance programs, hospital privileges, Quality Care Programs and compliance with federal and state laws and regulations.

Appointment reminders and health related benefits services ONLY with your consent identified on the registration form.

Disclosure to your family and friends concerning any  related care information with your consent on the registration form which can be modified at any time orally, followed by written consent.

Medical records are provided only to executors of estates.

Consent is not required for emergency care and treatment. An emergency is identified as a medical condition that in the judgement of the physician requires information for care on your behalf.

• Certain disclosures can be made without your consent, and they are as follows:

Disclosure required by the government or law enforcement agencies. This would include transplant registries.

Information used for public health purposes, medical examiners or related to a person’s death or for the health department for disease tracking. This would include a funeral director.

Information used for health care oversight, such as site review by an insurance program.

Worker’s compensation or employee paid exams.

• Your rights for your health information include:

The right to request limits on the uses and disclosures at registration or at any time during your care. The to choose how we send this information to you, including an alternate address. The right to see an obtain copies of your PHI, but there may be  copy and postage fees. The right to get a listing of who we have made disclosures to about your PHI. The right to correct your file through an amendment process if appropriate.

This practice reserves the right to modify or change this Privacy Statement and process at any time. Revisions to the Notice will be available upon request by contacting the office. The changes will be effective retroactively to the initial date of the Privacy Notice. An updated Privacy Notice will be posted in the office within 60 days of revision.

If you have a concern or complaint about how your protected health information is being used, from this time forward you should first contact our Practice Administrator to resolve your concerns or you may contact the office listed below.

Office of Civil Rights-Regional Manager Department of Health & Human Services

233 N. Michigan Ave., Suite 240 Chicago, IL 60691