Notice of Privacy Practices

This notice describes how medical information about you may be used or disclosed and how you can get access to this information.

Please review this information carefully.

Each time you visit a LAMOILLE HEALTH PARTNERS physician, or other healthcare provider, a record of your visit is made. This information is your health or medical record and it is an essential part of the health care we provide for you. LAMOILLE HEALTH PARTNERS is required by the Federal Privacy Rules to:

• Maintain the privacy of your health information
• Provide you with this notice about our privacy practices with respect to your health information
• Follow the information practices that are described in this notice

We are committed to protecting the privacy and security of your health information and will follow the terms of our notice that is currently in effect.

LAMOILLE HEALTH PARTNERS reserves the right to change our health information practices and the terms of this notice, and to make the new provisions effective for all protected health information we maintain, including health information created or received prior to the effective date of any such revised notice. If our health information practices change, we will post our revised notice in the reception areas and on our website. We will not use or disclose your health information except as described in this notice.

Although your health record is the physical property of LAMOILLE HEALTH PARTNERS, the information belongs to you. You have the right to:

• Receive this notice describing the uses and disclosures we expect to make of your health information.
• Request restrictions on use or disclosure to a health plan when full payment for a service has been made out of pocket. The Request for Restriction on Use and Disclosure Form (on website) must be filled out and given to the clinic.
• Request additional restrictions on uses and disclosures of your health information, however, LAMOILLE HEALTH PARTNERS is not required to agree to any such request. The Request for Restriction on Use and Disclosure Form must be filled out.
• Request that we send you confidential communications of protected health information by alternative means or to alternative locations. The Request for Specified Methods of Communication Form (on website) must be filled out and returned to the clinic.
• Inspect and obtain a copy of your health record. Contact the clinic for instructions on how to do this.
• Request that your health record be amended. A request for amending your health information must be in writing using the Amendment/Correction Request Form (on website) and directed to the appropriate clinic contact.
• Obtain an accounting of disclosures of certain health information made within the last six years for purposes other than treatment, payment and health care operations. The “Request for Accounting of Disclosures Form (on website) must be filled out and directed to the Privacy Officer at LAMOILLE HEALTH PARTNERS.
• Obtain a paper copy of the Notice of Privacy Practices upon request even if you have received the Notice electronically.
• Be notified within 60 days if there is a breach-compromise to the privacy/security of your health information
• We will use your health information for treatment. For example, a doctor treating you for an injury asks another doctor about your overall health condition.

We will use your health information for payment. For example, a bill may be sent to you or your insurance company or health plan. The information on or accompanying the bill may include information that identifies you and may contain your diagnosis, procedures performed, and supplies used.

We will use and disclose health information for uses and disclosures that are necessary to operate and manage our office and to review our care to make sure that all of our patients receive quality care. For example, we may use your health information to evaluate our staff in caring for you.

We may use and disclose health information about you to remind you that you have an appointment with us for treatment or that it is time for you to schedule an appointment with us.

We may provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.  

We may disclose health information to business associates that provide us with services if the information is necessary for the services. 

For example, we may use another company to perform billing services on our behalf or consult with us about our electronic records. All of our business associates are obligated to protect the privacy of your information and are not permitted to use or disclose any health information other than as specified in our contract.

We may use your health information for fundraising to support LAMOILLE HEALTH PARTNERS’s operations. You may opt–out of fundraising communications by contacting the Privacy Officer. We will honor your opt out, permit you to opt back in and will not condition treatment on your decision. 

The Federal Privacy Rules require us to disclose your personal health information to you at your request and to the Secretary of Health and Human Services when requested as part of an investigation or compliance review.

In addition, we are required to use and disclose your health information without your authorization for certain purposes:

• When required by state or federal law
• To state and federal public health authorities, including state medical officers, the Food and Drug Administration, and other agencies charged with preventing or controlling disease
• To government authorities, including protective service agencies, authorized to receive reports of abuse and neglect
• To government health oversight agencies, such as the state and federal Departments of Health and Human Services, Medicare/Medicaid Peer Review Organizations, state Boards of Medicine, Nursing, and Pharmacy, and other licensing authorities
• When required by court order in a judicial or administrative proceeding
• To law enforcement officials for certain law enforcement purposes, including the reporting of certain types of wounds or injuries 
• To coroners, medical examiners, or funeral directors for purposes of identifying a deceased person or carrying out their duties as required by law
• For purposes of organ or tissue donation and transplantation, consistent with applicable law
• For research approved by an Investigational Review Board or Privacy Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information
• When required to avert a serious threat to health or safety
• When requested for certain specialized government functions authorized by law, including military and similar situations, e.g., national security, correctional facility (if you are an inmate), Workers Compensation to comply with laws related to work related injury programs.

We expect to make other uses and disclosures of your protected health information only on the basis of written authorization forms signed by you. You have the right to revoke any such authorization at any time, except to the extent we have already relied on it in making an authorized use or disclosure.

You have the right to complain to the LAMOILLE HEALTH PARTNERS Privacy Officer or the Secretary of Health and Human Services if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to LAMOILLE HEALTH PARTNERS or to the Department of Health and Human Services.