Action Medicine DPC

400 Washington St. Ste 101 Braintree, MA 02184 

781-767-0910

Notice of Privacy Practices Your Information. Your Rights. Our Responsibilities. October 1st, 2017 At Action Medicine DPC (“Action Medicine” or “we” or “us”) we are dedicated to preserving and protecting the privacy of your Personal Health Information (PHI). This notice describes how medical information Atlas collects about you and your PHI may be used and under what circumstances your PHI may be disclosed. Additionally, notice explains the process about how you can get access to your PHI. Please review this Notice of Privacy Practices carefully. 

1.Uses and Disclosures Of PHI

The following categories describe the different ways in which we may use and disclose your individually identifiable health information, unless you object by filing a written notice to Action Medicine DPC as described below in sections 2 and 6: 

• •Treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosingmedical conditions, and providing treatment. For example, results of laboratory testsand procedures will be available in your medical record to all health professionalswho may provide treatment or who may be consulted by staff members. Additionally,we may disclose your health information to others who may assist in your care, suchas other healthcare providers, your spouse, your children or parent.
• •Payment. Your health information may be used in order to bill and collect paymentfor the services and items you may receive from us. For example, we may use anddisclose your health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your health information to bill you directly for services and items. 

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• Health care operations. Your health information may be used as necessary tosupport the day to day activities and management of Action Medicine DPC. Forexample, information on the services you received may be used to support budgetingand financial reporting, activities to evaluate and promote quality, to developprotocols and clinical guidelines, to develop training programs, and to aid incredentialing medical review and legal services.
• Appointment reminders. Your health information will be used by our staff to contactyou and send you appointment reminders.
• Information about treatments. Your health information may be used to send youinformation that you may find interesting on the treatment and management of yourmedical condition. We may also send you information describing other health relatedproducts and services that we believe may interest you.
• Law enforcement. Your health information may be disclosed to law enforcementagencies to support government audits and inspections, to facilitate law enforcementinvestigations, and to comply with government mandated reporting.
• Release of Information to Family/Friends. Our practice may release your healthinformation to a friend or family member that is involved in your care, or who assistsin taking care of you. For example, a parent or guardian may ask that a babysitter taketheir child for an appointment. In this example, the babysitter or friend may haveaccess to this child’s medical information.
• Patient mass communication. We may use your name and email address(es) and/ortext numbers to contact you with bulk messaging. For instance, to share newpromotions for the clinic, to send clinic newsletters, or to notify you of a physician’supcoming absence, such as for vacations.

Other uses and disclosures in certain special circumstances. 

• •Public Health Risks – (i.e. vital statistics, child abuse/neglect, reporting reactions todrugs or problems with products or devices, exposure to communicable diseases such asCOVID-19)

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• •Health Oversight Activities – (i.e. County Health Departments including State andFederal Health agencies).
• •Lawsuits and Similar Proceedings – May use or disclose in response to a court oradministrative order, if you are involved in a lawsuit or similar proceeding or inresponse to a discovery request, subpoena, or other lawful process.
• •Deceased Patients – may be required to release to a medical examiner or coroner. Ifnecessary, we may also release information in order for funeral director to performtheir jobs.
• •Organ and Tissue Donation
• •Serious Threats to Health or Safety
• •Military – If you are a member of the U.S. or foreign military forces (includingveterans) and if required by the appropriate authorities.
• •National Security
• •Inmates – Our practice may disclose your health information to correctionalinstitutions or law enforcement officials if you are an inmate or under the custody of alaw enforcement official. Disclosure would be necessary for the institution to providehealth care services to you, for the safety and security of the institution, and/or toprotect your health and safety or the health and safety of others.
• •Worker’s Compensation – (i.e. when PHI records have been lawfully subpoenaed)

Disclosures of your health information or its use for any purpose other than thoselisted above requires your specific written authorization. If you change your mindafter authorizing a use or disclosure of your information, you may submit a writtenrevocation of the authorization. However, your decision to revoke the authorizationwill not affect or undo any use or disclosure of information that occurred before yournotified us of your decision to revoke your authorization.

2.Your Rights

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

●The right to request restrictions on the use and disclosure of your protected healthinformation for treatment, payment, or health care operations. You have the right to restrict our disclosure to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do not agree, we are bound by our agreement except when otherwise required by law, in emergencies or when the information is necessary to treat you. You must make your request in writing to the attention of the Privacy Officer. Your request must be described in a clear and concise fashion: 

a)the information you wish restricted;

b)whether you are requesting to limit our practice’s use, disclosure

or both;

c)to whom you want the limits to apply.

●The right to receive confidential communications concerning your medical conditionand treatment. 

●The right to inspect and copy your protected health information. We will provide acopy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of the denial. 

●The right to amend or submit corrections to your protected health information. Thisrequest must be made in writing and submitted to Privacy Officer with reasons to support your request. We may deny your request if you ask us to amend information that is, in our opinion: 

a)accurate and complete;

b)not part of the health information kept by or for the practice;

c)not part of the health information which you are permitted to inspect and copy;or 

d)not created by our practice, unless the individual or entity that created is notavailable to amend the information. 

We will provide a written explanation for any denial in 60 days. 

●The right to receive an accounting of how and to whom your protected healthinformation has been disclosed. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any that you asked us to make). 

We will provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. 5 

●The right to receive a printed copy of this notice, even if you have agreed to receive thenotice electronically.

3.Requests to Inspect Protected Health Information

You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting your physician and/or privacy officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request. 

4.Action Medicine DPC Practice’s Duties

We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice. 

5.Right to Revise Privacy Practices

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. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all protected health information we maintain.

6.Complaints

If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to: 

Action Medicine DPC 400 Washington St. STE 101Braintree, MA 02184

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint. This notice is effective on or after October 1st, 2017.