Notice of Privacy Practices (HIPAA) at Princeton Lifestyle Medicine
Notice of Privacy Practices - Princeton Lifestyle Medicine
Lynne B. Kossow, MD
Barbara A. Brown, MD
Francis Rehor, MD
Emily Sandberg, MD
Effective Date: May 21, 2025
SUMMARY
WHAT IS THIS NOTICE FOR? This Notice of Privacy Practices (Notice) describes how your doctors at Princeton Lifestyle Medicine (PLM), their selected covering physicians, and the PLM practice staff (We or Us) may use and disclose your medical information that we maintain and how you can get access to this information.
WHO ARE WE? Princeton Lifestyle Medicine is an Internal Medicine practice which consists of four independent physicians working in an Organized Healthcare Arrangement (OHCA) as well as their shared employed medical assistants, employees and other personnel. This Notice applies to these individuals as well as all the services that are provided to you at our offices.
WHY DO YOU NEED THIS NOTICE? The Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act (HIPAA), places certain obligations upon us regarding how we may use and disclose your personal health information (PHI). Your PHI includes medical information about you such as your medical record and the care and services you have received. We are committed to maintaining the privacy of your PHI. When we need to use or disclose it, we will comply with this Notice. Anytime we are permitted to or required to share your PHI with others, we only provide the minimum amount of data necessary to respond to the need or request unless otherwise permitted by law.
WHEN CAN WE USE/DISCLOSE YOUR PHI? There are certain uses and disclosures of your PHI that we may undertake without your written or other authorization. These uses and disclosures may be for purposes such as to provide you with treatment, obtain payment for services we have provided, and other health care operations (such as administration, quality improvement, cost studies and other activities designed to improve the care we provide to all our patients). Some other examples include PHI being shared with or disclosed to: your caregivers who you have specifically identified as being involved in your care and have not expressed an objection to us sharing your health information with; public health authorities for public health activities authorized by law; reporting of abuse or neglect as may be required by law; health care oversight activities; judicial and administrative proceedings, as required and permitted by law; law enforcement officials for limited purposes required or authorized by law; workers’ compensation, and other individuals and activities as set forth in this Notice. Individuals who may have access to your information without your written or other authorization may include doctors, nurses, health care students, and other hospital staff involved in your treatment.
WE MUST OBTAIN YOUR WRITTEN AUTHORIZATION FOR ANY USE OR DISCLOSURE NOT SET FORTH IN THIS NOTICE. You may revoke this authorization AT ANY TIME. In addition to obtaining your written authorization for uses or disclosures not described in this Notice, we generally will also need to seek your written authorization or approval prior to disclosing the following information:
We will also seek your written authorization for any “marketing” activities we may conduct or where we would receive money for providing a third party with your PHI.
WHAT RIGHTS DO YOU HAVE FOR YOUR PHI? You have the right to ask us to limit certain uses and disclosures of your PHI. We will consider ALL requests but may not be required to agree to your requested limitations. You also have the right to inspect and receive copies of your PHI, the right to request a change or amendment be made to your PHI, the right to an accounting (a list) of certain disclosures of your PHI, and the right to revoke any authorization you may have made to the extent we have not yet relied upon it. You also have the right to receive a paper copy of this Notice at any time.
CAN WE CHANGE THIS NOTICE? We may change this Notice at any time. The revised Notice will apply to all PHI that we maintain. However, if we do change this Notice, we will only make changes to the extent permitted by law. We will also make the revised Notice available to you by posting it in a place where all individuals seeking services from us will be able to read the Notice as well as on our website at www.princetonlifestylemedicine.com. You may also obtain the Notice in hard copy from our Office.
ADDITIONAL INFORMATION/COMPLAINTS. You may contact our Office if you wish any additional information or have questions concerning this Notice or your PHI. If you feel that your privacy rights have been violated, you may also contact our Office OR file a written complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services. We will NOT retaliate against you if you file a complaint with us or the Office of Civil Rights.
THE ABOVE IS ONLY A SUMMARY OF THE RIGHTS AND OBLIGATIONS WITHIN THIS NOTICE. PLEASE READ CAREFULLY THE ENTIRE NOTICE THAT FOLLOWS.
WE WELCOME ANY QUESTIONS YOU MAY HAVE.
NOTICE OF PRIVACY PRACTICES
Princeton Lifestyle Medicine
Lynne B. Kossow, MD
Barbara A. Brown, MD
Francis Rehor, MD
Emily Sandberg, MD
Effective Date: May 21, 2025
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.
USES AND DISCLOSURES OF YOUR PHI THAT DO NOT REQUIRE YOUR AUTHORIZATION
We are permitted by law to use and disclose your PHI without your written or other form of authorization under certain circumstances as described below. This means that we do not have to ask you before we use or disclose your PHI for purposes such as to provide you with treatment, seek payment for our services, or for health care operations. We may also use or disclose your PHI without asking you for other activities or to state and/or federal officials.
Treatment, Payment and Health Care Operations.
If you are not present or, due to your incapacity or an emergency, you are unable to agree or object to a use or disclosure, we may exercise our professional judgment in order to determine whether such use or disclosure would be in your best interests. Where we would disclose information to a family member, other relatives, or another individual involved in your care, we would disclose only that information we believe is directly relevant to his or her involvement with your care or payment related to your care. We will also disclose your PHI in order to notify or assist with notifying such persons of your location, general condition or death. You may at any time request that we do NOT disclose your PHI to any of these individuals.
USES AND DISCLOSURES OF YOUR PHI THAT REQUIRE YOUR WRITTEN AUTHORIZATION
In general, we will need your specific written authorization on our HIPAA Authorization Form to use or disclose your PHI for any purpose other than those listed above. For example, we would need your written authorization to disclose psychotherapy notes, or need you to indicate on the HIPAA Authorization Form that we may send you marketing materials. We will seek your specific written authorization for at least the following information unless the use or disclosure would be otherwise permitted or required by law as described above:
YOUR RIGHTS REGARDING YOUR PHI
Although we will carefully consider all requests for additional restrictions on how we will use or disclose your PHI, we are not required to grant your request unless your request relates solely to disclosure of your PHI to a health plan or other payor for the sole purpose of payment or health care operations for a health care item or service that you or your representative have paid us for in full and out-of-pocket. Requests for restrictions must be in writing. Please contact the Office if you wish to request a restriction.
Requests for amendments must be in writing. Please contact the Office if you wish to request an additional restriction on a use/disclosure of your PHI.
INFORMATION REGARDING THE LENGTH AND DURATION OF THIS NOTICE
This Notice is effective as of the “Effective Date” indicated at the top of this Notice. We will abide by the terms of this Notice as is currently in effect, however, we may change this notice at any time. Changes to this Notice will apply to all PHI that we maintain. However, if we do change this Notice, we will only make changes to the extent permitted by law. We will also make the revised Notice available to you by posting it in a place where all individuals seeking services from us will be able to read the Notice as well as on our website at www.princetonlifestylemedicine.com. You may obtain the new Notice in hard copy as well from our Office.
COMPLAINTS/ADDITIONAL INFORMATION
You may contact our Office at any time if you wish any additional information or have questions concerning this Notice or your PHI. If you feel that your privacy rights have been or may have been violated, you may also contact our Office OR file a written complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services. We will NOT retaliate against you if you file a complaint with us or the Office of Civil Rights. If you wish to file a written complaint with the Office of Civil Rights, please contact the Office and we will provide you with the contact information.
OUR CONTACT INFORMATION
You may contact us with any concerns or for additional information regarding our privacy practices by calling or writing the Office at:
Princeton Lifestyle Medicine
731 Alexander Rd, Ste 201
Princeton, NJ 08540
(609) 655-3800