We may release your medical information to Workers' Compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Public Heath Risks:
Your medical information may be disclosed for public health activities such as:
We may have to disclose your medical information in response to a court or administrative order.
If asked by a law enforcement official, we may release your medical information:
In response to a court order, subpoena, warrant or similar process
• To identify or locate a suspect, fugitive, material witness or missing person
You have the right to request access to, inspect and copy your medical information. This includes medical and billing information, but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to: Deepa Venkatrao, 461 Vose Avenue, 2nd Floor, South Orange, New Jersey, 07079. If you request a copy we may charge a fee for the costs of copying, mailing or other supplies related to your request.
You have the right to ask us to amend or change any information you feel is incorrect or incomplete. You have the right to ask for this amendment for as long as the information is kept in this office. An amendment request must be made in writing, including the reason you are requesting the amendment. You may be denied if it is not in writing or does not include a reason for the request.
In addition, we may deny your request if you ask us to amend information that:
You have the right to an "accounting of disclosures of." This is a list of the disclosures we have made of your medical information for reasons other than what was stated above. To request this list you must again request it in writing. Your request must state a time period and cannot include dates before April 2003. The first list you request within a 12-month period will be free. For an additional list, you may be charged a fee for providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request.
You have a right to request a restriction or limitation on your medical information. This includes the amount of information we provide to a friend, family member or one involved with your care or payment of treatment. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency care. To request restrictions, the request must be in writing and include: what information you want to limit, whether you want to limit our use, disclosures or both and to whom you want the limits to apply. (Example: disclosures to your spouse)
You also have the right to request that we communicate with you about your medical matters in a certain way. For example, you may request us to contact you only at work and not at home. Again, your request must be made in writing and express how or where you want to be contacted. We will honor all reasonable requests and not ask for a reason.
You have the right to a paper copy of this notice. You may request a copy at any time. If you are accessing this policy on Tranquilmoney, Inc.'s web site, you may print a copy of it.
Changes to This Notice
Other uses and disclosures of medical information not covered by this notice or the laws that apply to use will be made only with your written consent. If you provide us permission to use or disclose medical information, you may revoke that permission at any time, in writing. If you revoke your permission, we will no longer use or disclose your medical information for the reason covered in your request. You understand that we cannot take back any disclosures we have already made with your permission and that we are required to retain our records of the care that we provided to you.
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