JOINT NOTICE OF PRIVACY PRACTICES - THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED, DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
MHP Conshohocken, LLC. are required by law to maintain the privacy of your Protected
Health Information (PHI). MHP Conshohocken, LLC. provide clinically integrated services and
consist of an organized health care arrangement (OCHA).This Notice describes how we will treat your PHI and
how we may use and disclose your PHI to carry out treatment, payment or health care operations and for other
purposes that are permitted or required by law. We may share your health information for treatment, payment
and health operations as described in this Notice. This Notice also describes your rights to access and control
your PHI. PHI is information about you, including demographic information, that may identify you and that
relates to your past, present or future physical or mental health or condition and related health care services.
Uses and Disclosures of Protected Health Information. Your PHI may be used and disclosed by the physician,
our office staff and others outside of our offices that are involved in your care and treatment for the purpose of
providing health care services to you, to pay your health care bills, to support the operation of the business, and
any other use required by law. We may disclose PHI to family members, close friends or others concerned with
your care and treatment.
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any
related services. This includes the coordination or management of your health care with a third party. For
example, your PHI may be provided to a physician to whom you have been referred or are receiving treatment
from to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your PHI will be used to obtain payment for your health care services. For example, we may provide
PHI to your insurance company to obtain authorization and payment for services rendered. We may contact the
Guarantor for your visit in order to obtain payment.
Healthcare Operations: We may use or disclose your PHI in order to support our business activities. These
activities include, but are not limited to business associates, quality assessment activities, internal
investigations, performance reviews, and training employees. In addition, we will use a sign-in sheet at the
registration desk where you will be asked to provide your name and insurance company. We may also call you
by name in the waiting room when the physician is ready to see you. We may use or disclose your PHI to contact
you to remind you of an appointment, to notify you of test results, to inform you of health-related services that
may be of interest to you, and to check on your treatment, progress, and satisfaction with our services.
We may use or disclose your PHI in the following situations without your authorization: As required by Law, for
Public Health issues, Communicable Diseases, Health Oversight, Abuse or Neglect, Food and Drug Administration
requirements, Legal proceedings, Law Enforcement, Coroners, Funeral Directors, Organ Donation, Preliminary
Research Identification, Research with an IRB waiver, Criminal Activity, Military Activity, to avert a serious and
imminent threat to a person or the public, National Security, to comply with Worker’s Compensation laws,
Inmates, Disaster Relief and other Required Uses and Disclosures. Under the law, we must make disclosures to
you and when required by the Secretary of the Department of Health and Human Services.
Other permitted and required uses and disclosures, such as for marketing or sale of your PHI to third parties, will
be made only with your authorization. Once given, you may withdraw authorization at any time in writing
delivered to the address given below.
You have the right to inspect and copy your protected health information. Under federal law, you may not
inspect or copy psychotherapy notes, information compiled in anticipation of, or use in, a legal proceeding, and
PHI that is otherwise prohibited.
You have the right to request a restriction of your protected health information. This means you may ask us not
to use or disclose any part of your PHI for the purposes of treatment, payment or health care operations. Your
request must be in writing, delivered to the address given below, and state the specific restriction requested and
to whom you want the restriction to apply. If you have paid for your services in full and ask us not to disclose
your visit to your insurance company, we will honor that request. We are not required to agree to any other
restriction that you may request and if we believe it is in your best interest to permit use and disclosure of your
PHI, it will not be restricted. You then have the right to use another health care professional.
You have the right to receive confidential communications from us by alternative means, or at an alternative
location by notifying us in writing, delivered to the address given below.
You have the right to obtain a paper copy of this notice from us, upon request to the Clinic Manager or our
You may have the right to ask us to amend your protected health information. If we deny your written request
for amendment, you have the right to deliver a statement of disagreement with us at the address given below
and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health
information. Your request must be in writing, delivered to the address given below. We are required to notify
you if your unsecured PHI is involved in a reportable breach.
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have
been violated. Or, you may file a complaint with us by mail or by contacting our Privacy Officer at 484-243-6735.
We will not retaliate against you for filing a complaint.
Management Company reserves the right to change the terms of this notice. Any change will apply to all PHI
that we maintain. We post our current policy at each location and on our website. All written requests must be
delivered to the Clinic Manager or mailed to HIPAA Privacy Officer. 48A E Ridge Pike, Conshohocken, PA 19428.