HIPAA Privacy Notice (effective as of April 14, 2003)

This notice describes how medical information about you may be used and shared and how you can get access to this information. Please review it carefully.

Uses and Disclosures of Your Medical Information

1. Treatment.Your "Protected Health Information" is routinely shared among health care professionals involved in your care to coordinate or manage treatment, both within and outside Lahey Clinic. Laboratory results, for example, may be shared with a rehabilitation hospital as part of your discharge planning.
2. Payment.Your medical information may be shared with your medical insurer so that Lahey Clinic can be paid by your insurer for services provided to you. A summary of your hospital stay may be provided to your insurer; for example, to determine that hospital services were medically necessary.
3. Health Care Operations.Your medical information is sometimes used to assess and improve quality of care or re-allocate resources. Non-patient specific information is used wherever possible. The details of your surgical procedure, for instance, may be shared among surgeons at a department meeting to evaluate your surgery based on the outcome.
4. Facility Directory.Unless you tell us not to, we may use the following information in a facility directory: (a) your name; (b) your location in Lahey Clinic; (c) your general condition; and (d) your religious affiliation. We may share this information with members of the clergy, or to other persons who ask for you by name (except for your religious affiliation). You may limit or prohibit these uses and disclosures by notifying a Lahey Clinic representative, doctor, or nurse orally or in writing of your restriction or prohibition. In an emergency or if you can not tell us what you want us to do, we will do what we think you would want us to do, based on your other visits to Lahey Clinic (if any). We will tell you about any uses or disclosures as soon as we can and give you a chance to object as soon as practicable.
5. State Law.State law mandates sharing of your medical information to state agencies under certain circumstances, without your consent. Examples include abuse reporting to the Department of Social Services, and Death Reports to the Office of the Medical Examiner.
6. Medical Research.Your medical information may be used to further medical research, but only after approval by the Institutional Review Board, when written permission is not required by Federal or State law.
7. Other Uses and Disclosures. Any other sharing of your medical information will be made only with your written permission and you may take back your permission at any time so long as you tell us in writing except if the Lahey Clinic has acted in reliance upon your permission, or if your permission was obtained so that the services provided would be covered by insurance.

In Addition. The Lahey Clinic may contact you to remind you about your appointment or tell you about health-related benefits or services that may be of interest to you. We may use certain information (name, address, telephone number, dates of service, age and gender) to contact you in the future to raise money for Lahey Clinic. We may also give this information to the Lahey Clinic Foundation for the same purpose. The money raised will be used to increase and improve the services and programs we give to our patients. If you do not wish to be contacted for our fundraising efforts, please contact the Director of Annual Programs and Operations, Lahey Clinic, 41 Mall Road, Burlington, MA 01805, (781) 744-3908, (781) 744-5265 (FAX).

Your Rights

1. You may ask us to limit our sharing of your information, but the Lahey Clinic does not have to agree to what you ask.
2. You have the right to receive communications of your information at alternative locations or by alternative means.
3. You have the right to see and get a copy of your medical records.
4. If you think there is something wrong or missing in your medical information, you can ask that it be changed, unless the information was created elsewhere, is unavailable, or is determined to be already accurate and complete.
5. You have a right to ask us for a limited accounting of disclosures of your information. The medical records department can provide you with more details.

The Duties of the Lahey Clinic

1. The Lahey Clinic is required by law to keep your medical information private and to give patients this Notice of its legal duties and privacy practices for medical information. The Lahey Clinic is required to agree to the terms of this Notice. The Lahey Clinic reserves the right to change the terms of this Notice, and to make the new terms apply to all medical information it keeps. This Notice and any changed Notices will be conspicuously posted in public spaces at the Clinic, made available on the Lahey Clinic web site, and given to you in paper copy upon your request.
2. Any patient believing that his or her privacy rights have been violated may complain through the Lahey Clinic Customer Relationship Management Department at 781-744-8556 or file a complaint directly with the Secretary for the United States Department of Health and Human Services at e-mail address ocrprivacy@os.dhhs.gov or call 202-619-0257. Patients will not be retaliated against for filing a complaint.
3. For further information about this Notice contact the Customer Relationship Management Department at 781-744-8556 and ask to speak to a patient advocate.