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.
Who We Are
This Notice applies to Conceive NJ, its physicians, clinical staff, employees, and business associates.
Our Responsibilities
We are required by law to:
- Notify you if a breach occurs that may compromise the privacy or security of your information
- Maintain the privacy and security of your protected health information (PHI)
- Provide you with this Notice explaining our legal duties and privacy practices
- Follow the terms of the Notice currently in effect
- Notify you if a breach occurs that may compromise the privacy or security of your information
How We May Use and Disclose Your Information
For Treatment
We may use and share your PHI to provide, coordinate, or manage your fertility, reproductive, gynecologic, or obstetrical care.
Example: Sharing information with labs, embryology teams, referring physicians, or other providers involved in your care.
For Payment
We may use and share your PHI to bill and receive payment from health plans or other payors.
Example: Sending information to your insurance company for coverage determinations.
For Health Care Operations
We may use and share your PHI to operate our practice, improve quality, train staff, and ensure compliance with law.
Example: Quality assessments or internal audits.
Special Protections for Reproductive Health Information
Federal law strictly limits how protected health information related to lawful reproductive health care may be used or disclosed.
Prohibited Uses and Disclosures
We will not use or disclose your PHI for the purpose of:
- Investigating, imposing liability on, or taking legal action against a person for seeking, obtaining, providing, or facilitating lawful reproductive health care
Example: We will not disclose information in response to a request intended to penalize a patient or provider for fertility treatment or other lawful reproductive services.
Written Attestation Requirement
For certain requests (including some law enforcement or legal requests), the requester must provide a written attestation confirming the information will not be used for a prohibited purpose.
We will not disclose PHI unless this attestation is received and reviewed.
Other Permitted or Required Disclosures
We may disclose PHI:
- As Required by Law
- To Prevent a Serious Threat to Health or Safety
- To Business Associates who perform services for us under written agreements
- For Public Health Activities
- For Health Oversight Activities
- For Workers’ Compensation
- For Military or Veteran Activities
- For Legal Proceedings in response to a valid court or administrative order
- To Law Enforcement, only as permitted by law and subject to reproductive health protections
- For Data Breach Notification Purposes
- For Research, subject to legal safeguards and approval processes
Individuals Involved in Your Care
We may share relevant PHI with family members, partners, or others involved in your care or payment for care, unless you object.
Your Rights
You have the right to:
Get a Copy of Your Records
- Inspect or obtain a copy of your medical and billing records (excluding psychotherapy notes)
- Receive records in paper or electronic form
- Direct us to send a copy to a third party you choose
- Receive records within 30 days, with one permitted 30-day extension if needed
- Be charged only a reasonable, cost-based fee, or no fee in certain circumstances
Request Corrections
Ask us to amend your records if you believe information is incorrect or incomplete.
Get a List of Certain Disclosures
Request an accounting of disclosures not made for treatment, payment, or health care operations.
Request Confidential Communications
Ask us to contact you in a specific way or at a specific location. We will accommodate reasonable requests.
Restrict Certain Disclosures
Request restrictions on disclosures to a health plan if you pay for a service in full out-of-pocket.
Get a Paper Copy of This Notice
You may request a paper copy at any time, even if you received this Notice electronically.
Be Notified of a Breach
You have the right to be notified if your unsecured PHI is breached.
Changes to This Notice
We may change this Notice at any time. The revised Notice will apply to all PHI we maintain and will be available in our office and on our website.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with:
Conceive NJ Compliance Officer
Suzanne O’Reilly
Phone: 732-807-1613 ext. 102
Email: [email protected] may also file a complaint with the U.S. Department of Health and Human Services.
You will not be retaliated against for filing a complaint.