WHAT IS THIS NOTICE FOR? This Notice of Privacy Practices (Notice) describes how Maryville (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? Maryville is a private, nonprofit organization which consists of all employed doctors, nurses, employees and other healthcare professionals. This Notice applies to these individuals as well as all services that are provided to you at our facility/any of our facilities, including but not limited to
1903 Grant Avenue, Williamstown, NJ 08094
129 Johnson Road # 7, Turnersville, NJ 08012
1173 E. Landis Ave., Vineland, NJ 08360
121 Johnson Road Suite 4, Turnersville, NJ 08012
1907 New Rd, Northfield, NJ 08225
WHY DO YOU NEED THIS NOTICE? The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 42 U.S.C. 1320d et seq., 45 C.F.R. Parts 160 & 164, as amended by the Health Information Technology for Economic and Clinical Health Act, the Confidentiality Law (“Confidentiality Law” or “Part 2”), 42 U.S.C. 290dd-2, 42 C.F.R. Part 2, and the laws of the State of New Jersey as provided for in the Community Mental Health Services Act, N.J.A.C. 10:37-1.1 et seq. place certain obligations upon us with regard to 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 the full terms of 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? Maryville is governed by HIPAA, Part 2 and other State laws which restrict how we may use and disclose your PHI. In addition to restrictions on the use and disclosure of PHI, the federal and State laws place additional restrictions on how we may use and disclose certain drug and alcohol, as well as mental health, information. Therefore, in general, we may use or disclose PHI only when (1) you give us your written authorization on a form that complies with HIPAA, Part 2 and State law; or (2) there is an exception as described in this Notice such as, but not limited to, uses and disclosures made pursuant to a court order or medical emergency.
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:
- HIV/AIDS related information
- Sexually transmitted disease information
- Psychotherapy notes
- Mental health information
- Drug & alcohol information
- Genetic information
- Any information where you, if a minor, sought emancipated treatment (e.g., care related to your pregnancy or child, sexually transmitted diseases, etc.)
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 https://www.maryvillenj.org. You may obtain the new Notice in hard copy as well from our Privacy Office.
ADDITIONAL INFORMATION/COMPLAINTS. You may contact our Privacy 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 Privacy 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.
For questions and concerns, please contact Mary Jo Bernardo, Director of Performance Improvement & Corporate Compliance at 856-341-5012 or firstname.lastname@example.org or by writing to Mary Jo Bernardo, Maryville, Inc. 129 Johnson Road, Suite 7, Turnersville, NJ 08012.