Jersey Women’s Center
1014 Haddonfield Road
Cherry Hill, New Jersey 08002
notice describes how medical information about you may be used and
and how you can get access to this information. Please review it
1. Our pledge regarding protecting your medical information:
The privacy of your medical information is extremely important to
us. At the South Jersey Women’s Center, we have always taken
extreme effort to protect patient confidentiality. However, a recent
federal law (HIPPAA) now requires that all medical providers take
similar measures and adopt privacy policies that will assure that
your medical information is never inappropriately released. The
following information describes how our office is complying with
2. Our legal duty:
Our office is required to keep your medical records and all medical
information private. We are required to provide you this notice,
which describes our legal duties, our privacy practices, and your
rights regarding your medical information. We do have the right
will be changed in this notice as well.
3. Use and disclosure of medical information:
The following section describes different ways that we may use and
disclose information. Whenever it is necessary to disclose information,
we will only disclose the absolute minimum information necessary
for that purpose. Many of the situations listed below are extremely
unusual. However, the law requires that we inform you of any and
all possible ways that your health information might be used or
disclosed, even the rarest situations.
We will not disclose your information for any purpose not listed
below, unless you give us specific and written permission to do
• Using and disclosing information to provide medical treatment:
We may use medical information about you in order to provide medical
treatment or services to you. We may disclose information about
you to doctors, nurses, and other staff that are directly involved
in taking care of you, in order that they can provide proper care
• Using and disclosing information to obtain payment: We
may need to use and disclose information about you in order to
receive payment for services that we’ve rendered to you.
For example, we may need to provide information about your condition
and treatment to you health insurance company in order for them
to pay us, or to reimburse you for any care you’ve received.
We may also need to tell your health plan, in advance, of any
upcoming care in order to obtain any required pre-authorization
or to determine if your plan will covered a planned procedure.
• Using and disclosing information to perform health care
operation: We may use or disclose your information in order to
perform various internal health care operations, which may include
employees performance evaluations and employee training programs.
If your information is being used for any such internal health
care operation, only employees of the Center would have access
to your information. Occasionally, insurance companies will require,
as part of their physician credentialing, an audit of selected
charts from their own patients covered by their insurance plan.
In this case, we are required to release information to the insurance
company, but we will release only the minimum information as required
by law. Insurance companies are bound by the same federal privacy
laws as we are, so they are required to protect the information
released to them as well.
• Additional uses and disclosures:
• Notification: In the case of an emergency, we may be
required to provide information about your general condition
and location to a family member, or another person responsible
for your care. If you are present, we will get your permission.
In the case of an emergency where you are not present or cannot
give consent, we will release only the health information that
is directly necessary for your health care, according to our
• Court Orders and Judicial and Administrative Proceedings:
We may be required to disclose medical information in response
to a court order, subpoena, discovery request, or other lawful
process, under certain circumstances. We may share limited information
with law enforcement officials concerning the medical information
of a suspect, fugitive, material witness, crime victim or missing
person. We may share the medical information of an inmate or other
person in lawful custody with a law enforcement official or correctional
institution under certain circumstances.
• Public Health Activities: In some circumstances, we are
required by law to disclose medical information to the public
health department regarding a patient’s state of health.
Instances that require notification include the diagnosis by the
Center of certain communicable diseases, and certain non-communicable
diseases. We may also be required to disclose your medical information
to personnel of the Food and Drug Administration for purposes
of reporting adverse events associated with product defects or
problems, or for the purpose of enabling a drug or product recall.
• Abuse or Neglect: We may be required by law to report
to the appropriate authorities if we reasonably believe that you
are a possible victim of abuse or neglect or a possible victim
of other crimes. We may share your medical information if it is
necessary to prevent a serious threat to your health or safety
or to protect the health and safety of others. We may also be
required to share medical information to help law enforcement
officials capture a person who has admitted to being part of a
crime or has escaped from custody.
• Law Enforcement: We may be required by law to report
health information to law enforcement officials. These circumstances
include reporting as required by a court order, reporting of abuse
or neglect or certain other wounds, reporting information regarding
an individuals identification or location, reporting suspected
victims of crimes, reporting death and crimes on our premises.
4. Your Individual Rights:
You have the right to view or obtain copies of your medical records.
All requests must be made in writing. If you request copies of your
records, there may be a fee for copy services, however, that fee
will not exceed the maximum fee allowed by law.
You have the right to receive a list of all the times that we or
our business associates have shared your medical information for
purposes other that treatment, payment, or health care operations.
You have the right to request, in writing, that we place additional
restrictions on our use or disclosure of you medical information.
We are not required to agree to these restrictions, but if we do,
we will abide by our agreement, except in the case of an emergency.
You have the right to request that we communicate with you about
your medical information by different means, for example, by phone
or by mail, or to different locations, for example to a different
You have the right to request that we change your medical information
in your medical record. We may deny your request if we did not create
the information you want changed or for certain other reasons. If
we do deny your request, we will provide you with a written explanation.
You may respond with a statement of disagreement that will be added
to your record. If we accept your request to change the information,
we will make reasonable efforts to inform others, including people
that you name, of the change and to include the changes in any future
disclosure of information.