Liberty Health Services Privacy Practices
This Notice of Privacy Practices describes how medical information may be used and disclosed and how you can get access to his information. Please carefully read the information enclosed herein and acknowledge your receipt and understanding of the information provided.
Uses and Disclosures:
Treatment – Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.
Payment – Your health information may be used to seek payment from your insurance company(s) (health, dental, auto, or other) and from any other source that you may use to pay for services such as credit card, cashier check, personal check and or banking company(s). For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
Health care operations – Your health information may be used as necessary to support the day-to-day activities and management of Liberty Health Services, LLC. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
Uses that do not require your authorization:
- As required by law/law enforcement
- Public health reporting
- Agreement with a Qualified Service Organization/Business Associate
- For audits and investigation
- Medical Emergencies
- Suspicion of Child Abuse or Neglect
- Deceased client
- Criminal activity on premises/against program personnel and/or court order
Other uses and disclosures require your authorization – Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.
Additional Uses of Information:
Payment reminders – Our staff will use your health information to send you payment reminders.
Information about treatments – Your health information may be used to send you information on the treatment and management of your medical condition that you may find to be of interest. We may also send you Information describing other health-related goods and services that we believe may interest you.
Individual Privacy Rights:
You have certain rights under the federal privacy standards as defined in 42 U.S.C. 290dd-3 and 42 U.S.C. 290ee-3 for Federal laws and 42 CFR Part 2 for Federal regulations. These include:
- The right to request restrictions on the use and disclosure of your protected health information;
- The right to receive confidential communications concerning your medical condition and treatment;
- The right to inspect and copy your protected health information;
- The right to amend or submit corrections to your protected health information;
- The right to receive an accounting of how and to whom your protected health information has been disclosed; and
- The right to receive a printed copy of this notice.
Liberty Health Services, LLC’s Duties:
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice.
Right to Revise Privacy Practices:
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.
Requests to Inspect Protected Health Information:
As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting our office and speaking with a staff member. If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address. You will not be penalized or otherwise retaliated against for filing a complaint.
Contact our office and request to speak with a staff member for further information concerning our privacy practices. (If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to):
Liberty Health Services, LLC
29 Ashleigh Dr
Derry, NH 03038
Phone: (603) 216-0277