Notice of Privacy Practices (HIPAA)

How We May Use & Share Your PHI (Without Your Written Authorization)

We may use/disclose PHI for:

• Treatment — to provide, coordinate, or manage your care (e.g., sharing information with your primary care clinician or a specialist).

• Payment — to bill and collect payment for services (e.g., sending information to your health plan for verification or prior authorization).

• Health Care Operations — for activities that support quality care (e.g., quality assessment, licensing, internal audits, and staff training).

We may also share PHI when permitted or required by law, including: public health and safety activities; health oversight; responding to court orders and subpoenas; law enforcement purposes; research under safeguards; to medical examiners; for organ/tissue donation; workers’ compensation claims; to avert a serious threat to health or safety; and for specialized government functions when applicable.

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Uses & Disclosures That Require Your Written Authorization

We will obtain your authorization before using or disclosing your PHI for purposes not described in this Notice. In particular, we will get your authorization for most marketing communications, any sale of PHI, and most disclosures of psychotherapy notes (if applicable). You may revoke an authorization in writing at any time, except where we have already relied on it.

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Your Rights

1. Access your record: Request to see or get an electronic or paper copy of your medical record and other PHI we have about you. We will provide a copy or summary, usually within 30 days. Reasonable, cost‑based fees may apply as allowed by law.

2. Request a correction: Ask us to amend PHI you believe is incorrect or incomplete. We may deny your request in certain cases; if so, we’ll tell you why in writing within 60 days.

3. Request confidential communications: Ask us to contact you in a specific way (e.g., at a different address or phone number). We will say “yes” if it is reasonable.

4. Request restrictions: Ask us to limit how we use/share PHI. We are not required to agree except in limited cases (e.g., when you pay in full out‑of‑pocket for a service and request that we not share information about that service with your health plan, if feasible and not otherwise required by law).

5. Get a list of certain disclosures: Request an accounting of certain PHI disclosures for the six years prior to your request (excludes treatment, payment, and operations, among other exceptions).

6. Get a copy of this Notice: Request a paper copy at any time, even if you agreed to receive it electronically.

7. Choose someone to act for you: If you have given someone medical power of attorney or have a legal guardian, that person can exercise your rights.

8. File a complaint: You can complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights (OCR). We will not retaliate against you for filing a complaint.

 

Our Responsibilities

• We are required by law to maintain the privacy of PHI, provide this Notice, and abide by its terms.

• We will notify you following a breach of your unsecured PHI, as required by law.

• We may change our privacy practices and this Notice. Changes will apply to PHI we maintain. The current Notice will be posted in our office and on our website with a new effective date.

 

Your Preferences

When appropriate, we may share limited information with family, friends, or caregivers involved in your care or in disaster relief situations if you agree or when it is in your best interest and you are not able to tell us your preference.

 

Questions, Requests, or Complaints

RENEW Spine & Pain Wellness Center
1401 Marlton Pike East, Suite 29, Cherry Hill, NJ 08034
Phone: (856) 843‑5870

Email: renewspinepainwellnesscenter@gmail.com
To contact HHS OCR: 1‑800‑368‑1019 • TDD 1‑800‑537‑7697 • Online complaint portal available at the HHS Office for Civil Rights website.