NOTICE OF PRIVACY PRACTICES
1. OUR PLEDGE REGARDING MEDICAL INFORMATION
The Privacy of your medical information is important to us. We understand that your medical
information is personal and we are committed to protecting it. We create a record of the care and services
you receive at our organization. We need this record to provide you with quality care and to comply with
certain legal requirements. This notice will tell you about the ways we may use and share medical
information about you. We also describe you rights and certain duties we have regarding the use and
disclosure of medical information.
II. OUR LEGAL DUTY
1. Keep your medical information private.
2. Give you this notice describing our legal duties
privacy practices, and your rights regarding your
3. Follow the terms of the notice that is now in effect.
1. Change our privacy practices and the terms
of this notice at any time, provided that
the changes are permitted by law.
2. Make the changes in our privacy practices
and the new terms of our notice effective for
all medical information that we keep, including
information previously created or received before
1. Before we make an important change in our
Privacy Practices, we will change this notice
and make the new notice available upon request.
III. USE AND DISCLOSE OF YOUR MEDICAL INFORMATION
The following section describes different ways that we use and disclose medical information. For each
kind of use or disclosure, we will explain what we mean and give any example. Not every use or
disclosure will be listed. However, we have listed all of the different ways we are permitted to use and
disclose medical information. We will not use or disclose your medical information for any purpose not
listed below, without your specific written authorization. Any specific written authorization you provide
may be revoked at any time by writing to us.
We my use medical information about you to provide you with medical treatment or services. We may
disclose medical information about you to doctors, nurses, technicians, medical students, or other people
who are taking care of you. We may also share medical information about you to your other health care
providers to assist them in treating you.
Example: You are in the hospital with a broken leg. You also have diabetes. A number of health care and
support staff needs to know about your diabetes during your stay:
– The doctor treating you for the broken leg needs to know if you have diabetes because diabetes may slow the healing process.
– The dietitian needs to know about your diabetes to arrange proper meals.
– The pharmacy needs to know about possible medicines that you may need as a diabetic.
– The information about your diabetes may help in diagnostics, testing, and x-ray work.
We may use and disclose your medical information for payment purposes.
Example: You are treated in the hospital for a broken leg.
– We may need to give your health insurance plan information about surgery you received at our
organization so that your health plan will pay us or repay you for any surgery that you paid for.
– We may also tell your health plan about a treatment you are going to receive to get approval or to
determine if you plan will pay for the treatment.
– We will forward all health plan information to the billing service to process all medical
information so that your health plan will pay us or repay you for any surgery that you paid for.
FOR HEALTH CARE OPERATIONS
We may use and disclose your medical information for our health care operations. This might included
measuring and improving quality, evaluating the performance of employees, conducting training
programs, and getting the accreditation, certificates, licenses and credentials we need to serve you
ADDITIONAL USES AND DISCLOSURES
Unless you notify us that you object,the following medical
information about you will be placed in our
facilities’ directories: – Your Name
– Your Location in Our Facility
– Your Condition described in general terms
– Your religious affiliation, if any
We may disclose this information to members of the clergy or, except
for your religious affiliation, to others who contact us and ask for
information about you by name
Medical information to notify or help notify:
-A family member
-Your personal representative
-Another person responsible for your care
Medical information with a public or private organization or person
who can legally assist in disaster relief efforts.
We may provide medical information to one of our affiliated
fundraising foundations to contact your for fundraising purposes. We
will limit our use in sharing information that describes you in general,
not personal, terms and the dates of your health care. If any fundraising
materials are used, we will provide you a description of how you may
choose not to receive future fundraising communications.
Medical information for research purposes in limited circumstances
where the research has been approved by a review board that has
reviewed the research proposal and established protocols to ensure the
privacy of medical information.
To help them carry out their duties, we may share the medical
information of a person who has died with a coroner, medical
examiner, funeral director, or an organ procurement organization.
Subject to certain requirements, we may disclose or use health
information for military personnel and veterans, for nation security and
intelligence activities, for protective services for the President and
others, for medical suitability determinations for the Department of
State, for correctional institutions and other law enforcement custodial
situations, and for government programs providing public benefits.
We may disclose medical information in response to a court or
administrative order, subpoena, discovery request, or other lawful
process, under certain circumstances. Under limited circumstances,
such as a court order, warrant, or grand jury subpoena, we may share
your medical information with law enforcement officials. We may
share limited information with a law enforcement official concerning
the medical information of a suspect, fugitive, materiel 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.
As required by law, we may disclose your medical information to
public health or legal authorities charged with preventing or
controlling disease, injury or disability, including child abuse or
neglect. We may also disclose your medical information to persons
subject to jurisdiction of the Food and Drug Administration for
purposes of reporting adverse events associated with product defects or
problems, to enable product recalls, repairs or replacements, to track
products, or to conduct activities requited by the Food and Drug
Administration. We may also, when we are authorized by law to do so,
notify a person who may have been exposed to a communicable
disease or otherwise be at risk of contracting or spreading a disease or
We may disclose medical information to appropriate authorities if we
reasonably believe that you are a possible victim of abuse, neglect,
domestic violence, or the possible victim of their crimes. We may
share your medical information if it is necessary to prevent a serious
risk to your health or safety or the health or safety of others. We may
share medical information when necessary to help law enforcement
officials capture a person who has admitted to being part of a crime or
has escaped from legal custody.
We may disclose health information when authorized and necessary to
comply with laws relating to workers compensation or other similar programs.
We may disclose medical information to an agency providing health
oversight for oversight activities authorized by law, including audits,
civil, administrative, or criminal investigations or proceedings,
inspections, licensure, or disciplinary actions, or other authorized
Under certain circumstances, we may disclose health information to
law enforcement officials. These circumstance include reporting
required by certain laws, (such as the reporting of certain types of
wounds), pursuant to certain subpoenas or court orders, reporting
limited information concerning identification and location at the
request of a law enforcement official, reports regarding suspected
victims of crimes at the request of a law enforcement, report death,
crimes on our premises, and crimes in emergencies.
IV. YOUR INDIVIDUAL RIGHTS
– Look at or get copies of your medical information. You may request that we provide copies in a
format other than photocopies. We will use the format that you request unless it is not practical
for us to do so. You must make your request in writing. You may get the form to request access
by using the contract information listed at the end of this notice. You may also request access by
sending a letter to the contact person listed at the end of this notice. lf you request copies, we will
charge you $3.50 for each page, and postage if you want the copies mailed to you. Contact us
using the information listed at the end of this notice for a full explanation of our fee structure.
– Receive a list of all the times we or our business associates shared your medical information for
purposes other than treatment, payment, and health care operations and other specified
– Request that we place additional restrictions on our use or disclosure of your medical
information. We are not required to agree to these additional restrictions, but if we do, we will
abide by our agreement (except in the case of an emergency).
– Request that we communicate with you about your medical information by different means or to
different locations. Your request that we communicate your medical information to you by
different means or at different locations must be made in writing to the contact person listed at the
end of this notice.
– Request that we change your medical information. We may deny your request if we did not
create the information you want changed or for certain other reasons. If we deny your request,
we will provide you a written explanation. You may respond with a statement of disagreement
that will be added to the information you wanted changed. lf we accept your request to change the
information, we will make reasonable efforts to tell others, including people you name, of the
change and to include the changes in any further sharing of that information.
– If you have received this notice electronically, and wish to receive a paper copy, you have the
right to obtain a paper copy by making a request in writing to the contact person listed at the end
of this notice
V. QUESTIONS AND COMPAINTS
Terrapin Care Center
9658 Baltimore Avenue
#420 College Park,
MD 20740 – 1423
If you think that we may have violated your privacy rights, contact the person named above. You may
also submit a written complain to the U.S. Department of Health and Human Services. We will provide
you with the address to file your complaint with the U.S. Department of Health and Human Services. We
will not retaliate in any way if you choose to file a complaint.