The sole purpose we have in collecting information is to capture responses from people who are interested in our services. We use the information to reply to people who have expressed an interest in our services.
We also have an email signup section on our form, which we use to publish a periodic email newsletter on ideas and trends pertaining to plastic surgery. If someone subscribes to this newsletter, we will send them messages from time to time (unless they decide to “opt-out” at any given point).
If you have any questions, comments or need any additional information, please feel free to contact us.
Thank you for your interest in Capella Surgery.
All material on this site © 2008 Surgical Weight Reduction, P.C., unless otherwise noted. If you are interested in referencing material from this site, or linking to this site, please use the main Contact form and your request will be considered.
Dr. Joseph Capella
Effective April 14, 2003
We maintain protocols to ensure the security and confidentiality of your personal information. Within our practice, access to your information is limited to those who need it to perform their jobs.
At the offices of Dr.’s Capella we are committed to treating and using protected health information about you responsibly. This Notice of Privacy Policies describes the personal information we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your protected health information. This Notice is effective April 14, 2003, and applies to all protected health information as defined by federal regulations:
Understanding Your Health Record
Each time you visit Dr.’s Capella a record of your visit is made. Typically, this record contains your symptoms, examination and test resulis, diagnoses. treatment, and a plan for future care of treatment. This information, often referred to as your health or medical record, serves as a:
|·||Basis for planning your care and treatment|
|·||Means of communication among the many health professionals who contribute to your care|
|·||Legal document describing the care you received|
|·||Means by which you or a third-party payer can verify that services billed were actually provided|
|Tool in educating health professionals|
|Source of data for medical research|
|·||Source of information for public health officials charged to improve the health of the state and nation|
|·||Source of data for our planning and marketing, and|
|·||Tool by which we can assess and continually work to improve the care we render and outcomes we achieve|
Understanding what is in your record and how your health information is used helps you to: ensure its accuracy; better understand who, what, when, where, and why others may access your health information; and make more informed decisions when authorizing disclosure to others.
Our practice is required to:
|·||Maintain the privacy of your health information|
|·||Provide you with this notice as to our legal duties and privacy practices with respect to information we collect and maintain about you|
|·||Abide by the terms of this notice|
|·||Notify you if we are unable to agree to a requested restriction, and|
|Accommodate reasonable requests you may have to communicate your health information|
We will not use or disclose your health information in a manner other than described in the section regarding Examples Of Disclosures For Treatment, Payment, And Health Operations, without your written authorization, which you may revoke as provided by 45 CFR I 64.508(b)(5), except to the extent that action has already been taken.
Examples Of Disclosures For Treatment, Payment, And Health Operations
We will use your health information for treatment.
We may provide medical information about you to health care providers, our practice personnel, or third parties who are involved in the provision, management, or coordination of your care.
lnformation obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course at treatment that should work best for you: Your medical information will be shared among health care professionals involved in your care.
We will also provide your other physician(s) or subsequent health care provider(s) (when applicable) with copies of various reports that should assist them in treating you.
We will use your health information for payment.
We may disclose your information so that we can collect or make payment for the health care services you receive.
If you participate in a health insurance plan, we will disclose necessary information to that plan to obtain payment for your care.
For More Information Or To Report A Problem
If you have questions and would like additional information, you may contact our practice’s Privacy Officer, Jeannette Abondano, at (201) 818-0199. If you believe your privacy rights have been violated, you can either file a complaint with Jeannette Abondano, or with the Office for Civil Rights, U.S. Department of Health and Human Services (OCR). There will be no retaliation for filing a complaint with either our practice or the OCR. The address for the OCR regional office for New Jersey is: Office for Civil Rights, U.S. Department of Health and Human Services, Jacob Javitz Federal Building, 26 Federal Plaza, Suite 3312, NY, NY 10278.
If you would like a copy of this Privacy Notice, please ask a member of our medical staff.
I have read the above Notice of Privacy Practices, detailing how my health information may be used/disclosed as permitted under federal and state law.
Signed:____________________________ Date: ________________________
I wish to place the following restrictions on disclosure of my health information: