Each time you visit a healthcare provider a record of you visit is made. Typically, this record contains your symptoms examination, and test results, diagnoses treatment, a plan for future care or Treatment and billing-related information. This notice applies to all of the records of your care generated by your health care provider. If you have any questions about this notice, please ask to speak to our privacy officer. You may request a copy of this notice at any time.


Our Responsibilities

MILL CITY MEDICAL GROUP is required by law to maintain the privacy of your health information and to provide you with a description of our legal duties and privacy practices regarding your health information.  The current Notice will be posted in the main reception area. The notice will include the effective date. In addition, we will make our best effort to provide you with a copy of this notice that we request you acknowledge with your signature.

We are required by law to abide by the terms of this Notice and notify you if we make changes to this Notice which may be at any time. Changes to the Notice will apply to your medical information that we already maintain as well as new information received after the change occurs. If we change our Notice, it will be posted in the main reception area. You may also request that a revised Notice be sent to you in the mail or you may ask for one at your next appointment or appropriate visit. This Notice will also serve to advise you as to your rights with regard to your medical information.


How we may use and disclose Medical Information about you:

The following categories describe examples of the way we use and disclose medication information.

For treatment:  We may use medical information about you to provide, coordinate and manage your treatment or services. We may disclose medical information about you to other doctors, nurses, technicians (e.g. clinical laboratories or imaging companies) medical students or other personnel who are involved in your care. We may communicate your information either orally or in writing by mail or facsimile.

We may also provide subsequent healthcare provider with copies of various reports that should assist him or her in treating you. For example, your medical information may be provided to a care provider to whom you have been referred so as to ensure that the doctor has appropriate information regarding your previous treatment and diagnosis.


For payment: We may use and disclose medical information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example, we may need to give your insurance company information before it approves or pays for the health care services we recommend for you.

For health care operations: We may use or disclose, as needed, your health information in order to support our business activities. These activities may include, but are not limited to quality assessment activities, employee review activities, licensing, legal advice, accounting support, information systems report, billing and collections and conducting or arranging for other business activities. In addition, we may also call you by name in the waiting room when your care provider is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment by telephone or reminder card.

Business Associates: There are some services provided in our organization through contracts with business associates. Examples include billing and collection, software support. If these services are contracted, we may disclose your health information to our business associate so that they can perform the job that we have asked them to do and bill you or your third party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information through written contract. (Business Associate Agreement)


Other permitted and required uses and disclosures that may be made with your consent, authorization or opportunity to object.


We also may use and disclose your health information as set forth below. You have the opportunity to agree or object to the use or disclosure of all or part of your health information (such as in an emergency situation), then your clinician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the information that is relevant to your health care will be disclosed.

Individuals involved in your care or payment for your care: Unless you object , we may release information about you to a friend or a family member who is involved in your medical care or who helps to pay for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.


Future communications: We may communicate to you via newsletters, mailings or other means regarding treatment options, information on health-related benefits or services to remind you that you have an appointment for medical care; or other community based initiatives or activities in which our facility is participating. If you are not interested in receiving these materials, please contact our Privacy Officer.

Other permitted and required uses and disclosures that may be made without your authorization or opportunity to object.


We may use or disclose your health information in the following situations without your authorization or without providing you with an opportunity to object. These situation include:

As required by law: We may use and disclose health information to the following types of entities, including but not limited to:

  • Food and drug administration

  • Public health or legal authorities charged with preventing or controlling disease, injury or disability

  • Correctional institutions

  • Workers compensation agents

  • Organ and tissue donation organizations

  • Military command authorities

  • Health oversight agencies

  • Funeral directors, coroners and medical directors

  • National security an intelligence agencies

  • Protective services for the President and others

  • Authority that receives reports on abuse and neglect

Law enforcement/legal proceedings: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena or court order.


State-specific Requirements: Many states have requirements for reporting which may include population-based activities relating to improving health or reducing health care costs, cancer registries, birth defect registries and others.


Your health information rights: Although your health record is the physical property of the practice that compiled it, you have the right to.


Inspect and copy:  You have the right to inspect and copy medical information that may be used to make decisions about your care. We ask that you submit your request in writing. Usually, this includes medical and billing records, but does not include psychotherapy notes or information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. Requests for access to and copies of your medical information must be submitted to MILL CITY MEDICAL GROUP in writing. There may be a fee charged up to the maximum amount as prescribed by governing law.

Amend:  If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information by submitting a request in writing. You have the right to request an amendment for as long as we keep the information. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.


An accounting of disclosures: You have the right to request an accounting of our disclosures of medical information about you except for certain circumstances, including disclosures for treatment, payment, health care operations or where you specifically authorized a disclosure. MILL CITY MEDICAL GROUP will provide the first accounting to you in any 12-month period without charge, upon your written request. The cost for subsequent requests for an accounting within the 12-month period will be up to the maximum amount prescribed by governing law.

Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on  the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a procedure that you had. We ask that you submit these requests in writing. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.

Request confidential communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will agree to the request to the extent that it is reasonable for us to do so. For example, you can ask that we use an alternative address for billing purposes. We ask that you submit these requests in writing.


A paper copy of this Notice: You have the right to a paper copy of this notice. You may ask use to give you a copy of this notice at any time Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.


To exercise any of your rights, please obtain the required forms form the practice and submit your request in writing to the practice’s privacy officer indicated below.


Complaints: If you believe your privacy rights have been violated, you may file a complaint with us by calling 978-970-1607 and asking for the Privacy Officer or by contacting the Secretary of the Federal Department of Health and Human Services by calling 1-800-368-1019, or by contacting the Office of Civil Rights regional office. All complaints must also be submitted in writing within 180 days of when you knew that the act or omission occurred. You will not be penalized for filing a complaint.


Other uses of Medical Information: Other uses and disclosures of medical information not covered by the Notice or the laws that apply  to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission; we will no longer use or disclose medical information about you for the reasons covered by your written authorization. However, we are unable to take back any disclosures we have already made with your permission and we are required to retain our records of the care that we provided to you.