Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Who Is Covered by This Notice

This Notice applies to WorkOccMed Medical Group, PLLC and any of its examining providers, clinical staff, and administrative affiliates (including WorkOccMed LLC, acting as our Business Associate) who create or receive Protected Health Information ("PHI") in connection with the examinations and testing we coordinate on your behalf, including DOT and non-DOT physical examinations, drug and alcohol testing, and related occupational health services.

Our Commitment to Your Privacy

We are required by law to maintain the privacy of your PHI, to provide you with this Notice describing our legal duties and privacy practices with respect to your PHI, and to abide by the terms of the Notice currently in effect.

How We May Use and Disclose Your Health Information

Treatment

We may use and disclose your PHI to provide, coordinate, or manage your examination or testing, and to consult with other healthcare providers involved in your care.

Payment

We may use and disclose your PHI to bill and obtain payment from you, your employer, or a third-party payor for the services we provide.

Healthcare Operations

We may use and disclose your PHI for our internal operations, including quality assessment, staff training, accreditation, and business management activities.

DOT and Regulatory Reporting

As required by 49 CFR Part 40 and related DOT agency regulations, we disclose specific testing results and related information to your employer's Designated Employer Representative (DER), to the reviewing Medical Review Officer (MRO), and, where a reportable violation occurs, to the FMCSA Drug & Alcohol Clearinghouse. We limit these disclosures to the information required by applicable regulation.

As Required by Law

We will disclose PHI when required to do so by federal, state, or local law — for example, in response to a valid court order or subpoena, or as required for public health reporting.

Other Permitted or Required Uses

To avert a serious threat to health or safety
For workers' compensation and similar programs, as authorized
For public health activities, such as reporting disease or injury
To health oversight agencies for audits, investigations, and inspections

Uses and Disclosures Requiring Your Written Authorization

Uses and disclosures not described in this Notice will be made only with your written authorization. You may revoke that authorization in writing at any time, except to the extent we have already acted in reliance on it.

Your Rights Regarding Your Health Information

Right to Inspect and Copy. You have the right to inspect and obtain a copy of your PHI, with limited exceptions. Requests should be submitted in writing to our Privacy Officer.
Right to Amend. You have the right to request that we amend your PHI if you believe it is incorrect or incomplete, for as long as we maintain it.
Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we have made of your PHI.
Right to Request Restrictions. You have the right to request restrictions on how we use or disclose your PHI. We are not required to agree to every request.
Right to Request Confidential Communications. You have the right to request that we communicate with you about your PHI in a specific way or at a specific location.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice at any time, even if you agreed to receive it electronically.
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint.

Changes to This Notice

We reserve the right to change this Notice and to make the revised Notice effective for PHI we already maintain, as well as PHI we create or receive in the future. The current Notice will be available on this page and posted at our practice location.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services. To file with us, contact:

WorkOccMed Medical Group, PLLC — Privacy Officer
411 Hackensack Ave, Suite 200, Hackensack, NJ 07601
Phone: (888) 233-4567
Email: privacy@workoccmed.com

To file with HHS: hhs.gov/ocr/complaints. There will be no retaliation for filing a complaint.

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