THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. FURTHER DETAILS INCLUDE HOW YOU OR YOUR PERSONAL REPRESENTATIVE MAY GAIN ACCESS TO THIS INFORMATION. PLEASE READ AND REVIEW IT CAREFULLY

This Notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability & Accountability Act (HIPAA) and it describes how Osteopathic Family Medicine of Northern New Jersey (Practice) and our health care providers, volunteers, trainees, and staff may use or disclose your protected health information in order to provide treatment, payment, or healthcare operations and for other purposes discussed in this Notice. All medical information may be shared, but be aware that safeguards are in place to protect it.
This Notice also describes your rights to access and amend your protected health information. By law we are required to protect the privacy of your medical information and to abide by the terms of this Notice. You have the right to approve or refuse the release of specific information outside of our Practice except when the release is required or authorized by law or regulation.
We may change the terms of this Notice at any time; the new Notice will then be effective for all medical information that we maintain at that time and thereafter. We will provide you with any revised Notice at the time of the change
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE – You will be asked to provide a signed acknowledgment of receipt of this Notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. The delivery of your health care services will in no way be conditioned upon your signed acknowledgment. If you decline to provide a signed acknowledgment, we
will continue to provide your treatment, and will use and disclose your protected health information in accordance with law.
OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION – “Protected health information” is individually identifiable health information and includes demographic information (for example, age, address, etc.), and relates to your past, present or future physical or mental health or condition and related health care services. Our Practice is required by law to do the following:

(1) keep your protected health information private;
(2) present to you this Notice of our legal duties and privacy practices related to the use and disclosure of your protected health information;
(3) follow the terms of the Notice currently in effect; and
(4) post and make available to you any revised Notice.

We reserve the right to revise this Notice and to make the revised Notice effective for health information we already have about you as well as any information we receive in the future. The Notice’s effective date is at the top of the first page and at the bottom of the last page.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION – The office may use your medical information and disclose it for purposes of treatment, payment, and healthcare operations; however, use or disclosure of SUD treatment records for payment and/or healthcare operations generally require your written consent. Below are examples of permitted uses and disclosures of your protected health information. These examples include, but are not limited to the following:
A) Required Uses and Disclosures – By law, we must disclose your health information to you unless it has been determined by a health care professional that it would be harmful to you. Even in such cases, we may disclose a summary of your health information to certain of your authorized representatives specified by you or by law. We must also disclose health information to the Secretary of the U.S. Department of Health and Human Services (HHS) for investigations or determinations of our compliance with laws on the protection of your health information.
a) Treatment – We will use and disclose your protected health information to provide, coordinate or manage your medical care and any related services. This includes the coordination or management of your health care with a third party that has been given
permission to have access to your medical information. For example, we may disclose your protected health information from time-to-time to another physician or health care provider (for example, a specialist, pharmacist or laboratory) who, at the request
of your physician, becomes involved in your care. In emergencies, we will use and disclose your protected health information to provide the treatment you require.
b) Payment – Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities we may need to undertake before your health care insurer approves or pays for the health care services
recommended for you, such as determining eligibility or coverage for benefits. For example, obtaining approval for a procedure might require that your relevant protected health information be disclosed to obtain approval to perform the procedure at a
particular facility. We will continue to request your authorization to share your protected health information with your health insurer or third-party payer.
c) Health Care Operations – We may use or disclose, as needed, your protected health information to support our daily activities related to providing health care. These activities include, but are not limited to, reviewing our treatment of you, employee performance reviews, billing, training of personnel, medical students, licensing, marketing and fundraising activities and conducting or arranging for other business activities. For example, we may disclose your protected health information to a billing agency in order to prepare claims for reimbursement for the services we provide to you. We may call you by name in the waiting room when your physician 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. For example, we will contact you at your home telephone number to remind you of your next appointment and/or mail a postcard appointment reminder to your home address. We will share your protected health information with other persons or entities who perform various activities (for example, a transcription service) for our Practice.
These business associates of our Practice are also required by law to protect your health information. We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health- related benefits and services that might interest you. For example, your name and address may be used to send you a newsletter about our Practice and our services.
Required by Law: We may use or disclose your protected health information if law or regulations require the use or disclosure.
d) Health Information Exchange – We do not participate in a health information exchange (“Exchange”) as we are an individual entity and are not associated with any healthcare system. If this were to change at any time you will be notified.

B) Other Permitted and Required Uses and Disclosures That May Be Made with Your Consent, Authorization or Opportunity to Object– The Practice may use and disclose your medical information in the instances discussed below. You are allowed to agree or object to the use or disclosure of all or part of your medical information.
a) Emergencies – We may use or disclose your medical information for emergency treatment or to an entity assisting in disaster relief efforts. If this happens, we shall try to obtain your consent as soon as reasonable after the delivery of treatment. If the
practice is required by law to treat you and has attempted to obtain your consent but is unable to do so, the practice may still use or disclose your medical information to treat you.
b) Communication Barriers – We may use and disclose your medical information if the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and, in our professional judgment, you intended to consent
to use or disclose under the circumstances.
c) Others Involved in Your Health Care – Unless you object, we may disclose medical information to a member of your family, a relative or close friend, if your medical information directly relates to that person’s involvement. If you are unable to agree or
object to such a disclosure, we may disclose such information if we determine that it is in your best interest based on our professional judgment. We may use or disclose medical information to notify or assist in notifying a family member or any other person that is responsible for your care of your location, general condition or death. If you are not present/able to agree or object to the use or disclosure of the medical information, then your health care provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the medical information that is relevant to your health care will be disclosed.
C) Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object. We may use or disclose your medical information in the following situations without your consent or authorization. These
situations include:
a) Law Enforcement – We may disclose protected health information for law enforcement purposes which includes information requests for identification and location; and circumstances pertaining to victims of a crime. These law enforcement purposes
include the following purposes:
i) responding to a court order, subpoena, warrant, summons or otherwise required by law
ii) identifying or locating a suspect, fugitive, material witness or missing person;
iii) pertaining to victims of a crime;
iv) suspecting that death has occurred as a result of criminal conduct;
v) in the event that a crime occurs on the premises of the practice; and
vi) responding to a medical emergency (not on the Practice’s premises) and it is likely that a crime has occurred.
b) Abuse or Neglect – We may disclose your medical information to a public health authority that is authorized by law to receive reports of child/elder abuse or neglect. In addition, we may disclose your medical information to the governmental entity
authorized to receive such information if we believe that you have been a victim of abuse, neglect or domestic violence as is consistent with the requirements of applicable federal and state laws.
c) Public Health – We may disclose your protected health information to a public health authority who is permitted by law to collect or receive the information. These activities are necessary for the government agencies to oversee the health care system,
government benefit programs, other government regulatory programs and civil rights laws. For example, the disclosure may be necessary to prevent or control disease, injury or disability; report births and deaths; or report reactions to medications or problems with medical products.
d) Communicable Diseases – We may disclose your protected health information, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition.

e) Health Oversight – We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These health oversight agencies might include government agencies that oversee the health care system, government benefit programs, or other regulatory programs.
f) Food and Drug Administration – We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events; track products, enable product recalls; make repairs or replacements; or
conduct post-marketing review.
g) Legal Proceedings – We may disclose protected health information during any judicial or administrative proceeding, in response to a court order or administrative tribunal (if such disclosure is expressly authorized), and in certain conditions in response to a
subpoena, discovery request, or other lawful process.
h) Coroners, Funeral Directors, and Organ Donations – We may disclose protected health information to coroners or medical examiners for identification to determine the cause of death or for the performance of other duties authorized by law. We may
also disclose protected health information to funeral directors, as authorized by law. Protected health information may be used and disclosed for cadaver organ, eye or tissue donations.
i) Research– We may disclose protected health information to researchers when authorized by law. We will obtain your written authorization to use your PHI for research purposes except when an Internal Review Board (“IRB”) or Privacy Board has
determined that the waiver of your authorization satisfies the following:
i) the use or disclosure involves no more than a minimal risk to your privacy based on the following:
(1) an adequate plan to protect the identifiers from improper use and disclosure;
(2) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and
(3) an adequate, written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted;

ii) the research could not practicably be conducted without the waiver; and
iii) the research could not practically be conducted without access to and use of the PHI.
j) Organ and/or Tissue Donation– If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue
donation and transplantation.
k) Military Activity and National Security – When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel for activities believed necessary by appropriate military command
authorities to ensure the proper execution of the military mission, including determination of fitness for duty; or to a foreign military authority if you are a member of that foreign military service. We may also disclose your protected health information,
under specified conditions, to authorized Federal officials for conducting national security and intelligence activities including protective services to the President or others.
l) Workers’ Compensation – We may disclose your protected health information to comply with workers’ compensation laws and similar government programs.
m) Criminal Activity – Consistent with applicable federal and state laws, we may disclose your medical information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the
public. We may also disclose medical information if it is necessary for law enforcement authorities to identify or apprehend an individual.
n) Inmates – We may use or disclose your protected health information, under certain circumstances, if you are an inmate of a
correctional facility.
o) Parental Access – New Jersey state laws concerning minors permit or require certain disclosure of protected health information to parents, guardians, and persons acting in a similar legal status. We will act consistently with the laws of this State (or, if you
are treated by us in another state, the laws of that state) and will make disclosures following such laws.
p) Required Uses and Disclosures – Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500,
et seq.
q) Imminent Threat to Health and Safety – Under applicable Federal and State laws, we may disclose your protected health information to law enforcement or another health care professional if we believe in good faith that its use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR PERMISSION – In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. Following are examples in which your agreement or objection is required:
Individuals Involved in Your Health Care – Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. We may also give information to someone who helps pay for your care. Additionally, we may use or disclose protected health information to notify or assist in
notifying a family member, personal representative, or any other person who is responsible for your care, of your location, general condition, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and coordinate uses and disclosures to family or other individuals involved in your health care.
D) The Following Is a Statement of Your Rights with Respect to Your Medical Information and a Brief Description of How You May exercise These Rights:
You may exercise the following rights by submitting a written request to our Privacy Officer. Our Privacy Officer can guide you in pursuing these options. Please be aware that our Practice may deny your request; however, in most cases you may seek a review of the denial.

a) Right to Inspect and to Obtain a Copy of your Medical Information – You may inspect and/or obtain a copy of your protected health information that is contained in a “designated record set” for as long as we maintain the protected health information. A designated record set contains medical and billing records and any other records that our Practice uses for making decisions about you. This right does not include inspection and copying of the following records:

psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding; and protected health information that is subject to a law that prohibits access to protected health information. You will be charged a fee for a copy of your record and we will advise you of the exact fee at the time you make your request. We may offer to provide a summary of your information and, if you agree to receive a summary, we will advise you of the fee at the time of your request.
b) Right to Request Restrictions of your Medical Information – You may ask us not to use or disclose any part of your protected health information for treatment, payment or health care operations. Your request must be made in writing to our Privacy Officer.
In your request, you must tell us:
i) what information you want restricted;
ii) whether you want to restrict our use or disclosure, or both;
iii) to whom you want the restriction to apply, for example, disclosures to your spouse; and
iv) an expiration date.
If we believe that the restriction is not in the best interests of either party, or that we cannot reasonably accommodate the request, we are not required to agree to your request. If the restriction is mutually agreed upon, we will not use or disclose your protected health information in violation of that restriction, unless it is needed to provide emergency treatment. You may ask us not to disclose certain information to your health plan. We must agree with that request only if the disclosure is not for the purpose of
carrying out treatment and pertains solely to a health care item or service for which we have been paid out of pocket in full. You may revoke a previously agreed upon restriction, at any time, in writing.
c) Right to Request Alternative Confidential Communications – You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for your request. We will accommodate reasonable requests, when possible.
d) Right to Request Amendment – If you believe that the information we have about you is incorrect or incomplete, you may request an amendment to your protected health information as long as we maintain this information. While we will accept requests for amendment, we are not required to agree to the amendment.
e) Right to an Accounting of Disclosure – You may request that we provide you with an accounting of the disclosures we have made of your protected health information. This right applies to disclosures made for purposes other than treatment, payment or
health care operations as described in this Notice and excludes disclosures made directly to you, to others pursuant to an authorization from you, to family members or friends involved in your care, or for notification purposes. The accounting will only include disclosures made no more than 6 years prior to the date of your request. The right to receive this information is subject to additional exceptions, restrictions, and limitations as described earlier in this Notice.
f) Rights Related to an Electronic Health Record – If we maintain an electronic health record containing your protected health information, you have the right to obtain a copy of that information in an electronic format and you may choose to have us
transmit such copy directly to a person or entity you designate, provided that your choice is clear, conspicuous, and specific. You may request that we provide you with an accounting of the disclosures we have made of your protected health information
(including disclosures related to treatment, payment and health care operations) contained in an electronic health record for no more than 3 years prior to the date of your request (and depending on when we acquired an electronic health record).
g) Right to be Notified of a Breach– You have the right to be notified if our practice (or a Business Associate of ours) discovers a breach of unsecured protected health information.
h) Special Protections – This Notice is provided to you as a requirement of HIPAA. There are several other privacy laws that also apply to HIV-related information, mental health information, psychotherapy notes, and substance abuse information. These laws
have not been superseded and have been taken into consideration in developing our policies and this Notice. Psychotherapy notes, specifically, are subject to stricter privacy standards and most uses and disclosures require authorization from you.
i) Complaints – If you believe these privacy rights have been violated, you may file a written complaint to our Privacy Officer or the Secretary of Health and Human Services; information provided below:

i) The Privacy Officer is Dr. DeFeo if you believe your privacy rights have been violated , can be contacted at this office or by calling our telephone number 551-815-1000 or emailed at osteofamilmed@outlook.com, or you may file a complaint with us by notifying our Privacy Contact in writing by sending a letter to 541 Cedar Hill Avenue, Wyckoff,
NJ 07481
ii) The Secretary of Health and Human Services if you believe your privacy rights have been violated, as follows: U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-
complaint/index.html.
No retaliation will be held against you for filing a complaint.
j) Redisclosure – Information that is disclosed to third-parties pursuant to the HIPAA Privacy Rule is subject to redisclosure by the recipient and may no longer be protected by the HIPAA Privacy Rule.
k) Right to Obtain a Copy of this Notice – You may obtain a paper copy of this Notice from us by requesting one.
E) State Law – Applicable per New Jersey state law(s), for the Practice to release information about mental health treatment, genetic information, your AIDS/HIV status, alcohol or drug abuse treatment, or other specific medical information or conditions, you may be required to sign an authorization form unless state law allows us to make the specific type of use or disclosure without your authorization.
F) Applicability – This Notice and the obligations of Practice herein shall apply only to the extent that the information to be created, used and/or disclosed by Practice is PHI (as defined by HIPAA) and subject to HIPAA protections. By providing this Notice, Practice is neither conceding nor admitting that any such information qualifies as PHI.
G) Substance Abuse Treatment – We are required to protect the privacy and security of your substance use disorder patient records in accordance with 42 U.S.C. § 290dd–2 and 42 C.F.R. Part 2, the Confidentiality of Substance Use Disorder Patient Records (“Part 2”), in addition to HIPAA and applicable state law. In a civil, criminal, administrative, or legislative proceeding against an individual, we will not use or share information about your SUD treatment records unless a court order requires us to do so (after notice and an opportunity to be heard is provided to you, as provided in 42 CFR part 2) or you give us your written permission You may report suspected violations to the U.S. Attorney for the judicial district in which the violation occurs. Contact information for the U.S. Attorney office where we operate is below:
The U.S. The Attorney’s Office for the District of New Jersey is headquartered in Newark at 970 Broad Street, 7th Floor, Newark, NJ 07102, with additional offices in Trenton and Camden. For inquiries or to contact the office, call 973-645-2700 or visit their official website a https://www.justice.gov/usao-nj/contact-us.
Suspected violations by an opioid treatment program may be reported to the Substance Use and Mental Health Services Administration (SAMHSA), Opioid Treatment Program Compliance Office by phone at 204-276-2700 or online at OTPextranet@opiod.samhsa.gov.

Privacy Officer Contact Information
Osteopathic Family Medicine of Northern NJ
Dr. Daniel Defeo, DO
541 Cedar Hill Avenue; Suite 2
Wyckoff, NJ 07481
Phone: (551)815-1000
Email: osteofamilymed@outlook.com