Notice of Privacy Practices

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

During your first appointment at James A. Simon MD PC (dba “IntimMedicine Specialists”), a medical record was created that contains critical information such as your name, address, age, insurance coverage and medical condition. This record is updated each time you visit or contact James A. Simon MD PC (dba “IntimMedicine Specialists”). Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), this information is referred to as your Individually Identifiable Health Information (IIHI) or Protected Health Information (PHI).

The terms of this Notice of Privacy Practices (“Notice”) apply to all records containing your PHI created or retained by James A. Simon MD PC (dba “IntimMedicine Specialists”). We reserve the right to revise or amend this Notice as needed, including when required by law or policy updates. Any revision will apply to all records, past and future. Copies of the current Notice are posted in our office at all times and available upon request.

Our Obligations

We are required by law to:

• Maintain the privacy of Protected Health Information (PHI).
• Provide this notice outlining our legal duties and privacy practices regarding your health information.
• Follow the terms of the notice currently in effect.

How We May Use and Disclose Health Information

We may use and disclose your PHI without your authorization under the following circumstances:

1. Treatment: We may use your PHI to provide treatment, such as contacting a pharmacy or consulting physician.
2. Payment: We may use and disclose your PHI to bill and collect payment for services rendered, including communication with your insurance provider.

• Healthcare Operations: Used internally to evaluate and improve the quality of care provided.
• Public Health Risks: Disclosures may be made to authorized public health agencies for reporting and control of disease, injury, abuse, or product recalls.
• Health Oversight Activities: Disclosure to government agencies for legally required oversight functions (e.g., Medicare audits).
• Lawsuits and Legal Proceedings: Disclosure may occur in response to a court or administrative order, subpoena, or lawful process.
• Workers’ Compensation: Disclosure may be made to comply with relevant laws.
• Law Enforcement: Disclosure may occur when required by a law enforcement request.
• Military and National Security: Disclosures may be made to authorized military or national security officials.
• Data Breach Notification: Disclosure as legally required to notify you of any unauthorized access to your health information.

Uses and Disclosures Requiring Opportunity to Object

1. Individuals Involved in Your Care: Unless you object, we may disclose relevant information to family or friends involved in your care.
2. Disaster Relief: We may disclose information to disaster-relief organizations to coordinate care or notify family of your status.

Your Written Authorization is Required

The following uses and disclosures require your written consent:

• Uses and disclosures for marketing purposes.
• Disclosures constituting a sale of your PHI.
• Use or disclosure of psychotherapy notes.

Other uses not covered by this Notice will be made only with written authorization, which you may revoke at any time in writing. Revocations do not affect prior disclosures made in reliance on that authorization.

Your Rights

You have the following rights regarding your PHI maintained by James A. Simon MD PC (dba “IntimMedicine Specialists”):

1. Confidential Communications: You may request communication about your health in a specific way or location by writing to the Privacy Officer.
2. Requesting Restrictions: You may request limits on how your PHI is used or disclosed. Requests must be in writing, though we are not required to grant all restrictions.
3. Inspection and Copies: You have the right to inspect and obtain a copy of your PHI. Requests must be written; reasonable fees may apply for copies or mailing.
4. Electronic Copies: You may request an electronic version of your medical record when available.
5. Breach Notification: You have the right to be notified if a breach of your PHI occurs.
6. Amendment: You may request corrections to your PHI if you believe it is inaccurate or incomplete.
7. Accounting of Disclosures: You may request a list of certain non-routine disclosures of your PHI.
8. Paper Copy of Notice: You may request a paper copy of this Notice at any time.
9. Out-of-Pocket Payments: You may request that PHI related to services paid in full out-of-pocket not be disclosed to your health plan.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with James A. Simon MD PC (dba “IntimMedicine Specialists”) or with the U.S. Department of Health and Human Services.

To file a complaint with our office, contact the Office Manager/HIPAA Coordinator at James A. Simon MD PC (dba “IntimMedicine Specialists”).

To file a complaint with the Department of Health and Human Services, write to:

Barbara Holland, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
150 S. Independence Mall West, Suite 372
Public Ledger Building, Philadelphia, PA 19106-9111

You will not be penalized for filing a complaint.

Contact Information

Privacy Officer / HIPAA Coordinator:
Title: Office Manager / Privacy Officer
Address: James A. Simon, MD PC (“IntimMedicine Specialists”), 1850 M Street NW, Suite 450, Washington, DC 20006
Telephone: 202-293-1000
Email: info@intimmedicine.com

If you have questions, please call 1-202-293-1000.