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Notice of Patient Privacy Practices

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 THE NOTICE: You have the right to a paper copy of this notice. You may ask us 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 from the Privacy Officer and submit your request in writing.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with us by calling 978-779-6223 and asking for the Privacy Officer or by contacting the Secretary of the Federal Department of Health and Human Services. All complaints must be also submitted in writing. You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this 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 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 you.

JUDICIAL/ADMINISTRATIVE PROCEEDINGS

We must disclose your protected health information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or as directed by a proper court order.

PRIVACY OFFICER: Mindy Parent

Telephone Number: (978) 779-6223

Prepared by Total Compliance Solutions, Inc. These procedures are prepared with the understanding that Total Compliance Solutions and its agents are not engaged in rendering legal, accounting, or other professional services. This information is advisory only. Final interpretation is the responsibility of the regulatory or accrediting body administering the standard regulation referenced.

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