Notice of Privacy Practices

Effective Date: February 1, 2026

HIPAA and 42 C.F.R. PART 2 STATEMENT

This Joint Notice of Privacy Practices (“Joint Notice”) is provided to you pursuant to the Health Insurance Portability and Accountability Act of 1996, and its implementing regulations ("HIPAA"), as amended. It is designed to tell you how we may, under federal law, use or disclosure your Protected Health Information.

For Part 2 records, this Notice describes how health information about you may be used and disclosed, your rights with respect to your health information, how to file a complaint concerning a violation of the privacy or security of your health information, or of your rights concerning your information.

You have a right to a copy of this Notice in paper or electronic form. You can view it online at www.atlanticare.org, request a copy when you come in for an appointment, or contact our Privacy Office to have one sent to you. If you have any questions about this Notice, ask any staff member where you receive care or contact our Privacy Office at (609) 407-7788. The Privacy Office address is on the last page of this Notice.

Please read this document carefully.

WHO/WHAT IS COVERED BY THIS JOINT NOTICE

This Joint Notice covers all AtlantiCare facilities, programs, employees, volunteers, medical residents, and participating members of the physician staff and allied health professionals. The information contained in the record of your medical care generated by AtlantiCare is referred to as Protected Health Information (PHI). This Joint Notice applies to all Protected Health Information about you that is maintained by AtlantiCare, including any such information that is maintained in paper or electronic form, or spoken. This includes records of your care maintained by AtlantiCare, whether created by AtlantiCare employees, your physician, consulting physicians, or others covered by this Joint Notice.

When you receive services from us, we may create, collect and maintain information about you such as your medical record, billing record and other information related to the care and services we may provide to you. We need this information to provide you with the appropriate level of care and also to comply with certain legal obligations we may have. We are required by law to provide you with this Notice of our legal duties and privacy practices with respect to certain health information that we maintain about you.

This Joint Notice also describes how authorized health care providers may use and disclose your Protected Health Information electronically through the AtlantiCare Health Information Exchange (HIE). You can get additional information about the AtlantiCare HIE from your participating provider’s registrar or receptionist or by visiting our website, www.atlanticare.org.

Federal and New Jersey State Law Implications

The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), as amended by the Health Information Technology for Economic and Clinical Health Act, and the laws of the State of New Jersey place certain obligations upon us with regard to your protected health information and require that we keep private and confidential any such information that identifies you. HIPAA is a federal law, which places limitations on the types of uses and disclosures health care providers and others may make of protected health information. At times, State or other regulations may afford more protection of your protected health information or provide additional patient rights that exceed those under HIPAA.

42 C.F.R. Part 2 Records

If you receive services from our dedicated substance use disorder (SUD) program (“Part 2 Program”) and your record contains SUD information protected by Part 2 (your “Part 2 Record”), the federal Confidentiality of Substance Use Disorder Patient Records regulations at 42 C.F.R. Part 2 (“Part 2”) place certain additional obligations upon us with regard to your Part 2 Record and requires that we keep private and confidential any such SUD information that identifies you.

Under these laws, we may not use or disclose your protected health information or Part 2 Record except as allowed by law. We take this obligation and your privacy seriously. When we need to use or disclose your protected health information or Part 2 Record, we will comply with the terms of this Notice. Anytime we are permitted to or required to share your protected health information or Part 2 Record outside AtlantiCare, we only provide the minimum amount necessary to respond to the need or request, unless otherwise permitted or required by law.

Additional Rights under New Jersey Law

New Jersey law may further limit our uses and disclosures of your PHI. This includes AIDS/HIV-related information, venereal disease information, genetic information, tuberculosis information, mental/behavioral health information, psychotherapy notes, certain drug and alcohol treatment information and certain information related to the emancipated treatment of a minor (e.g., when the minor seeks emancipated treatment for pregnancy or treatment related to the minor's child or a sexually transmitted disease). In these cases, AtlantiCare will abide by the most stringent of the regulations as they pertain to PHI, including obtaining your prior written consent, if required, before any such information is disclosed to a third party. These restrictions also apply to the sharing of any special categories of information through the AtlantiCare Health Information Exchange.

New Jersey Health Information Exchanges

AtlantiCare and other health care providers participate in Health Information Exchanges (“HIEs”), including the AtlantiCare HIE, which allows patient information to be shared electronically through a secured connection network. We may use or disclose your PHI in connection with the AtlantiCare HIE, or another HIE that we may participate in for your treatment, to ascertain whether you have health insurance and what it may cover, and to evaluate and improve the quality of medical care provided to all of our patients. Other health care providers and health plans may also have access to your information in the HIE for similar treatment, payment and health care operations purposes or to the extent permitted by law.

Right to Opt Out of HIEs

If you wish to opt out of sharing your data on the AtlantiCare HIE, call 888-569-1000 or download the Opt Out Form from https://www.atlanticare.org/patients-and-visitors/for-patients/health-i…

If you opt out of the AtlantiCare HIE, your PHI will continue to be accessed and released, electronically or otherwise, as needed to provide treatment to you, but will not be made available for such purpose through the AtlantiCare HIE.

Required Uses and Disclosures

Under the law, disclosures must be made to you, upon your request (unless medically contraindicated) and when required by the Secretary of the Department of Health and Human Services to investigate or determine compliance with HIPAA.

Permitted Uses and Disclosures (Written Consent Not Required)

We are permitted by law to use and disclose your protected health information without your written consent or other form of Authorization under certain circumstances. This means that we do not have to ask you before we use or disclose your protected health information for purposes listed below. For Part 2 Records, we are permitted by law to use and disclose your Part 2 Record without your written or other form of consent only in very limited circumstances as described below. This means that we do not have to ask for your consent before we can use or disclose your Part 2 Record for the purposes listed below. Treatment. We will share your PHI with other professionals who are treating you. This includes disclosure of your PHI to doctors, hospitals, pharmacies and other third parties who are involved in your care. For example, we will disclose your PHI to another physician to whom you have been referred, to the physician who referred you to us or to a home health agency that will be caring for you. We will use your PHI during continuum of care rounds which may include, without limitation, physicians, nurses, care managers, social workers, pharmacists, physical therapists, spiritual care workers and nutrition staff who are involved in your care. We may call your name in our waiting room when your doctor or other provider is ready to see you.

Payment.

We may use and disclose your protected health information in order to bill for and get payment for the services we provide to you. For example, we may send your information to your health insurance company for payment of the services we provided. We may also send your information to our billing company to be in touch with you regarding any payment issues.

Health Care Operations.

We may use and disclose your protected health information for our internal administration planning and activities to improve the quality and cost effectiveness of the care that we deliver to you. For example, we may use your information to evaluate the performance of our staff and for training and education purposes. We may access or send your information to our attorneys or accountants in the event we need the information in order to address one of our own business functions.

Business Associates.

Protected Health Information will be provided to third party “business associates” that perform various activities and services on our behalf (e.g. billing, transcription and medical equipment) on behalf of AtlantiCare. In such situations, AtlantiCare will have a written contract in place that restricts the ability of the business associate to use or disclose your Protected Health Information in accordance with HIPAA requirements.

Part 2 Record – Treatment, Payment and Business Operations.

We will obtain a single written consent for all current and future uses and disclosures of such Part 2 Record we may need to make for treatment purposes unless otherwise permitted by Part 2. HOWEVER, if we receive substance use disorder (SUD) information about you from another health care provider, including a health care provider who is subject to Part 2, and you have authorized such provider to make disclosure of your SUD information for treatment, payment and health care operations purposes, we are permitted to use and disclose such information as permitted by HIPAA and described in this Notice without the need for any such additional consent from you.

Medical Emergencies.

Although generally we do not need your consent to use or disclose your protected health information for treatment purposes, we may disclose information in your Part 2 Record to medical personnel in the event of a medical emergency to the extent we cannot obtain your consent. If required by Part 2, we will document the disclosure in your records with the name of the personnel to whom the disclosure was made and their affiliation with a health care facility, the name of the person making the disclosure, the date and time of the disclosure, and the nature of the emergency.

Public Health Activities.

We may disclose your PHI to local, state or federal public health authorities as authorized by law to prevent or control disease, injury or disability; to report child abuse or neglect; report domestic violence; report to the Food and Drug Administration problems with products and reactions to medications; and report disease or infection exposure. We may use or disclose your PHI to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, such as the Red Cross. To the extent the public health authority requires, or Part 2 Record would be contained in protected health information disclosed to such public health authority, the information may need to be de-identified - that is, all specific information that identifies you as having had or having a SUD condition may be removed from your record before it is shared if required by Part 2.

Health Oversight Activities.

We may disclose your PHI to government agencies for activities authorized by law, including audits, investigations, surveys, accreditation, certification and other proceedings. Disclosure of any Part 2 Record in these circumstances may be subject to additional restrictions.

Response to Subpoenas or for Judicial and Administrative Proceedings.

In general, Protected Health Information may be used and disclosed in the course of an administrative or judicial proceeding. However, we will attempt to ensure that you have been made aware of the use or disclosure of your protected health information prior to its release. For protected health information containing your Part 2 Record, a court order accompanied by a subpoena requesting the Part 2 Record will generally be required. Your Part 2 Record will only be used or disclosed based on a court order after notice and an opportunity to be heard is provided to you unless otherwise required by 42 U.S.C. 290dd-2 and Part 2.

Law Enforcement.

We may use or disclose your PHI if requested by law enforcement officials to identify or locate a suspect, fugitive, material witness or missing person, or, in some cases, to comply with a court order or subpoena and for other law enforcement purposes. Disclosure of any Part 2 Record in these circumstances may be subject to additional restrictions.

Correctional Facilities.

If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your PHI to the respective correctional institution or law enforcement official in accord with laws, rules, regulations and our policies.

Coroners, Medical Examiners and Funeral Directors.

We may disclose certain PHI to a coroner or medical examiner. We may also disclose certain PHI about deceased patients to funeral directors so that they may carry out their duties. Disclosure of any Part 2 Record in these circumstances may be subject to additional restrictions.

Organ Donation.

We may disclose the PHI of organ donors to organizations involved in procuring, banking or transplanting organs and tissues.

Research.

We may use or disclose your PHI for certain research purposes when such research is approved by an Institutional Review Board as appropriate. Disclosure of any Part 2 Record in these circumstances may be subject to additional restrictions. To Avert a Serious Threat to Health or Safety. We may use or disclose your PHI in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.

Specialized Government Functions.

We may use or disclose your PHI for specialized government functions such as military, national security and presidential protective services. We may use and disclose the PHI of patients who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits; or (3) to a foreign military authority if you are a member of that foreign military service.

Worker’s Compensation.

We may use and disclose your PHI for purposes of handling your workers’ compensation claims in compliance with applicable laws, rules and regulations.

Fundraising.

From time to time, we may contact you by phone, email or in writing to solicit tax-deductible contributions to support our activities. The money raised will be used to expand and improve the services and programs we provide to the community. In doing so, we may disclose to our fundraising staff certain demographic information about you, such as your name, address and phone number, as well as certain other limited information. You have a right to opt-out of receiving these communications and may do so at any time.

Marketing.

Unless allowed by law, we may not receive payment directly or indirectly for your PHI without your authorization. Without your authorization, we will not disclose your PHI for marketing purposes as set forth under the HIPAA rules.

Business Associates.

Some of the services we provide are performed through contractual relationships with outside parties or business associates. These services may include (but are not limited to) financial, auditing and legal. We take efforts to only provide business associates with the minimum necessary amount of PHI to carry out their contractual duties. All business associate contracts restrict the ability of the business associate to further use or disclose your PHI so that it is appropriately safeguarded in compliance with HIPAA regulations.

Appointment Reminders.

We may contact you via mail, telephone, text or e-mail to remind you of an upcoming appointment. We may leave you a message that includes the date, time and general information about an upcoming appointment. If you do not wish to receive appointment reminders, please notify your healthcare professional.

Patient Reunions.

We may hold reunions for various patient groups to celebrate their success in treatment. If you are or were part of such a patient group, we may use your PHI to invite you.

Treatment Alternatives & Other Health Related Benefits and Services.

We may use or disclose your PHI to contact you with information about treatment alternatives or other health-related benefits and services, including disease management, health promotion, preventive care, and wellness programs that may be of interest to you.

Hospital Directory.

Unless you tell us not to, we will include certain information about you in the hospital directory if you are admitted to one of our hospitals. This information may include your name, your location in the hospital, your general condition, your religious affiliation and whether you wish to have our spiritual care chaplains visit you. This information may also be disclosed to people who ask for you by name, such as your relatives, friends and the media. Your religious affiliation may be given to community clergy even if they don't ask for you by name. You may opt out of participating in the Hospital Directory at the time of admission or anytime during your admission.

Spiritual Care Staff.

Our doctors and other healthcare providers work with our spiritual care chaplains as part of the treatment team at our hospitals, unless you tell us that you do not want our spiritual care chaplains to be involved. Spiritual care chaplains may call on you during your hospital stay. You may opt out at the time of your admission or anytime during your admission.

Individuals Involved in Your Care.

Unless you inform us of your objection in writing, we will use or disclose your Protected Health Information in order to notify or assist in notifying your family, your personal representative or another person responsible for your care about your location, your condition, or of your death. We may also discuss your health care with your family and friends to the extent that they are involved in your care. We may share information in a disaster relief situation. If you are unable or unavailable to agree or object to our discussing these matters with your family and/or friends, our health professionals will use their judgment as to whether any communications with your family or others are necessary and/or appropriate.

As Required by Law or Legal Process.

We will disclose your PHI when we are required to do so by local, state or federal law. Protected Health Information will be used and disclosed to the extent that such use or disclosure is required by law. Examples of these requirements include communicable disease reporting, incidence of burns, seizures, gun shots, abuse, organ donations, product recalls, product failures, birth/deaths and/or birth defects. Examples of the authorities/agencies to which PHI may be disclosed include: New Jersey Department of Health and Senior Services, the Division of Motor Vehicles, Local and/or State Police, the Medical Examiner and County Prosecutor, the Perinatal Co-operative, Organ Procurement Agencies, the Drug Enforcement Administration, the Ombudsman, the Office of Civil Rights, the Centers for Medicare and Medicaid Services and/or Peer Review Organizations.

USES AND DISCLOSURES OF PART 2 RECORDS THAT REQUIRE YOUR WRITTEN CONSENT.

Authorizations.

Use and disclosure of your PHI for purposes other than those listed above requires your authorization. When you complete an authorization form that complies with the law, we will disclose your PHI as you have directed, however we are not able to take back any uses or disclosures that we already made with your authorization. If you provide us with a written authorization to disclose your PHI, you may revoke it at any time. Your revocation must be in writing. Please contact our Health Information Management Department at (609) 441-8987 or visit online at www.atlanticare.org to obtain a copy of the Authorization. In general, we will need your specific written authorization to use or disclose your protected health information for any purpose other than those listed above in Section III. For example, we would need your written authorization to disclose psychotherapy notes. Likewise, we may need you to authorize us to send you marketing materials or fundraising communications. Certain categories of sensitive information subject to special protection (“Sensitive Information”) may also require a separate written authorization. If applicable law requires us to obtain a written authorization prior to making a use or disclose of Sensitive Information for a purpose that is described in this Notice, we will obtain such authorization from you before making such use or disclosure.

We will seek your specific written authorization and/or consent for at least the following unless the use or disclosure would be otherwise permitted or required by law:

Treatment, Payment and Health Care Operations by Part 2.

If you receive services from our Part 2 Program and your protected health information contains a Part 2 Record, we will generally obtain a single written consent for all current and future uses and disclosures of such Part 2 Record we may need to make for treatment, payment and business operation purposes unless otherwise permitted by Part 2.

This may include disclosing diagnosis, lab and other test results and progress notes to other providers involved in your care, sending your information to our billing company or insurance companies that provide payment for the services, and using your information internally to train our staff or to internally improve the services provided by us. This information may be further disclosed to another Part 2 provider, a covered entity, or a business associate/qualified service organization to the extent permitted under HIPAA and Part 2. HOWEVER, if we receive substance use disorder (SUD) information about you from another health care provider, including a health care provider who is subject to Part 2, and you have authorized such provider to make disclosure of your SUD information for treatment, payment and health care operations purposes, we are permitted to use and disclose such information as permitted by HIPAA and described in this Notice without the need for any such additional consent from you.

Restrictions on Use of Part 2 Record.

Your Part 2 Record or testimony relaying the content of such records, may NOT and shall NOT be disclosed by us for the purposes of any civil, criminal, administrative or legal proceedings against you unless you have provided your written consent or pursuant to a court order. Any court order must be accompanied by a subpoena or similar legal mandate compelling disclosure.

Part 2 SUD Counseling Notes.

We must obtain your separate written consent prior to disclosing any SUD Counseling Notes which may be contained within your Part 2 Record unless otherwise permitted by Part 2. An authorization for disclosure of SUD Counseling Notes may not and will not be combined with any other authorization.

Fundraising for Our Part 2 Program.

We must obtain your separate written consent prior to using or disclosing any part of your Part 2 Record for fundraising purposes. Additionally, we will first provide you with a clear and conspicuous opportunity to elect to not receive fundraising communications (i.e., to “opt out” of such communications) before we use or disclose any part of your Part 2 Record to fundraise for the benefit of our Part 2 Program. [2.22(b)(1)].

Psychotherapy notes.

We must obtain your specific written authorization prior to disclosing any psychotherapy notes unless otherwise permitted by law. An authorization for disclosure of psychotherapy notes may not be combined with any other authorization.

Use or disclosure of protected health information related to Reproductive Health Care.

We may be required to obtain your explicit consent in writing to disclose Reproductive Health Care Services information in any civil action or proceeding preliminary thereto or in any probate, legislative or administrative proceeding unless an exception applies under applicable law, and you have a right to withhold such written consent. Unless you give your specific written authorization, we will generally not be permitted to use or disclose your protected health information (1) to conduct a criminal, civil, or administrative investigation into any person for the mere act of seeking, obtaining, providing, or facilitating reproductive health care; (2) to impose criminal, civil, or administrative liability on any person for the mere act of seeking, obtaining, providing, or facilitating reproductive health care; or (3) to identify a person for any purpose described in subsections (1) and (2). For example, if law enforcement seeks information related to allegations that Reproductive Health Care was provided by a health care provider even though such care was lawful where provided, we would generally be prohibited from disclosing protected health information for such purposes. We may further be required to obtain an attestation from certain requestors seeking protected health information which may contain Reproductive Health Care information for certain purposes, such as law enforcement requests, judicial or administrative proceedings or health oversight activities, that the requestor will not use your information for such prohibited purposes.

HIV /AIDS information.

In most cases, we will NOT release any of your HIV/AIDS related information unless you have signed an authorization expressly stating that we may do so. There are certain purposes, however, for which we may be permitted to release your HIV/AIDS information without obtaining your express authorization. For example, for treatment activities, to comply with a court order, if required by law, or to the New Jersey Department of Health or other governmental entity.

Sexually transmitted disease information.

In most cases, we will not release any of your protected health information that identifies you as having had or having a sexually transmitted disease unless you have signed an authorization expressly stating that we may do so. We may use and disclose information related to sexually transmitted diseases without obtaining your authorization only where permitted by law, including to the New Jersey Department of Health and Senior Services and only under limited circumstances.

Tuberculosis Information.

In most cases, we will not release any of your protected health information that identifies you as having or being suspected of having tuberculosis (TB) unless you have signed an authorization expressly stating that we may do so. We may use and disclose TB information where authorized by law, to the New Jersey Department of Health, or otherwise authorized by court order. Mental health information. We may be required to obtain your specific written authorization prior to disclosing certain mental health information unless otherwise permitted by law.

Genetic information.

We may be required to obtain your specific written authorization prior to obtaining or retaining your genetic information, or using or disclosing it for treatment, payment or health care operations and other purposes. We may use or disclose your genetic information without your written authorization only where it would be permitted by law, such as for paternity tests for court proceedings, newborn screening requirements, identifying a body or otherwise authorized by a court order. Information related to emancipated treatment of a Minor. If you are a minor who has sought emancipated treatment from us, such as treatment related to your pregnancy or treatment of your child, or a sexually transmitted disease (STD), or outpatient behavioral mental health, we must obtain your specific written authorization prior to disclosing any of this information to another person, including your parent or guardian, unless otherwise permitted or required by law.

Marketing activities.

We must obtain your specific written authorization in order to use any of your protected health information to mail or email you marketing materials. However, we may provide you with marketing materials face-to-face without obtaining authorization, in addition to communicating with you about services or products that relate to your treatment, case management, or care coordination, alternative treatments, therapies, providers or care settings. If you do provide us with your written authorization to send you marketing materials, you have a right to revoke your authorization and may do so at any time for future marketing communications. If you wish to revoke your authorization, please contact the Privacy Office at (609) 407-7788 or write to the Privacy Office at 2500 English Creek Ave., Bldg. 500, Egg Harbor Twp., NJ 08234.

Activities where we receive money for exchanging protected health information.

For certain activities in which we would receive money (remuneration) directly or indirectly from a third party in exchange for your protected health information, we must obtain your specific written authorization prior to doing so. However, we would not require your authorization for activities such as for treatment purposes. You have a right to revoke your authorization at any time. If you wish to revoke your authorization, please contact the Privacy Office at (609) 407-7788 or write to the Privacy Office at 2500 English Creek Ave., Bldg. 500, Egg Harbor Twp., NJ 08234.

Other uses of your PHI.

Other uses and disclosures of your PHI not covered by the categories included in this Notice or applicable laws, rules or regulations will be made only with your written permission or authorization.

YOU HAVE RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

Right To Inspect And Copy

You have the right to inspect and receive a copy (paper or electronic) of your PHI, usually within 30 days of your request that may be used to make decisions about your care. You may choose a personal representative to act on your behalf to access your medical information. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action. You may also direct us in writing to transmit your PHI to another entity or individual. To do so, you must complete a Patient Access Request Form, which you can obtain by contacting our Health Information Management Department or the Privacy Office. Contact information for those offices may be found on the last page of this Notice.

You will be charged a reasonable cost-based fee. We may deny your request in very limited circumstances. If you are so denied, in some cases, you may request that the denial be reviewed. We will comply with the outcome of the review.

Right To Amend

You have the right to request an amendment of PHI contained in your designated record if you believe the information is incorrect or incomplete. However, we may deny such a request in the following circumstances:

The record was not created by AtlantiCare, unless you provide us with a reasonable basis to believe that the originator of PHI is no longer available to act on the requested amendment.
The record is not part of the designated record set.
The record would not be available for inspection under 45 CFR 164.524.
The record is accurate and complete.

Generally, we must respond to your request within sixty (60) days. However, we may extend the time for such action by no more than thirty (30) days as provided under HIPAA. If we do not agree to your request, we will provide you with information about our denial and explain how you can disagree with the denial by filing a statement of disagreement with us. We may then prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. All of these documents will be placed in the appropriate part of your Designated Record Set.

If you are requesting that we amend your records because you believe that you are a victim of medical identity theft, we will use reasonable efforts to assist you in making corrections to your record which are determined to be appropriate under the circumstances. To request an amendment, please contact our Health Information Management Department or the Privacy Office to obtain an Amendment Request Form. Contact information for those offices may be found on the last page of this Notice.

Right To An Accounting Of Disclosures

You may request an accounting of certain disclosures we have made of your protected health information within the period of six (6) years from the date of your request for the accounting. With respect to your electronic Part 2 Record, you may request an accounting of disclosures for treatment, payment and health care operations which we made through an electronic medical record for a period of three (3) years from the date of your request. The first accounting you request within a period of twelve (12) months is free. Any subsequently requested accountings may result in a reasonable charge for the accounting statement. Please contact the Privacy Office if you wish to request an accounting of disclosures. We will generally respond to your request in writing within thirty (30) days from receipt of the request.

Right To List Of Disclosures Through Intermediary

If we make disclosures of your Part 2 Record using an intermediary (a special kind of entity that receives Part 2 Record pursuant to your consent that enables the exchange of Part 2 Record among participating treating providers), you may request in writing a list of disclosures made through such Intermediary for a period of three (3) years from the date of your request. We will generally respond to your request in writing within thirty (30) days from receipt of the request.

Right To Request Restrictions

You have the right to request restrictions on the uses and disclosures of your PHI for treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care, or for notification purposes as described in this Notice. Please contact the Privacy Office to obtain a Restriction Request Form.

Restriction requests must be in writing and state the specific restriction requested and to whom you want the restriction to apply. Please note that AtlantiCare is not required to comply with your request, unless you are asking us to restrict the use and disclosure of your PHI to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full.

Right To Request Confidential Communications

You have the right to request your Protected Health Information be received by you through confidential means, i.e. alternative address or other method of contact. Your request must be in writing to the Privacy Office. We may condition this accommodation by asking you for information as to how payment will be handled for services we provide to you. We will not request an explanation from you as to the basis for the request. Please send your written request to the Privacy Office and state the specific alternate means or location.

Right To Notification

In accordance with law, AtlantiCare has a duty to notify you in accordance with federal and state notification laws if there is a breach of your unsecured Protected Health Information. This will be done by mail or by other means if necessary.

Right To A Paper Copy Of This Notice

You have the right to request a copy of the Notice electronically or on paper. You have the right to discuss this Notice with our Privacy Office at any time.

Changes to this Notice

We are required by law to maintain the privacy of your Protected Health Information and to provide you with a copy of this Notice. We are also required to abide by the terms of this Notice. We reserve the right to amend this Notice at any time in the future and to make the new Notice provisions applicable to all your Protected Health Information – even if it was created prior to the change in the Joint Notice. If such amendment is made, we will immediately display the revised Notice at our office, and on our Web Site at https://www.atlanticare.org/about-us/notice-of-privacy-practices. We will also provide you with a copy, at any time, upon request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer and/or with the Office of Civil Rights of the U.S. Department of Health and Human Services. We have provided both addresses on the last page of this Notice. To file a complaint with the AtlantiCare Privacy Office, call (609) 407-7788. Violation of Part 2 is a crime. Suspected violations of Part 2 may be reported to the United States Attorney in the district where the violation occurs. The covered entities of AtlantiCare value your right to privacy. You will not be retaliated against for filing a complaint.

Contact Information

You may contact us with any concerns or for additional information regarding our privacy practices by calling or writing to the Privacy Office at:

AtlantiCare Privacy Office
2500 English Creek Ave., Bldg. 500
Egg Harbor Twp., NJ 08234
(609) 407-7788

AtlantiCare Health Information Management
1925 Pacific Avenue
Atlantic City, NJ 08401
(609) 441-8987
Email: [email protected]

United States Department of Health & Human Services
200 Independence Ave., SW
Washington, DC 20201
(877) 696-6775
Website: www.hhs.gov/ocr/privacy/hipaa/complaints

This Notice is being provided to you on behalf of AtlantiCare Health System, Inc. and its’ affiliated entities (an “OCHA”). All of the AtlantiCare hospitals, our physicians, doctor offices, service locations, facilities, entities and our foundation follow the terms of this Notice. AtlantiCare affiliated entities’ locations are listed on our website at www.atlanticare.org.