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.
Draft prepared: September 6, 2026 · Effective Date: [TO BE SET UPON FINAL REVIEW]
This Notice is issued by InfuseCare Medical Management, d/b/a Infuse Care ("Infuse Care," "we," "us," or "our").
You have the right to: get a copy of your paper or electronic medical record; correct your paper or electronic medical record; request confidential communication; ask us to limit the information we share; get a list of those with whom we've shared your information; get a copy of this privacy notice; choose someone to act for you; and file a complaint if you believe your privacy rights have been violated.
You have some choices in the way that we use and share information as we: tell family and friends about your condition; provide disaster relief; market our services and sell your information; and raise funds.
We may use and share your information as we: treat you; run our organization; bill for your services; help with public health and safety issues; do research; comply with the law; respond to organ and tissue donation requests; work with a medical examiner or funeral director; address workers' compensation, law enforcement, and other government requests; and respond to lawsuits and legal actions.
To the extent that we have your substance use disorder patient records, subject to 42 CFR Part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or summary, usually within 30 days of your request, and may charge a reasonable, cost-based fee.
You can ask us to correct health information about you that you think is incorrect or incomplete. We may say no to your request, but we'll tell you why in writing within 60 days.
You can ask us to contact you in a specific way, or to send mail to a different address. We will say yes to all reasonable requests.
You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and may say no if it could affect your care. If you pay out of pocket in full for a service, you can ask us not to share that information with your health insurer for payment or operations purposes — we will say yes unless a law requires us to share it.
You can ask for an accounting of the times we've shared your health information for the six years prior to your request, who we shared it with, and why (excluding treatment, payment, and health care operations disclosures). We provide one accounting a year for free.
You can ask for a paper copy of this notice at any time, even if you agreed to receive it electronically.
If someone has authority to act as your personal representative — such as medical power of attorney or legal guardianship — that person can exercise your rights and make choices about your health information.
You can complain by contacting Infuse Care using the information below. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights: 200 Independence Avenue, S.W., Washington, D.C. 20201 · 1-877-696-6775 · hhs.gov/hipaa/filing-a-complaint/index.html. We will not retaliate against you for filing a complaint.
We can use your health information and share it with other professionals treating you — for example, coordinating with your referring physician about your infusion therapy and progress.
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
We can use and share your health information to bill and get payment from health plans, including the preauthorization and benefits-investigation work described on our website.
We are allowed or required to share your information in other ways that contribute to the public good, such as public health and research, subject to legal conditions. This includes: helping with public health and safety issues (preventing disease, medication recalls, reporting adverse reactions or suspected abuse); doing research; complying with the law; responding to organ and tissue donation requests; working with a medical examiner or funeral director; addressing workers' compensation, law enforcement, and other government requests; and responding to lawsuits and legal actions.
We are required by law to maintain the privacy and security of your protected health information, and to let you know promptly if a breach occurs that may have compromised it. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing, and you may change your mind at any time by letting us know in writing.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
Beth Newhouse, RN — Privacy Officer
InfuseCare Medical Management, d/b/a Infuse Care
301 Lakehurst Blvd, Suite 301, Toms River, NJ [ZIP CODE]
Phone: 732-444-2930 · Fax: (732) 960-3449 · Email: admin@infusecare.com
This Notice is effective as of [DATE] and remains in effect until revised or replaced.