Each time you visit a hospital, physicians or other healthcare provider, a record of your visit is made. Typically this record contains your symptoms, examination and test results, diagnosis, treatment, and a plan for future care or treatment. This information often referred and serves as a means of communication among the many healthcare professionals who contribute to your care. Understanding what is in your medical record and how your health information is used helps you to ensure its accuracy, better understand who, what, where, and why others may access your health information, and make more informed decisions when authorizing disclosures to others.

We, at Wellesley Primary care Medicine, P.C. pledge to provide you with the highest quality of care and to build a relationship that is based on trust. This trust includes out commitment to respect the privacy and confidentiality of your health information.

This notice of our Privacy Practices is being given to you because federal law gives you the right to be told ahead of time about:

  1. How WPCM, PC, will handle your medical records
  2. What our legal duties are related to your medical information
  3. What your rights are with regards to your medical information
  4. A method for filing complaints about our privacy practices


When you need health care, you give information about yourself and your health to doctors, nurses, and other health care workers and staff. This information, along with the record of care you receive is “protected information” (or “health information”). This information is kept in a paper such as your medical record and in an electronic form on the computer.

(A) WPMC, PC uses and discloses (shares) health information for many different reasons. For some of these uses and disclosures, we will need to obtain prior written authorization (permission). However, Wellesley Primary Care Medicine, PC may legally use or disclose your health information for treatment, payment, and healthcare operations. We do not need to receive prior authorization for uses and disclosures described within the following categories:

For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of these categories:

For treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose (share) medical information about you to other doctors, and health care providers involved in you care. Example: A primary care physician may refer you to a specialist such as a radiologist or a surgeon. The specialist may tell you that you need to be admitted to the hospital for treatment or surgery. All of the doctors in the example will share medical information about you. This is to coordinate care before, during and after you go into the hospital.

For Payment. We May use and disclose (share) your health information in order to bill and collect payment for the treatment and services provided to you. Example: A bill may be sent to you or a third party payer. If you have health insurance, information on or accompanying the bill may include a portion of your health information that identifies you, as well as, you diagnosis, procedures and supplies used for treatment. The insurance company used the information to tell if you are eligible for benefits or if the services you received were medically needed for payment purposes. We may also provide your health information tour business associates, such as a billing company, claims processing companies and, others that process our healthcare claims.

For healthcare operations. We may disclose (share) your health information for activities that are known as health care operations. These activities use healthcare information for the purpose of evaluating our performance and finding better ways to provide care. We may use your health information in order to evaluate the performance of the healthcare professionals who provided healthcare services to you. We may also share you health information with outside parties (“business associates”) who perform services on behalf of Wellesley Primary Care Medicine, PC the business associates must agree to keep your health information private. Examples of activities that make up healthcare operations include; legal counsel, transcription, storage, auditing, consulting services.

(B) Other uses of your health information. Wellesley Primary Care Medicine, PC, may use your health information to contact you about;

TM Scheduled appointments, registration/insurance updates, pre-procedure assessments or test results;

TM With information about patient care issues and treatment choices;

TM With other health-related benefits and services that may be of interest to you.

(C) We may disclose (share) your health information to others without your consent in certain situations. Example: If you need emergency treatment, or if you are unable to communicate with us (unconscious or in severe pain). In each of these situations we will try to get your consent. But, if you were able to do so, we will disclose health information without consent.

(D) Other Specific Uses and Disclosures that DO NOT REQUIRE YOUR CONSENT.

(a) When disclosure of health information is requires by federal, state, or local law, administrative or legal proceedings, health oversight activities, or by law enforcement. Examples of some required reporting include; health information about victims of abuse, neglect or domestic violence; patients with gunshot and or other wounds. In addition we disclose health information when ordered in a legal or administrative proceeding.

The Right to See or Get Copies of Your Health Information. In most cases, you have the right to look at or get copies of your PHI that we have, but you must make the request, in writing. We will respond within thirty (30) days from the receipt of your request. If you ask for a copy of your records, you will be charged a fee of $25 Dollars. If your request is denied, we will inform you, in writing, our reasons for the denial and explain your rights to have the denial reviewed. We may offer to give you a summary or explanations of the information you’re re questing as long as you agree in advance to this and to any fees that this might cost. If you ask for information we do not have, but we know where it is, we must tell you where to direct your request.

The Right to Receive an Accounting of Disclosure (a record of when and to whom, your health information was shared without your authorization). You have the right to obtain a list of the instances that we have shared your health information. You must make this request in writing. You may request as far back as six years, beginning April 14, 2003. The listing you will get will include date, name, and address (if known) of the person or organization receiving it. It will also include a brief description of the information given, a brief statement on why the information was shared, or a copy of the written request for the information.

The list will not include uses or disclosures that you have already consented to, such as those mode for the treatment, payment, or health care operations, directly to you or your family. The list also will not include uses or disclosures made for national security purposes, to connections or law enforcement personnel, or before April 14, 2003.

We have 60 days to respond to your written request. If we are not able to act on your request witin the 60 days, we will notify you that we are extending your response time by 30 days. If we do that we will explain the delay in writing and give you a new date of when to except a response. We will provide this list at no charge, but if you make more then 1 request in the same year, we will charge you $25 dollars for each additional request.

The Right to Correct or Update you Health Information. If you believe that there is a mistake in your health information or a piece of important information missing, you have the rights to request that we correct the current information or add the missing information. You must provide the request and reason for the request in writing.

We have 60 days to respond to your request. We may deny your request, in writing if the health information is; (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclose, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your rights to file a written statement of disagreement; you have the right to request that your request and our denial be attached to all future disclosures of your health information. If we approve your request, we will make the change to your protected health information. If we approve your request, we will make the change to your protected health information, letting you know that we have done it, and tell others that need to now about the change to your protected information.


(a) Make sure that medical information that identifies you is kept private.

(b) Provide you with this notice that explains our privacy practices and how, when and why we use and/or disclose (share) your health information.

(c) Follow the terms of the Notice currently in effect. However, we reserve the right to change our privacy policies and the terms of this notice at any time. Any changes will apply to the health information we already have. Before any important policy change goes into effect, we will change this Notice site in a clearly visible location within our practice for public viewing.

(d) You may request a copy of this notice at any time from our office staff.


Unless otherwise required by law your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you.