Advance Biomedical Treatment Center, LLC
Notice of Privacy Practices
This Notice describes how health information about you may be used and disclosed
and how you can get access to this information.
Advance Biomedical Treatment Center, LLC is required by applicable Federal and State law to maintain the privacy of your
protected health information (PHI). We are required to provide you with this Notice regarding our duties and practices in
using your health information. We shall abide by the terms of this Notice which will remain in effect until we replace it.
Advance Biomedical Treatment Center, LLC reserves the right to change its privacy practices and the terms of this Notice at
any time. It reserves the right to have the changes apply not only to health information acquired after the change in Notice,
but also to health information received before the change in Notice. Should our Notice be revised, we will post the revised
Notice in our office, in our website www.advbiomedtx.com, and also make the new Notice available upon request.
Advance Biomedical Treatment Center, LLC may use and disclose protected health information (PHI) about you for the
following purposes without obtaining your written consent:
To provide treatment (e.g. discussions between caregivers or other healthcare providers for coordination and
planning of your care). Treatment means provision of healthcare and related services, including consulting between
healthcare providers; and referring you to another healthcare provider to receive care;
To obtain payment for the service we provide to you.
To conduct our administrative and business operations, which includes, but is not limited to, conducting quality
improvement activities, reviewing the competence or qualifications of healthcare professionals, case management
and care coordination, contacting patients with information regarding treatment alternatives, conducting or arranging
for legal counsel, medical review and auditing functions including fraud and abuse detection.
Unless you object or specifically request to restrict use, Advance Biomedical Treatment Center, LLC may communicate
health information: (a) to your family member/s, legally authorized representative/s, and any other person identified by you
which is directly relevant to such person’s involvement in your care or payment for your care; and (b) to notify or assist in
the notification of a family member, a personal representative, or any other person responsible for you. If you are able, we
will provide you with the opportunity to consent or object to such disclosure. If you are unable to object due to your
incapacity or an emergency circumstance, Advance Biomedical Treatment Center, LLC, based upon its professional
judgment, will make such disclosure if it determines that it is in your best interest to do so. Such disclosure of health
information will be limited to information that is directly relevant to the recipient’s involvement with your healthcare.
Unless the health information is protected by Federal/State confidentiality laws, we may use and disclose your health
information without your consent or without providing you the opportunity to object as follows:
If the use or disclosure of health information is required by law and is limited to the relevant requirements of the
Disclosures required by law to state and federal public health authorities;
Disclosures made to government authorities for the purpose of reporting suspected abuse and neglect of children, the
elderly, and the mentally retarded;
Disclosures to health oversight agencies authorized by law, in connection with audits, civil, administrative, or
criminal investigations, licensure or disciplinary actions; or for monitoring compliance and quality;
Disclosures to persons exposed to a communicable disease if authorized by law to make such disclosure;
Disclosures in connection with judicial and administrative proceedings in response to an order of the court or
administrative tribunal, or in response to a lawfully issued subpoena;
Disclosures to law enforcement if mandated by law;
Disclosures to law enforcement if there is evidence of criminal conduct that occurred on the Center’s premises;
Disclosures to persons reasonably able to prevent or lessen serious and imminent threat to the health or safety of a
person or the public; or if necessary to apprehend an individual involved in a violent crime that we believe may have
caused serious physical harm to you;
ABTC Notice of Privacy Practices p.2 of 3
Advance Biomedical Treatment Center, LLC may make disclosures of your health information to provide follow-up contact
to you regarding upcoming appointments, treatment alternatives, health-related benefits, programs, services, events and
functions which may be of interest to you. We may use health information to provide you with appointment reminders (such
as voicemail messages, postcards, or letters).
Electronic mail (Email) is a service we offer to our patients for convenience in communicating with our medical office. If
you provided us with your email address, you accept responsibility and will hold Advance Biomedical Treatment Center,
LLC harmless in the event that any email communication is read by anyone but yourself. We may use your email address to
communicate personal health information. Advance Biomedical Treatment Center, LLC will not share or sell your email
address to third-parties.
The Advance Biomedical Treatment Center, LLC website provides some links to third-party websites. We have no control
over their privacy practices and assume no responsibility in connection with their use of their websites. We recommend that
you check the privacy policy of any website before you provide any personally identifiable information.
All other uses or disclosures will only be made with your specific written authorization, which may be revoked, except
to the extent it has already been relied upon. In all cases, when information about you or your child is released, we
will disclose only the minimum amount of information necessary to address the purpose of the request.
You have the right to request certain restrictions on the use of your protected health information for treatment,
payment, and our operations, disclosures to notify family and friends of your general condition, and disclosures to
others involved in your care or payment of your care. However, we are not required to honor all such restrictions.
The right to request that we communicate with you about your health information by alternative means or to
alternative locations. (You must make your request in writing.) Your request must specify the alternative means or
location, and provide satisfactory explanation how payments will be handled under the alternative means or location
you request.
You have the right to look at or get copies of your health information, with limited exceptions. You may request
that we provide copies in a format other than photocopies. We will use the format you request unless we cannot
practicably do so. (You must make a request in writing to obtain access to your health information. You may obtain
a form to request access by contacting the Center. We will charge you a reasonable cost-based fee for expenses such
as copies and staff time. Contact us for a full explanation of our fee structure.)
You have the right to receive a list of instances in which we disclosed your health information for purposes other
than treatment, payment, and healthcare operations. If you request this accounting more than once in a 1-year period,
we may charge you a reasonable, cost-based fee for responding to these additional requests.
You have the right to request that we amend your health information. (Your request must be in writing, and it must
explain why the information should be amended.) We may deny your request under certain circumstances.
If you receive this Notice on our website or by electronic mail (email), you are entitled to receive this Notice in
written form upon request.
If you believe we have violated your privacy rights, you may file a complaint to us or to the Department of Health and
Human Services. Please send a written complaint to:
Advance Biomedical Treatment Center, LLC
35 Jolley Drive Suite 102
Bloomfield, CT. 06002
Tel (860)242-2200 Fax (860) 242-2212
Attn: Julius A. Comia, M.D.Office Manager
If you would like more information regarding our privacy practices, please contact the office at (860)242-2200.
ABTC Notice of Privacy Practicesp.3 of 3
This is to acknowledge that I have received and have read the Notice of Privacy Practices of Advance
Biomedical Treatment Center, LLC.
Date: ___________
Name of Patient: ________________________________________ Date of Birth: ___________
Signature of Patient / Guardian: _____________________________________________________
If not signed by patient, please indicate relationship to patient.
Relationship: _____________________________ Witnessed by: ________________________
Internal Use Only:
If patient or patient’s representative refuses to sign acknowledgement of receipt of notice, please
document the date and time the notice was presented to patient and sign below.
Presented on (Date and Time): ______________________________________
By (Name and Title): _____________________________________________