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You acknowledge and agree that Eileen C. Comia, M.D. LLC will enter your protected health information (“PHI”) in a
database maintained by the Saint Francis Hospital and Medical Center (the “Hospital”). The PHI maintained in the database
will be used by Eileen C. Comia, M.D. LLC for treatment, payment and health care operations purposes. Eileen C. Comia,
M.D. LLC may also disclose your PHI maintained in the database to another provider (i) for treatment purposes, (ii) for
payment purposes and (iii) for health care operations if you have or had a relationship with the other provider and only for the
following reasons: (a) conducting quality assessment and improvement activities, including outcomes evaluation and
development of clinical guidelines, provided that the obtaining of generalizable knowledge is not the primary purpose of any
studies resulting from such activities; population-based activities relating to improving health or reducing health care costs,
protocol development, case management and care coordination, contacting of health care providers and patients with
information about treatment alternatives; and related functions that do not include treatment; or (b) reviewing the competence
or qualifications of health care professionals, evaluating practitioner and provider performance, health plan performance,
conducting training programs in which students, trainees, or practitioners in areas of health care learn under supervision to
practice or improve their skills as health care providers, training of non-health care professionals, accreditation, certification,
licensing, or credentialing activities; or (c) health care fraud and abuse detection or compliance. Eileen C. Comia, M.D. LLC
may also disclose your PHI maintained in the database to the Saint Francis Physician Hospital Organization (“PHO”) for use
by the PHO as a Business Associate of the Group for health care operational purposes, including without limitation, quality
and utilization review of health care services.”
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.
PATIENT RIGHTS
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.
Most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing purposes, and
disclosures that constitute a sale of PHI require patient authorization.
Other uses and disclosures not described in this Privacy Notice will be made only with authorization from the
individual.
You have the right to restrict certain disclosures of PHI to health plans/insurances if the patient pays out of pocket in
full for the health care service.
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.
Affected patients have the right to be notified following a breach of unsecured PHI.
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.
COMPLAINTS
If you believe Eileen C. Comia, MD LLC has 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:
Eileen C. Comia, MD LLC
35 Jolley Drive Suite 102
Bloomfield, CT 06002
Attn: Julius A. Comia, M.D. - Manager
FOR FURTHER INFORMATION
If you would like more information regarding our privacy practices, please contact the office at (860)242-2200.
