Notice of Privacy Practice



Effective Date: September 1, 2015

About This Notice
We are required by law to maintain the privacy of Protected Health Information and to give you this Notice explaining our privacy practices with regard to that information. You have certain rights – and we have certain legal obligations – regarding the privacy of your Protected Health Information, and this Notice also explains your rights and our obligations. We are required to abide by the terms of the current version of this Notice.

What is Protected Health Information?

“Protected Health Information” is information that individually identifies you and that we create or get from you or from another health care provider, health plan, your employer, or a health care clearinghouse and that relates to (1) your past, present, or future physical or mental health or conditions, (2) the provision of health care to you, or (3) the past, present, or future payment for your health care.

Who Will Follow This Notice?

All MFA healthcare providers, employees, residents, physicians, trainees and other members of the MFA workforce will follow this notice.

How We May Use and Disclose Your Health Information:

We typically use or disclose your health information in the ways described below, although not every use or disclosure falling within each category is listed:

Treatment. We use and disclose your health information to provide your medical treatment. For example, your physician may review your record or may confer with another non-MFA physician or provider about your care.

Payment. We use and disclose your health information so that we can bill and collect payment from you, a health plan, or a third party. For example, we may need to give your health plan information about a service provided to you so your health plan will pay us or reimburse you for the service.

Health Care Operations. We use and disclose your health information to run our practice, improve your care, and contact you when necessary. For example, we may use and disclose your health information to review our treatment and services, to evaluate the performance of our staff in caring for you, or to other persons for educational and learning purposes.

Additional Uses and Disclosures:

We are allowed to use and disclose your health information in other ways, as long as we comply with the law related to those uses or disclosures. We may use and disclose your health information to:

• Comply with federal, state, or local laws that require disclosure;
• Assist in public health activities, such as tracking diseases or medical devices;
• Inform authorities to protect victims of abuse or neglect;
• Comply with Federal and state health oversight activities, such as fraud investigations;
• Respond to law enforcement officials or to judicial orders, subpoenas, or other process;
• Inform coroners, medical examiners, and funeral directors of information necessary for them to fulfill their duties;
• Facilitate organ and tissue donation or procurement;
• Avert a serious threat to health or safety;
• Assist in specialized government functions such as national security, intelligence, and protective services;
• Inform military and veteran authorities if you are an armed forces member (active or reserve);
• Inform a correctional institution if you are an inmate;
• Inform workers’ compensation carriers or your employer if you are injured at work;
• Perform research;
• Work with Business Associates. We may disclose your health information to third parties who perform services on our behalf. In these situations, we require the third parties to provide us with assurances that they will safeguard your health information.
• Health Information Exchanges. We participate in health information exchanges to share your electronic health record among your healthcare providers. We may share information about you with other entities who participate in the health information exchange, and we may receive information about you from those entities.



Uses and Disclosures for Which You Can Opt Out:

In the instances listed below we may use or disclose your health information unless you object.

Individuals Involved in Your Care or Payment for Your Care. We may disclose your health information to a family member, close friend, or any other person involved in your care or payment for that care.

Disaster Relief. We may disclose your health information to disaster relief organizations that seek your health information to coordinate your care or to notify family and friends of your location or condition in a disaster.

Fundraising Activities. We may use or disclose your health information in order to contact you for fundraising activities. You can let us know if you do not want to be contacted again. If you are not able to tell us your reference, for example if you are unconscious, we may go ahead and share your health information if we believe it is in your best interest or if it is necessary to lessen a serious and imminent threat to health or safety.


Obtaining Your Written Authorization:

The following uses and disclosures of your health information will be made only if you provide us with your written authorization:

• Most disclosures of psychotherapy notes

• Uses and disclosures for marketing purposes

• Sale of your health information

Other uses and disclosures not described in this Notice will be made only with your authorization. If you do provide us with your written authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer; however, this will not affect prior uses and disclosures. 

Our Responsibilities

• We are required by law to maintain the privacy and security of your health information.

• We will let you know if a breach occurs that compromises the privacy or security of your health information.

• We will not use or share your information other than as described in this Notice, unless you provide us with your authorization.

• If a state or District of Columbia law is applicable and is more restrictive than federal law, we will follow the more restrictive law. For example, in some cases disclosures of your mental health information may be limited unless we obtain your written permission prior to the disclosure.

Your Rights:

The law entitles you to:

• Get an electronic or paper copy of your medical record. We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge you a reasonable, cost-based fee for the copies.

• Ask us to correct your medical record. 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.

• Request confidential communications. You can ask us to contact you in a specific way (for example home or office phone) or to send mail to a different address. We will agree to reasonable requests.

• Ask us to limit what we use or disclose. You can ask us not to use or disclose certain health information. We are not required to agree to your request, and we may say no if it would affect your care. If you pay for a service or healthcare item out of pocket in full, you can ask us not to disclose that information to your insurer for payment or operations purposes. We will agree to that limitation unless the law would require us to do otherwise.

• Get a list of those with whom we’ve shared your health information. You can ask for a list of the times we’ve shared your health information for six years prior to the date you ask. We will include disclosures except for those about treatment, payment, operations, and certain other disclosures. We’ll provide one listing a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

• Obtain a paper copy of this notice even if you receive it electronically.


If you believe that your privacy has been violated, you may file a complaint with us or with the Secretary of Health and Human Services in Washington, D.C. We will not retaliate or penalize you for filing a complaint with the Secretary or us.

To file a complaint with the Secretary of Health and Human Services contact us:

Write to us:
Office for Civil Rights, U.S. DHHS
150 S. Independence Mall West, Suite 372,
Public Ledger Building, Philadelphia, PA 19106

Call us: 1.877.696.6775

Visit us online:

To file a complaint with us or receive more information, contact the Privacy Officer using the contact information at the beginning of this notice.

ALERTLINE: 1-855-231-0615

Changes to this Notice

We reserve the right to change privacy practices and make the new practices effective for all the information we maintain. Revised notices will be posted in our facilities, and we will offer you a copy when you receive services.

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MFA Privacy Officer Mailing Address:
2120 L Street, NW, Suite 610, Washington, DC 20037

Telephone: 202-741-3348 or Alertline at 1-855-231-0615
Facsimile: 202-741-2653