Comprehensive Pain Management Specialists, LLC

Notice of Privacy


Effective:  September 18, 2013


















COMPREHENSIVE PAIN MANAGEMENT SPECIALISTS, LLC is committed to treating and using protected health information about you responsibly.  The Notice of Health Information Practices describes the personal information we collect, and how and when we use or disclose that information.  It describes your rights as they relate to your protected health information.  This Notice is effective September 18, 2013, and applies to all protected health information as defined by federal regulations.

Understanding Your Health Record/Information

Each time you visit COMPREHENSIVE PAIN MANAGEMENT SPECIALISTS, LLC, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment.  This information, often referred to as your health or medical record, serves as a:

  • ·         Basis for planning your care and treatment,
  • ·         Means of communication among the many health professionals who contribute to your care,
  • ·         Legal document describing the care you received,
  • ·         Means by which you or a third-party payer can verify that services billed were actually provided,
  • ·         A tool in educating health professionals,
  • ·         A source of data for medical research,
  • ·         A source of information for public health officials charged with improving the health of this state and the nation,
  • ·         A source of data for our planning and marketing,
  • ·        A tool with which we can access and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where and why others may access your health information, and make more informed decisions when authorizing disclosures of your health information to others.

Your Health Information Rights
Although your health record is the physical property of COMPREHENSIVE PAIN MANAGEMENT SPECIALISTS, LLC, the information belongs to you.  You have the right to:

  • ·         Obtain a paper copy of this Notice upon request, even if you have given us permission to submit all notices to you electronically,
  • ·         Inspect and copy your health record as provided for in 45 CFR 164.524,
  • ·         Request and amendment to your health records as provided in 45 CFR 164.528,
  • ·        Request communications of  you health information by reasonable alternative means or at alternative locations,
  • ·         Request communications of your health information by reasonable alternative means or at alternative locations,
  • ·         request a restriction on certain uses and disclosures of your information as provded by 45 CFR 164.522,
  • ·         Revoke your authorization to use or disclose health information except to the extent you’re your authorization was already relied upon, and
  • ·         Restrict disclosure of specific health information, provided such information pertains solely to a health care item or service for which you, or someone on your behalf, have paid for out-of-pocket and in full.

Our Responsibilities

  • ·         Maintain the privacy of your health information,
  • ·         Provide you with this Notice as to our legal duties and privacy practices with respect to information we collect and maintain about you and abide by the terms of this Notice,
  • ·         Notify you if we are unable to agree to a requested restriction or amendment to your health information,
  • ·         Notify you promptly if a breach occurs that may have compromised the privacy or security of your information, and
  • ·         Accommodate resonable requests you may have to communicate health information by alternative means or at alternate locations.

We reserve the right to change our practices and policies, including this Notice, and to make the new provisions effective for all protected health information we maintain.  Should our information practices or policies change, we will post such revised Notice in conspicuous locations at our offices and provide you with a physical copy upon request.  Additionally, a copy of the current version of this Notice in effect will be available at our website http// 

We will not use or disclose your health information without your authorization, except as described in this Notice.  You have a right to revoke your authorization.  We will discontinue using or disclosing your health information after we have received a written revocation of the authorization according to the procedures included in this Notice or the authorization.  We will not be held liable for any disclosures made pursuant to your authorization prior to our receipt of your written revocation of your authorization.

Examples of Disclosures for Treatment, Payment and Health Operations

We will use your health information for treatment.

For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you.  Your physician will document in your record his or her expectations of the members of your health care team.  Members of your health care team will then record the actions they took and their observations.  In that way, the physician will know how you are responding to treatment.

We will also provide your physician or a subsequent health care provider with copies of various reports that should assist him or her in your continuing or future treatment.

We will use your health information to bill and get payment for services we provide to you.
For example: A bill may be sent to you or a third-party payer.  The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health information for regular health care operations.
For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it.  This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

Additional Disclosures

Business Associates: There are some services provided in our organization through contracts with business associates as such term is defined in 45 CFR 160.103.  Examples include the physician services in the emergency department and radiology, certain laboratory tests, and a copy service we use when making copies of your health record.  When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered.  To protect your health information, however, we require the business associate to appropriately safeguard your information and maintain its confidentiality.

Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes.  This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location and general condition.

Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Funeral Directors: We may disclose health information to medical examiner and funeral directors consistent with applicable law to carry out their duties.

Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Marketing: We must obtain your specific written authorization in order to use any of your Health Information to provide you with marketing materials by mail, email or telephone.  We may, however, provide you with marketing materials face-to-face without obtaining authorization, in addition to communicating with you about services or products that relate to your treatment, case management, or care coordination, alternative treatments, therapies, providers or care settings.  If you do provide us with your written authorization to send you marketing materials, you have a right to revoke your authorization at any time. 

Psychotherapy Notes:  With limited exceptions, we must obtain your authorization for any use or disclosure of your psychotherapy notes that we maintain.

Fund raising:  We may contact you as part of fund-raising effort; however, you have the ability to opt-out of receiving such communications at any time.

Sale of Protected Health Information:  We must obtain your authorization prior to receiving direct or indirect remuneration in exchange for your health information; however, such authorization is not required where the purpose of the exchange is for: 

  • ·         Public health activities;
  • ·         Research purposes, provided that we receive only a reasonable, cost-based fee to cover the cost to prepare and transmit the information for research purposes;
  • ·         Treatment and payment purposes;
  • ·         Health care operations involving the sale, transfer, merger or consolidation of all or part of our practice and for related due diligence;
  • ·         Payment that is provided by our practice to a business associate for activities involving the exchange of protected health information that the business associate undertakes on our behalf (or a subcontractor undertakes on behalf of a business associate) and the only remuneration provided is for the performance of such activities;
  • ·         Providing you with a copy of your health information or an accounting of disclosures;
  • ·         Disclosures required by law;
  • ·         Disclosures of your health information for any other purpose permitted by and in accordance with the Health Insurance Portability and Accountability Act Privacy Rule, as long as the only remuneration we receive is a reasonable, cost-based fee to cover the cost to prepare and transmit your health information for such purpose or is a fee otherwise expressly permitted by other law; or
  • ·         Any other exceptions allowed by the Department of Health and Human Services.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public Health and Safety: As required by law, we may disclose your health information to public health or legal authorities charges with preventing or controlling disease, injury, or disability.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Government Requests:  We can use or share health information about you for special government functions such as military, national security, and presidential protective services.

Court Order:  We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Drug and Alcohol Information:   We must obtain your specific written authorization prior to disclosing information related to drug and alcohol treatment or rehabilitation under certain circumstances such as where you received drug or alcohol treatment at a federally funded treatment facility or program.

Mental Health Information.  We must obtain your specific written authorization prior to disclosing certain mental health information or information that would identify you as having a mental health condition.  We may use and disclose information related to mental health without obtaining your authorization only where permitted by law.

Required by Law.  We may use or disclose your health information when otherwise required by law.

Federal law makes provisions for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.


For More Information or to Report a Problem


If you have questions and would like additional information or would like to revoke any authorizations provided hereunder, we encourage you to contact our Administrator, Robyn Pintchuck, by phone at (570) 270-5700, or in writing at the following address: 


1177 Highway Blvd.
Wilkes-Barre, PA 18702


If you believe your privacy rights have been violated, you can file a complaint with the practice’s Administrator or with the Office for Civil Rights, U.S. Department of Health and Human Services.  There will be no retaliation for filing a complaint with either the Administrator or the Office for Civil Rights.  The address for the OCR is listed below:

Office for Civil Rights
Department of HHS
Jacob Javits Federal Building
26 Federal Plaza - Suite 3312
New York, NY 10278
Voice Phone (212)264-3313
FAX (212)264-3039 |
TDD (212)264-2355