Notice of Privacy Practices
Your Information. Your Rights. Our Responsibilities.
This Notice of Privacy Practices describes how your protected health information (PHI) may be used and disclosed and how you can access this information. Please review it carefully.
Effective Date: June 24, 2026
Privacy Officer:
Sam Cimino
Email: sam@feedwithsam.org
Phone: 978 968 9888
Your Rights
You have the right to:
Obtain a copy of your paper or electronic medical record.
Request that your medical record be corrected.
Request confidential communications.
Ask us to limit certain uses or disclosures of your information.
Receive a list of certain disclosures we have made of your information.
Receive a paper copy of this Notice.
Designate someone to act on your behalf.
File a complaint if you believe your privacy rights have been violated.
Your Choices
For certain health information, you have choices regarding how we share your information.
You may direct us regarding:
Sharing information with family members, friends, or others involved in your care.
Sharing information during disaster relief efforts.
Feed With Sam does not participate in hospital directories.
We will never share your information for:
Marketing purposes
Sale of your information
Most uses of psychotherapy notes
without your written authorization.
Our Uses and Disclosures
We may use and disclose your health information to:
Provide lactation consultation, infant feeding support, and related healthcare services.
Coordinate care with your healthcare providers when appropriate.
Operate our practice.
Contact you regarding appointments or follow-up care.
Bill for services or provide documentation, including superbills, when requested.
Comply with applicable federal and Massachusetts laws.
Protect public health and safety when required by law.
Respond to legal proceedings or government requests as permitted by law.
Your Rights Explained
Get a Copy of Your Medical Record
You may request an electronic or paper copy of your medical record and other health information maintained by Feed With Sam.
We will generally provide the requested information within 30 days. A reasonable, cost-based fee may apply.
Request a Correction
You may request that we correct information you believe is incorrect or incomplete.
If we deny your request, we will provide a written explanation within 60 days.
Request Confidential Communications
You may ask us to communicate with you in a particular way, such as by phone, email, or mail at a different address.
We will accommodate all reasonable requests.
Request Restrictions
You may request limitations on how we use or disclose your information for treatment, payment, or healthcare operations.
Although we are not always required to agree, we will consider every request carefully.
If you pay for services entirely out-of-pocket, you may request that we not disclose that information to your health insurer for payment purposes unless disclosure is required by law.
Accounting of Disclosures
You may request a list of certain disclosures we have made of your health information during the previous six years.
One accounting per year is provided without charge. Additional requests may incur a reasonable fee.
Receive a Copy of This Notice
You may request a paper copy of this Notice at any time, even if you previously agreed to receive it electronically.
Choose Someone to Act for You
If you have designated a medical power of attorney or legal guardian, that individual may exercise your rights and make decisions regarding your protected health information, consistent with applicable law.
File a Complaint
If you believe your privacy rights have been violated, you may contact:
Privacy Officer
Feed With Sam
Email: sam@feedwithsam.org
You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.
We will never retaliate against you for filing a complaint.
How We Use Your Health Information
Treatment
We use your health information to provide lactation consultations, infant feeding support, newborn care guidance, and related services.
We may communicate with your physician, pediatrician, obstetric provider, midwife, or other healthcare professionals involved in your care when appropriate and with your authorization or as permitted by law.
Practice Operations
We use health information to operate Feed With Sam, improve our services, maintain medical records, communicate with clients, and manage appointments.
Payment
When requested, we may prepare documentation such as superbills for reimbursement purposes or use health information necessary to process payments.
Other Permitted Uses and Disclosures
Federal and state law may allow or require us to disclose health information for purposes such as:
Public health reporting
Preventing serious threats to health or safety
Reporting suspected abuse, neglect, or domestic violence
Health oversight activities
Legal proceedings
Workers’ compensation claims
Law enforcement requests
Research when permitted by law
Compliance with state and federal regulations
Our Responsibilities
Feed With Sam is required by law to:
Maintain the privacy and security of your protected health information.
Notify you promptly if a breach occurs that may compromise the privacy or security of your information.
Follow the privacy practices described in this Notice.
Provide you with a copy of this Notice.
Obtain your written authorization before using or sharing your information for purposes not described in this Notice, unless otherwise permitted or required by law.
If you provide authorization, you may revoke it at any time in writing.
Changes to This Notice
Feed With Sam reserves the right to change the terms of this Notice at any time. Any changes will apply to all protected health information maintained by our practice.
The most current version of this Notice will always be available upon request and on our website.
Feed With Sam
Notice of Privacy Practices
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