NOTICE
OF PATIENT PRIVACY PRACTICES
As
required by the Privacy Regulations created as a result of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT
OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET
ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE PROTECTED HEALTH INFORMATION
(PHI).
PLEASE REVIEW THIS NOTICE CAREFULLY.
We must provide you with the following information:
•
How we may use and disclose your PHI
•
Your privacy rights in your PHI
• Our obligations concerning the use and disclosure of PHI
The terms of this notice apply to all records containing your personal
information that are created or retained by our practice. We reserve
the right to revise or amend this Notice of Patient Privacy Practices.
Any revisions or amendment to this notice will be effective for all
of your records that our practice has created or maintained in the
past, and for any of your records that we create or maintain in the
future. Our practice will post a copy of our current Notice in our
offices in a visible location at all times, and you may request a
copy of our most current Notice at any time, to take with you, upon
your request.
A. USES AND DISCLOSURES OF PHI
The following categories describe the different ways in which we
may use and disclose your Protected Health Information. Your PHI
may be used and disclosed by your provider, our office staff and
others outside of our office who are involved in your care and
treatment for the purpose of providing health care services to
you. Your PHI
may also be used and disclosed to pay your health care bills and
to support the operation of Comprehensive Orthopaedics.
1.
TREATMENT. We will use and disclose your PHI to provide, coordinate,
or manage
your healthcare and any related services. For example,
we may ask you to have laboratory tests, or MRI’s and we
may use the results to help us reach a diagnosis. We might use
your PHI
in order to write a prescription for you. Many of the people who
work for our practice, including but not limited to, our doctors
and nurses, may use or disclose your PHI in order to treat you
or to assist others in your treatment. Additionally, we may disclose
your PHI to others who may assist in your care, such as your spouse,
children or parents.
In addition, we may disclose your PHI from time-to-time to another
provider (specialist or laboratory) who, at the request of your
provider, becomes involved in your care.
2. PAYMENT. Our practice may use and disclose your PHI in order
to bill
and collect payment for the services and products you may receive
from us. This can include activities that your health insurance
plan may undertake before it approves or pays for the health
care services,
determining eligibility or coverage for insurance benefits,
reviewing services provided for medical necessity and/or undertaking
utilization
review activities. For example, we may contact your health
insurer to certify that you are eligible for benefits, and we
may provide
your insurer with details regarding your treatment to determine
if your insurer will cover your treatment. We also may use
and disclose
your PHI to obtain payment from other third parties and to
bill you directly for services and supplies.
3. HEALTH CARE OPERATIONS. Our practice may use and disclose
your PHI to operate our business. These activities include, but
are not
limited to improving the quality of care we provide and to reducing
health care costs.
For example, your name may be called in the waiting room when
it is time for your provider to see you. We may use or disclose
your
PHI to contact you to remind you of your appointment or missed
appointment.
“
Business associates” perform various activities such as billing,
and transcription services for us. We will share your PHI with
business associates whenever appropriate. A written contract with
the business
associate will outline the terms that will protect the privacy
of your PHI.
We might use or disclose your PHI to discuss with you information
about treatment alternatives or other health-related services.
4. DISCLOSURES REQUIRED BY LAW. Our practice will use and disclose
your PHI when we are required to do so by federal, state or local
law.
5. RELEASE OF INFORMATION TO FAMILY/FRIENDS. Our practice
may release your PHI to a friend or family member who is involved
in your care or who assists in taking care of you. For example,
a parent or guardian may ask that a family member go to the pharmacy
and pick up a prescription. In this example, the family member
may
have access to another family member’s medical information.
B.
OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES
THAT MAY BE MADE WITH YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY
TO OBJECT.
We may use and disclose your PHI in the following instances.
You have the opportunity to agree or object to all or part
of your PHI
being used or disclosed. If you are not able to agree or object
to the use or disclosure of your PHI, then your provider will,
using
professional judgment, determine whether the use is in your
best interest. In any event, only the PHI that is relevant
to your
health care will be disclosed.
1.
FACILITY DIRECTORIES: Unless you object, we will use and disclose
in our facility directory
your name, the location
at which you
are receiving care, your condition (in general terms). All
of this information,
will be disclosed to people that ask for you by name.
2. OTHERS INVOLVED IN YOUR HEALTHCARE: Unless you object,
we may disclose to a member of your family, a relative, a
close
friend
or any other person you identify, your PHI that directly
relates to
that person’s involvement in your health care. If you are
unable to object to such a disclosure, we may disclose such information
if we determine that it is in your best interest. We may use or
disclose
PHI to notify or assist in notifying a family member, personal
representative or any other person who is responsible for your
care.
3. EMERGENCIES: We may use or disclose your PHI in an emergency
treatment situation. If this happens, your provider will try to
obtain your consent as soon as reasonably possible
after
delivery of treatment.
If your provider or another provider in the practice is required
by law to treat you and the provider has attempted to obtain
your consent but is unable, he or she may still use your
PHI to treat
you.
4. COMMUNICATION BARRIERS: We may use and disclose your
PHI if your provider or another provider or staff member
in the practice
attempts to obtain your consent but is unable to do so due
to substantial
communication barriers and the provider determines, using
professional judgment, that you intend to under the circumstances.
C.
USES AND DISCLOSURES OF PHI BASED UPON YOUR WRITTEN
AUTHORIZATION
Other uses and disclosures of your PHI will be made only
with your authorization, unless otherwise permitted or
required by law as
described below. You can revoke this authorization in writing
at any time,
except to the extent that your provider or the provider’s
practice has taken in reliance on the authorization.
After you revoke your authorization, we will no longer
use or disclose your PHI for the reasons in the authorization.
D. OTHER PERMITTED AND REQUIRED USES AND DISCLOSURES THAT MAY BE
MADE WITHOUT YOUR CONSENT, AUTHORIZATION OR OPPORTUNITY TO OBJECT.
1.
PUBLIC HEALTH: Our practice may disclose your PHI to public
health authorities who are authorized by law to
collect information
for
the purpose of:
- Maintaining
vital records, such as births and deaths
- Reporting
child abuse or neglect
- Preventing
or controlling disease, injury or disability
- Notifying
a person regarding potential exposure to a communicable
disease
- Notifying
a person regarding a potential risk for spreading or contracting
a disease or condition
- Reporting
reactions to drugs or problems with products or devices
- Notifying
individuals if a product or devise they may be using has
been recalled
- Notifying
appropriate government agency and authority regarding
the potential
abuse or neglect of an
adult patient
- Notifying
your employer under limited circumstances
related
primarily to
workplace injury or illness
or medical surveillance
2.
HEALTH OVERSIGHT: We may disclose PHI to a health
oversight agency
for activities authorized
by law.
3. REQUIRED BY LAW: We
may use or disclose your
PHI
to the extent
that
law requires
the use or
disclosure. The
use or
disclosure
will be made in compliance
with the law and will
be limited to
the relevant
requirement of the law.
4. LEGAL PROCEEDINGS:
We may disclose PHI in
the
course of any judicial
or administrative proceeding,
in response
to
a court
or administrative
tribunal order.
5. LAW ENFORCEMENT: We
may disclose PHI, so
long as
applicable legal
requirements are met,
for law enforcement purposes.
6. ABUSE OR NEGLECT:
We may disclose your
PHI to
a public
health authority
who is authorized by
law to receive
reports of child
abuse or neglect. In
addition, if we believe
that you
have been a victim
of abuse, neglect or
domestic violence we
may disclose
your PHI.
7. FOOD AND DRUG ADMINISTRATION:
We may disclose your
PHI to a person or
company
required by the
Food and Drug
Administration
to report
adverse events, product
defects or problems,
biologic product
deviations, product
recalls; to make repairs
or replacements.
8. MILITARY ACTIVITY
AND NATIONAL SECURITY:
When
the appropriate
conditions apply,
we may use or
disclose
your PHI to individuals
who are Armed Forces
personnel.
9. INMATES: We may use
or disclose your PHI
if you
are an inmate
of a correctional
facility and
your provider
created
or received
your PHI in the course
of providing care for
you.
10. WORKERS’ COMPENSATION: Our practice may release your PHI
to worker’s
compensation and
similar programs.
11. REQUIRED USES AND
DISCLOSURES:
Under the law, we must
make disclosures
to you and when required
by the
Secretary
of the
Department
of Health and Human Services to
investigate
or determine our compliance
with the requirement
of Section
164.500 et.seq.
E.
YOUR RIGHTS REGARDING YOUR PHI
You have the following
rights
regarding the PHI that we
maintain
about you:
1.
CONFIDENTIAL COMMUNICATIONS:
You have
the right
to request
that
our practice
communicate
with
you about
your
health and related
issues
in a particular
manner
or at
a certain location.
2. YOU HAVE
THE
RIGHT TO REQUEST
A
RESTRICTION OF
YOUR
PHI: This means
you
may ask us not to
use
or disclose any part
of
your PHI for the purposes
of
treatment, payment
or
healthcare operations.
You
may also
request
that
any
part of your
PHI
not
be disclosed
to
family members
or
friends who
may
be involved
in
your
care
of
for
notification purposes
as
described in this
Notice
of
Patient Privacy
Practices.
Your
request
must
state
the
specific
restriction
requested
and
to whom
you
want the restriction
to
apply.
YOUR
PROVIDER
IS
NOT REQUIRED
TO
AGREE TO
A
RESTRICTION: If the
provider
believes
it
is in your
best
interest
to
permit use and
disclosure
of
your PHI,
your
PHI
will not
be
restricted. If your
provider
agrees
to
the requested
restriction,
we
may
not use
or
disclose
your
PHI
in violation
of
that restriction
unless
it
is needed
to
provide emergency
treatment.
With
this
in
mind, please
discuss
any restrictions
you
wish
to
request
with
your
provider.
In
order
to
request
a
restriction
in
our
use
or
disclosure
of
your
PHI,
you
must
make
your
request
in
writing
to:
Comprehensive
Orthopaedics,
S.C.
ATTN: Privacy
Officer
6308 – 8th
Avenue, Suite
505
Kenosha, WI
53143
Include
the following
in your request:
(a) the information
you wish restricted;
(b) whether
you are
requesting
to limit
our practice’s
use,
disclosure
or both;
and
(c) to whom
you want the
limits to apply.
3. YOU HAVE
THE RIGHT TO
INSPECT AND
COPY
YOUR PHI: This
means you
may inspect
and
obtain
a copy of PHI
about you that
is contained
in your
medical record.
A medical record
contains medical
and billing
records
and any other
records
that your
provider and
the practice
use for
making
decisions
about you.
Under federal
law, however,
you may
not inspect
or copy the
following
records: psychotherapy
notes; information
compiled in
reasonable
anticipation
of,
our use in,
a civil criminal,
or administrative
action or proceeding,
and PHI
that
is subject
to law
that prohibits
access to PHI.
In some circumstances,
you
may
have
a right to
have
this decision
reviewed.
You must submit
your request
in writing
(forms available
upon request)
in
order to inspect
and/or obtain
a copy of your
medical
record.
Our practice
may charge
a fee for
the costs of
copying, mailing,
labor and supplies
associated
with
your request.
4. YOU MAY
HAVE
THE RIGHT TO HAVE YOUR
PROVIDER
AMEND
YOUR PHI: This
means
you
may request an amendment
of
PHI about you in your
medical
record
as long as we
maintain
it. To request
an
amendment, your request
must
be made in writing
and
submitted to:
Comprehensive
Orthopaedics,
S.C.
ATTN:
Privacy
Officer
6308 – 8th
Avenue,
Suite
505
Kenosha,
WI
53143
You
must
provide
us
with
a
reason
that
supports
your
request
for
amendment.
In
certain cases,
we may
deny your
request for
an amendment.
We may
deny your
request if
you ask
us to
amend information
that is
in our
opinion:
(a)
accurate and
complete;
(b)
not part
of the
PHI kept
by or
for the
practice;
(c)
not part
of the
PHI which
you would
be permitted
to inspect
and copy;
or
(d)
not created
by our
practice, unless
the individual
or entity
that created
the information
is not
available to
amend the
information.
If
we deny
your request
for amendment,
you have
the right
to file
a statement
of disagreement
with us
and we
may prepare
a rebuttal
to your
statement and
will provide
you with
a copy
of any
such rebuttal.
5.
YOU HAVE
THE RIGHT
TO RECEIVE
AN ACCOUNTING
OF CERTAIN
DISCLOSURES WE
HAVE MADE,
IF ANY,
OF YOUR
PHI: This
right applies
to disclosures
for purposes
other than
treatment, payment
or healthcare
operations as
described in
the Notice
of Patient
Privacy Practices.
You have
the right
to receive
specific information
regarding these
disclosures that
occurred after
April 14,
2003.
6.
COMPLAINTS: You
may complain
to us
or the
Secretary of
Health and
Human Services
if you
believe your
privacy rights
have been
violated by
us. You
may file
a complaint
with us
by notifying
our privacy
officer. We
will not
retaliate against
you for
filing a
compliant.
You
may contact
our Privacy
officer at:
Comprehensive
Orthopaedics, S.C.
6308 – 8th
Avenue, Suite
505
Kenosha,
WI 53143
7.
YOU HAVE
THE RIGHT
TO OBTAIN
A PAPER
COPY OF
THIS NOTICE:
Upon request,
we will
provide you
a hardcopy
of this
Patient Privacy Notice.
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