Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.   Please review it carefully.
If you have any questions about this Notice please contact our Privacy Officer.

This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.  It also describes your rights to access and control your protected health information. Our practice is dedicated to maintaining the privacy of your PHI. "Protected Health Information" is information about you, including demographic information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.   
We are required to abide by the terms of this Notice of Privacy Practices.  We may change the terms of our notice, at any time.  The new notice will be effective for all protected health information that we maintain at that time.  Our practice will post a copy of our current notice in a visible location at all times. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.

A. Requirements

The following categories describe the different ways in which we may use and disclose your PHI.

   1. Treatment:
      Our practice may use your PHI to treat you.  For example, we may ask you to have laboratory tests (such as blood tests), 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, or we might disclose your PHI to a pharmacy when we order a prescription for you.  Many of the people who work for our practice – including, but not limited to, our doctors, nurses and medical assistants, may use or disclose your PHI in order to treat you or to assist others in your treatment.  Under certain circumstances we may disclose your PHI to others who may assist in your care, such as your spouse, children or parents.
   2. Payment:
      Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us.   For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insured with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.  We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members.  Also, we may use your PHI to bill you directly for services and items.
   3. Health Care Operations:
      Our practice may use and disclose your PHI as needed to operate our business.  These activities include but are not limited to quality assessment activities, training of medical students, licensing and conducting or arranging for other business activities.  We may call you by name in the waiting room when your physician is ready to see you.
      We may share your protected health information with third party "business associates" that perform various activities for the practice.  Whenever an arrangement between our office and a business associate involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy of your PHI.
   4. Appointment Reminders:
      Our practice may use and disclose your PHI to contact you and remind you of an appointment.
   5. Treatment Options:
      Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
   6. Release of Information to Family/Friends:
      Our practice may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you.  For example, a parent or guardian may ask that a stepparent may take a child to the orthopaedist’s office for treatment of an injury.  In this example, the stepparent may have access to this child’s medical information.
   7. 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.

B. Use and Disclosure of Your PHI in Certain Special Circumstances

The following categories describe unique scenarios in which we may use or disclose your identifiable health information.

   1. Public Health Risks:
      Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for purposes such as:
          * 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 device they may be using has been recalled
          * notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
          * notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
   2. Health Oversight:
      We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.   Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
   3. Legal Proceedings:
      We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.
   4. Law Enforcement:
      We may release PHI if asked to do so by a law enforcement official:
          * Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
          * Concerning a death we believe has resulted from criminal conduct
          * Regarding criminal conduct at our offices
          * In response to a warrant, summons, court order, subpoena or similar legal process
          * To identify/locate a suspect, material witness, fugitive or missing person
          * In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)
   5. Coroners, Funeral Directors, and Organ Donation:
      We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law.  We may also disclose protected health information to a funeral director, as authorized by law, to permit the funeral director to carry out his/her duties.  We may disclose such information in reasonable anticipation of death.  Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
   6. Research:
      Our practice may use and disclose your PHI for research purposes in certain limited circumstances.  We will obtain your written authorization to use your PHI for research.
   7. Serious Threats To Health And Safety:
      Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.  We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
   8. Military and National Security:
      Our practice may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.   Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law.  We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
   9. Inmates:
      Our practice may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.  Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
  10. Workers’ Compensation:
      Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.

C. 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 we communicate your protected health information to you by a certain means or at a certain location.  For example, you might request that we only contact by mail or at work. We are not required to agree to requests for confidential communications that are unreasonable.

      To make a request for confidential communications, you must submit a written request to our privacy officer/coordinator.  The request must tell us how or where you want to be contacted.  In addition, if another individual or entity is responsible for payment, the request must explain how payment will be handled.
   2. Requesting Restrictions:
      You have the right to request a restriction of your protected health information.  You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care.

      Your physician is not required to agree to a restriction that you may request.  If your physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted.   If your physician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment.
   3. Inspection and Copies:
      You have the right to inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information.  A "designated record set" contains medical and billing records and any other records that your physician and the practice uses for making decisions about you but does not include psychotherapy notes.  You must submit your request in writing to inspect and or obtain a copy of your PHI.  Our practice may charge a fee for the cost of copying, mailing, labor and supplies associated with your request as allowed by law.
   4. Amendment:
      You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice.  To request an amendment, your request must be made in writing and submitted to the Privacy Officer.  You must provide us with a reason that supports your request for amendment.  Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing.  Also, we may deny your request 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.
   5. Accounting of Disclosures:
      All patients have the right to request an "accounting of disclosures."   An "accounting of disclosures" is a list of certain non-routine disclosures our practice has made of your PHI for non-treatment of operations purposes.  Use of your PHI as part of the routine patient care in our practice is not required to be documented.  For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim.  In order to obtain an accounting of disclosures, you must submit your request in writing to the Privacy Officer.   All requests for an "accounting of disclosures" must state the period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003.
      The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period.  Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
   6. Right to a Paper Copy of This Notice:
      You are entitled to receive a paper copy of our notice of privacy practices.  You may ask us to give you a copy of this notice at any time.   To obtain a paper copy of this notice you must contact the Privacy Officer.
   7. Right to File a Complaint:
      If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.  To file a complaint with our practice, contact the Privacy Officer.  All complaints must be submitted in writing.  You will not be penalized for filing a complaint.
   8. Right to Provide an Authorization for Other Uses and Disclosures:
      Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.  Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing.  After you revoke your authorization, we will no longer use or disclose your PHI for the purposes described in the authorization.   Please note that we are required to retain records of your care.

If you have any questions regarding this notice or our health information privacy policies, please contact the Privacy Officer.