|Effective Date: April 14, 2003
Orthopedic Surgery Associates, P.C.
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 READ IT CAREFULLY.
A federal regulation, known as the "HIPAA Privacy Rule" requires that we provide detailed notice in writing of our privacy practices.
I. OUR COMMITMENT TO PROTECTING YOUR HEALTH INFORMATION
In this Notice, we describe the ways that we may use and disclose health information about our patients. The HIPAA Privacy Rule requires that we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify a patient. This information is called "protected health information" or "PHI". This Notice describes your rights as our patient and our obligations regarding the use and disclosure of PHI. We are required by law to:
- Maintain the privacy of PHI about you;
- Give you this Notice of our legal duties and privacy practices with respect to PHI; and
- Comply with the terms of our Notice of Privacy Practices that is currently in effect.
Orthopedic Surgery Associates' employees and staff understand that medical information about you and your health is personal. We are committed to protecting medical information about you. This Notice applies to any medical information or PHI about you created or maintained by Orthopedic Surgery Associates, P.C. While we may sometimes care for you during a hospital stay, the hospital may have different policies and/or notices about your medical information.
We reserve the right to make changes to this Notice and to make such changes effective for all PHI we may already have about you or create and maintain in the future. If and when this Notice is changed, we will post a copy in our office in a prominent location and on our Web site. We will also provide you with a copy of the revised Notice upon your request to our Privacy Official.
II. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The following categories describe the different ways we may use and disclose PHI for treatment, payment, or health care operations. The examples included with each category do not list every type of use or disclosure that may fall within that category.
Treatment: We may use and disclose PHI about you to provide, coordinate or manage your health care and related services.
- We may consult with other health care providers regarding your treatment if you were referred to us by them, or if we need to refer you out to another provider.
- We may use and disclose PHI when you need a prescription, lab work, or other health care services.
- We may use and disclose PHI to contact you as a reminder that you have an appointment for treatment at this office.
Payment: We may use and disclose PHI so that we can bill and collect payments for the treatment and service provided to you. We may tell an insurance company or a third party about care you are going to receive in order to obtain prior approval or determine your coverage.
Health Care Operations: We may use and disclose PHI in performing business activities which are called health care operations. Health care operations include quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities.
OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION:
Uses and Disclosures For Which You Have The Opportunity To Agree or Object
We may use and disclose PHI about you in some situations where you have the opportunity to agree or object to certain uses and disclosures of PHI about you. If you do not object, then we may make these types or uses and disclosures of PHI.
- Individuals Involved in Your Care or Payment for Your Care: We may disclose PHI about you to your family member, close friend, or any other person identified by you if that information is directly relevant to the person's involvement in your care or payment for your care. If you are present and able to consent or object, then we may only use or disclose PHI if you do not object. If you bring someone with you to a visit and have them accompany you while the doctor treats you and you have not stated any objections, PHI may be disclosed in that person's presence. We also may use professional judgment and our experience with common practice to make reasonable decisions about your best interests in allowing a person to act on your behalf to pick up filled prescriptions, medical supplies, x-rays, or other things that contain PHI about you. We may ask you to sign a "Patient Authorization For Use/Disclosure of Health Information" if in our judgment we feel it is necessary. In the event of your incapacity or emergency circumstances, we will disclose PHI based on a determination using our professional judgment.
OTHER USES AND DISCLOSURES WE CAN MAKE WITHOUT YOUR WRITTEN AUTHORIZATION OR OPPORTUNITY TO AGREE OR OBJECT:
We may use and disclose PHI about you in the following circumstances without your authorization or opportunity to agree or object, provided that we comply with certain conditions that may apply.
Required by law: We may use and disclose PHI as is required by federal, state, or local law. For example: in connection with the defense of a claim challenging the physician's professional competence; to review entity; to third party payers determining the amount and correctness of fees or the type and volume of services furnished pursuant to the third party payer's requirements; pursuant to a court order or to a police agency as part of a criminal investigation; in connection with the identification of a dead body; to the Public Health Department as part of a licensure investigation; if you are an organ donor; in connection with a child abuse and/or neglect investigation.
Abuse or Neglect: We may disclose your PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. We may disclose your PHI to the extent necessary to avert a serious threat to our health or safety or the health or safety of others.
National Security: We may disclose to military authorities the PHI of Armed Forces personnel under certain circumstances. We may disclose to authorized federal officials PHI required for lawful intelligence, counterintelligence, and other national security activities. We may disclose to correctional institutions or law enforcement officials having lawful custody, PHI of inmates or patients under certain circumstances.
Research: We may use or disclose PHI about you for research purposes under certain limited circumstances. We must obtain a written authorization to use and disclose PHI about you for research purposes except in situations where a research project meets specific, detailed criteria established by HIPAA's Privacy Rule to ensure the privacy of PHI.
Workman's Compensation: We may disclose PHI as authorized by workers' compensation laws or other similar programs that provide benefits for work-related injuries or illness.
Incidental Disclosure: We may disclose your medical information if it is an unavoidable byproduct of conducting business, including receiving services from cleaning personnel and those maintaining or repairing equipment.
Business Associates: We may disclose PHI to business associates who perform health care operations for us and who commit to respect the privacy of your health information.
OTHER USES AND DISCLOSURES OF PROTECED HEALTH INFORMATION REQUIRES YOUR AUTHORIZATION
All other uses and disclosure of PHI about you will only be made with your written authorization. If you have authorized us to use or disclose PHI about you, you may revoke your authorization at any time, except to the extent we have taken action based on the authorization.
III. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION.
Right to Request Restrictions: You have the right to request additional restrictions on the PHI that we may use for treatment, payment and health care operations. You may also request additional restrictions on our disclosure of PHI to certain individuals involved in your care that otherwise are permitted by the Privacy Rule. We are not required to agree to your request. If we do agree to your request, we are required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency. To request restrictions, you must make your request in writing to our Privacy Official. In your request, please include (1) the information that you want restricted; (2) how you want to restrict the information (3) to whom you want those restrictions to apply.
Right to Receive Confidential Communications: You have the right to request that you receive communications regarding PHI in a certain manner or at a certain location. You must make your request in writing to our Privacy Official. You must specify how you would like to be contacted.
Right to Inspect and Copy: You have the right to request the opportunity to inspect and receive a copy of PHI about you in certain records we maintain. This includes your medical and billing records. Please put your request in writing. We may charge you a reasonable fee for the copying, postage, labor and supplies used in meeting your request.
Right to Amend: You have the right to request that we amend PHI about you as long as such information is kept by or for our office. You must submit your request in writing to our Privacy Official. You must give us a reason for your request. We may deny your request in certain cases.
Right to Receive an Accounting of Disclosures: You have the right to request an "accounting" of certain disclosures that we have made of PHI about you. This is a list of disclosures made by us during a specified period of up to six years other than disclosures made: for treatment, payment, and health care operations; for use in or related to a facility directory; to family members or friends involved in your care; to you directly; pursuant to an authorization of you or your personal representative, or for certain notification purposes (including national security, intelligence, correctional, and law enforcement purposes) and disclosure made before April 14, 2003. You must put your request in writing.
Right to a Paper Copy of this Notice: You have a right to receive a paper copy of this Notice at any time. Please contact our Privacy Official.
Right to Request Restrictions to a Health Plan: You have the right to request a restriction on disclosure of PHI to a health plan (for purposes of payment or health care operations) in cases where you paid out of pocket in full, for the items received or services rendered.
IV. Breach of Unsecured PHI
If a breach of unsecured PHI affecting you occurs, OSA is required to notify you of the breach.
If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the United States Department of Health and Human Services. To file a complaint with our office, please contact our Privacy Official at the address and number listed below. We will not penalize you for filing a complaint.
If you have any questions about this Notice, please contact our Privacy Official at the address and telephone number listed on below.
VII. PRIVACY OFFICIAL CONTACT INFORMATION
You may contact our Privacy Official at the following address and phone number:
Practice Manager, Karen Kolman
Orthopedic Surgery Associates, P.C.
5315 Eillott Dr. Suite 301
Ypsilanti, MI 48197
Phone: (734) 572-4565 Fax: (734) 572-4503