Notice
of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFROMATION ABOUT YOU MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
This Notice of Privacy Practices is being provided to you as a requirement
of the Health Insurance Portability and Accountability Act (HIPAA).
This Notice describes how we may use and disclose your protected
health information (PHI) to carry out treatment, payment or health
care operations (TPO) and for other purposes that are permitted by
law. It also describes your rights to access and control your PHI
in some cases. Your PHI means any of your written and oral health
information, including demographic data that can be used to identify
you. This is health information that is created or received by your
health care provider, and that relates to your past present or future
physical or mental health or condition.
I. Uses and Disclosures of Protected Health Information (PHI)
The provider may use or disclose you PHI for purposes of providing
treatment, obtaining payment for treatment, and conducting health
care operations. Your PHI may be used or disclosed only for these
purposes unless the Provider has obtained you authorization or
the use or disclosure is otherwise permitted by the HIPAA Privacy
Regulations
or State law. Disclosures of you PHI for the purposes described
in this Notice made in writing, orally, or by facsimile.
A. Treatment: We will use and disclose your PHI
to provide, coordinate, or manage your health care and any related
services.
This includes the coordination or management of your health care
with a third party for treatment purposes. For example, we may disclose
you PHI to a pharmacy to fulfill a prescription, to a laboratory
to order a blood test, or to a home health agency that is providing
care in your home. We may also disclose PHI to other physicians who
may be treating you or consulting with your physician with respect
to your care. In some cases, we may also disclose your PHI to an
outside treatment provider to ensure that the provider has necessary
information to diagnose and/or treat you.
B. Payment: Your PHI will be used, as needed, to
obtain payment for
the services that we provide. This may include certain communications
to your health insurer to get approval for the treatment that we
recommend. For example, if a hospital admission is recommended, we
may need to disclose your PHI to your health insurer to get prior
approval for the hospitalization. We may also disclose PHI to your
insurance company to determine whether you are eligible for benefits
or whether a particular service is covered under your health plan.
In order to get payment for services, we may also need to disclose
your PHI to your insurance company to demonstrate the medical necessity
of the services or, as required by your insurance company, for utilization
review. We may also disclose PHI to another provider involved in
your care for the other provider's payment activities.
C. Operations: We may use or disclose your PHI,
as necessary, for our own health care operations in order to facilitate
the function
of the provider and to provide quality care to all patients. Health
care operations includes such activities as:
• Quality assessment
and improvement activities.
• Employee review activities.
• Training programs including those in which students, trainees, or
practitioners in health care learn under supervision.
• Accreditation, certification, licensing or credentialing activities
• Review and auditing, including compliance reviews, medical reviews,
legal services and maintaining compliance activities.
In
certain situations, we may also disclose PHI to another provider
or health plan for their
health care operations.
We may use a sign-in sheet at the registration desk where you
will be asked to sign your name and indicate you physician.
We may also
call you by name in the waiting room when your physician is
ready to see you. We may use or disclose your PHI, as necessary,
to
contact you to remind you of an appointment.
II. Uses and Disclosures Beyond Treatment, Payment and Health
Care Operations Permitted Without Authorization or Opportunity
to Object
Federal privacy rules allow us to use or disclose your PHI
without your permission or authorization for a number of reasons
including
the following:
A. When Legally Required: We will disclose you
PHI when we are
required to do so by any Federal, State or local law.
B. When There are Risks to Public Health: We may
disclose your PHI for
the following public activities and purposes:
• To prevent, control, or report disease, injury or disability as permitted
or required by law.
• To report vital events such as birth or death as permitted or required
by law.
• To conduct public health surveillance, investigations and interventions
as permitted or required by law.
• To collect or report adverse events and product defects, track FDA
regulated products, enable product recalls, repairs or
replacement to the FDA and to conduct post marketing surveillance.
• To notify a person who has been exposed to a communicable disease
or who may be at risk of contracting or spreading a disease
as authorized by law.
• To report information to an employer about an individual who is a
member of the workforce as legally permitted or required.
C.
To Report Abuse, Neglect or Domestic Violence: We may notify
government authorities if we believe that a patient is the
victim of abuse, neglect or domestic violence. We will
make this disclosure
only when specifically required or authorized by law or
when a patient agrees to the disclosure.
D. To Conduct Health Oversight Activities: We
may disclose your PHI to
a health oversight agency for activities including audits;
civil, administrative, or criminal investigations, proceedings,
or actions;
inspections; licensure or disciplinary actions; or other
activities necessary for appropriate oversight as authorized
by law. We
will not disclose your PHI if you are subject to an investigation
and
your health information is not directly related to your
receipt of health care or public benefits.
E. In Connection with Judicial and Administrative Proceedings: We
may disclose your PHI in the course of any judicial or
administrative proceeding in response to a subpoena.
F. For Law Enforcement Purposes: We may disclose
your PHI to a law
enforcement official for law enforcement purposes as follows:
• As required by law for reporting of certain types of wounds or other
physical injuries.
• Pursuant to court order, court ordered warrant, subpoena, summons
or similar process.
• For the purposes of identifying or locating a suspect, fugitive,
material witness or missing person.
• Under certain circumstances, when you are the victim of a crime.
• To a law enforcement official if the provider has a suspicion that
your death was the result of a criminal conduct.
• In an emergency in order to report a crime.
G.
To Coroners, Funeral Directors, and for Organ Donation: We
may disclose PHI to a coroner or medical examiner for identification
purposes, to determine cause of death or for the coroner
or medical examiner to perform other duties authorized
by law.
We may also
disclose PHI to a funeral director, as authorized by
law, in order to permit
the funeral director to carry out their duties. We
may disclose such information in reasonable anticipation
of death. PHI
may be used
and disclosed for cadaveric organ, eye or tissue donation
purposes.
H. For Research Purposes: We may use or disclose
your PHI for research
when use or disclosure for research has been approved
by an institutional review board or privacy board that
has
reviewed the research
proposal and research protocols to address the privacy
of your
PHI.
I. In the Event of a Serious Threat to Health or Safety: We
may, consistent with applicable law and ethical standards
of conduct, use or disclose your PHI if we believe,
in good
faith, that
such use or disclosure is necessary to prevent or lessen
a serious
imminent threat to your health or safety or to the
health and safety of the
public.
J. For Specified Government Functions: In certain
circumstances, the
federal regulations authorize the provider to use or
disclose your PHI to facilitate specified government
functions relating
to military
and veterans activities, national security and intelligence
activities, protective services for the President and
others, medical suitability
determinations, correctional institutions, and law
enforcement custodial situations.
K. For Worker's Compensation: The provider may
release your PHI to
comply with worker's compensation laws or similar programs.
L. Notification: The provider may release PHI
to notify or help notify:
• A family member
• Your personal representative
• Another person responsible for your care
We
will share information about your location, general condition
or death. If you are present, we will get your
permission
if possible before we share, or give you the opportunity
to refuse permission.
In case of an emergency, and if you are not able
to give or
refuse permission, we will share only PHI that is
directly necessary for your health care, according to our professional
judgment.
We will
also use our professional judgment to make decisions
in your best interest about allowing someone to pick up
medicine,
medical supplies,
x-ray or medical information about you.
III. Uses and Disclosures Permitted Without Authorization
but with Opportunity to Object
We may disclose your PHI to your family member
or a close personal friend if it is directly relevant
to
the person's
involvement
in your care or payment related to your care. We
can also disclose your
information in connection with trying to locate
or
notify family members or others involved in your
care concerning
your location,
condition or death.
You may object to these disclosures. If you do
not object to these disclosures or we can infer
from
the circumstances
that
you do not
object or we determine, in the exercise of our
professional judgment, that it is in your best
interests for us
to make disclosure of
information that is directly relevant to the person's
involvement with your care,
we may disclose your PHI as described.
IV. Uses and Disclosures Which You Authorize
Other than as stated above, we will not disclose
your health information other than with your written
authorization.
You may revoke your authorization
at any time, in writing, except to the extent that
we have
taken action in reliance upon the authorization.
V. Your Rights
You have the following rights regarding your health
information:
A. The Right to Inspect and Copy Your Protected
Health Information: You may inspect and obtain a copy of your PHI that
is contained in a designated record set for as
long s we
maintain the
PHI. A "designated
record set" contains medical and billing records and any other
records that your physician uses 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, or use in, a civil, criminal or
administrative action or proceeding; and PHI that
is subject to a
law
that prohibits access
to PHI. Depending on the circumstances, you may
have
the right to have a decision to deny access reviewed.
We may deny your request to inspect or copy your
PHI if, in our professional judgment, we determine
that
the access
requested
is likely to endanger
your life or safety or that of another person,
or that it is likely to cause substantial harm
to another
person
referenced
within the
information. You have the right to request a review
of the decision.
To inspect and copy your medical information, you
must submit a written request to the Privacy Officer
whose
contact information
is listed
on the last page of this Notice. If you request
a copy of your information, we may charge you a
fee
for the
costs of
copying,
mailing or other
costs incurred by us in complying with your request.
Please contact our Privacy Officer if you have
questions about access to your medical record.
B. The Right to Request a Restriction on Uses and
Disclosures of Your Protected Health Information: You
may ask us not to use or disclose
certain parts of your PHI for the purposes of treatment,
payment or health care operations. You may also
request that we do
not disclose your health information to family
members or friends who may be involved
in your care or for notification purposes as described
in this Notice of Privacy Practices. Your request
must state
the specific
restriction
requested and to whom you want the restriction
to apply.
The provider is not required to agree to a restriction
that you may request. We will notify you if we
deny your request
to a
restriction.
If the provider does agree 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. Under
certain circumstances,
we may terminate our agreement to a restriction.
You may request a restriction by contacting the
Privacy Officer.
C. The Right to Request to Receive Confidential
Communications From us by Alternative Means or
at an Alternative
Location: You have the
right to request that we communicate with you in
certain ways. We will accommodate reasonable requests.
We may
condition this
accommodation
by asking you for information as to how payment
will be handled or specification of an alternative
address
or other
method
of contact.
We will not require you to provide an explanation
of your request. Requests must be made in writing
to our
Privacy
Officer.
D. The Right to Have Your Physician Amend Your
Protected Health Information: You may
request an amendment
of PHI about you
in a
designated record set for as long as we maintain
this information. In certain cases, we may deny
your request
for amendment.
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.
Requests for
amendment must be in writing and must be directed
to our Privacy Officer. In this written request,
you must
also
provide a reason
to support the requested amendments.
E. The Right to Receive an Accounting: You have
the right to request an
accounting of certain disclosures of your PHI made
by the provider. This right applies to disclosures
for purposes
other than treatment,
payment or healthcare operations as described in
this Notice.
We are also not required to account for disclosures
that you requested,
disclosures that you agreed to by signing an authorization
form, disclosures for a facility directory, to
friends or family members
involved in your care, or certain other disclosures
we are permitted to make without your authorization.
The
request for an accounting
must be made in writing to our Privacy Officer.
The request should specify the time period sought
for
the accounting.
We are not
required to provide an accounting for disclosures
that take
place prior to
April 14, 2003. Accounting requests may not be
made for periods of time in excess of six years.
We will
provide
the first
accounting you request during any 12 month period
without charge. Subsequent
accounting requests may be subject to reasonable
cost-based fee.
F. The Right to Obtain a Paper Copy of this Notice: Upon request, we
will provide a separate paper copy of this notice
even if you already have received a copy of the
Notice or
have agreed
to
accept this
Notice electronically.
VI. Our Duties
The provider is required by law to maintain the
privacy of your health information and to provide
you with
the Notice
of our
duties and
privacy practices. We are required to abide by
the terms of this Notice as may be amended from
time
to time. We
reserve the right
to change the terms of this Notice and to make
the new Notice provisions effective for all PHI
that
we maintain.
If the
provider
changes its
Notice, we will provide a copy of the revised Notice
upon request.
VII. Complaints
You have the right to express complaints to the
provider and to the Secretary of Health and Human
Services
if you believe
that your privacy
rights have been violated. You may complain to
the provider by contacting the provider's Privacy
Officer
verbally
or in writing,
using the
contact information below. We encourage you to
express any concerns you may have regarding the
privacy of
your information.
You will
not be retaliated against in any way for filing
a complaint.
VIII. Contact Person
The provider's contact person for all issues regarding
patient privacy and your rights under the Federal
privacy standards
is the Privacy
Officer. Information regarding matters covered
by this Notice can be requested by contacting the
Privacy
Officer.
Complaints
against
the provider can be mailed to the Privacy Officer
by sending it to:
Orthopedic
Spine Care of LI, PC
1895 Walt Whitman Road
Suite 3
Melville, NY 11747
ATTN: Privacy Officer
The
Privacy Officer can be contacted by calling (631) 847-0200.
IX. Effective Date
This Notice is effective April 14, 2003.
|
