Practice Overview

Orthopedic & Sports Medicine Specialists

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This notice will tell you about the ways in which we may use and disclose medical information about you. Not every use or disclosure in a category will be listed but all of the ways we are permitted to use and disclose information will fall within one of the categories. We reserve the right to change this notice. We reserve the right to make the revised notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in plain view. Each time we revise our notice; we will post it in our office and make it available to you upon request.

We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to-

• Make sure that medical information that identifies you is kept private,
• Give you this notice of our legal duties and privacy practices with respect to medical information about you,
• Make a good faith effort to obtain your acknowledgement that you have received this notice, and
• Follow the terms of the notice that is currently in effect.

For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, or other personnel in our organization who are involved in taking care of you. For example, we may need to tell a nurse about your condition in order to coordinate the different things you need, such as lab work. We also may disclose medical information about you to health care providers outside our organization who are involved in your treatment, such as consulting a physician.

For Payment: We may use and disclose medical information about you so that the services you receive from us or other providers may be billed and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about treatment you received, so your health plan will pay us or reimburse you for the treatment, or to obtain prior approval or determine whether your plan will cover the treatment.

For Health Care Operations: We may use and disclose medical information about you for our operations and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine the medical information we have with medical information from other similar organizations to compare how we are doing and see where we can make improvements in the care and services we offer. We will remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. All disclosures of phychotherapy notes require your written authorization. If you give us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission.

• We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment.
• We may use and disclose medical information to tell you about or recommend treatment options or alternatives or other health related benefits or services that may be of interest to you.
• Unless you object, we may include certain limited information about you in our directory while you are a patient here. This information may include your name, location, your general condition (e.g. fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name. This is so your family, friends, and clergy can visit you while you are a patient with us and generally know how you are doing.
• If you do not object, we may release medical information about you to a friend or family member who is involved in your medical care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
• Under certain circumstances, we may use and disclose medical information about you for research purposes. We will almost always ask for your specific permission if the researcher will have access to information that reveals who you are, or will be involved in your care.
• We will disclose medical information about you when required to do so by federal, state and local law.
• We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
• If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate donation and transplantation.
• If you are a member of the armed forces, we may release medical information about you as required by military command authorities.
• We may release medical information about you to your employer for workers compensation or similar programs.
• We may disclose medical information about you for public health activities (such as reports of communicable diseases, births and deaths, child abuse or neglect, reactions to medications or problems with products), to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease, or to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.
• We may disclose medical information to a health oversight agency for activities such as audits and investigations that are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
• If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if a reasonable effort has been made to tell you about the request or to obtain an order protecting the information requested.
• We may release medical information if asked to do so by a law enforcement official; in response to a court order, subpoena, summons or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement; about death we believe may be the result of criminal conduct; about criminal conduct at this organization; and in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
• We may release medical information to a coroner or a medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors as necessary to carry out their duties.
• We may release medical information about you to authorized federal officials for intelligence, counter intelligence and other national security activities authorized by law.
• We may disclose medical information about you to authorized federal officials so they may provide protection to the President of the United States, or other persons or foreign heads of state or conduct special investigations.
• If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official if necessary.

You have the right to:

• Request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operation, or to someone who is involved in your care. For example, you could ask that we not use or disclose information about a procedure you had.
• Request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
• Inspect and copy the medical records we have about you.
• If you feel that medical information we have about you is incorrect or incomplete; you may ask us to amend the information.
• Request a list of the disclosures we made of medical information about you, except for treatment, billing and health care operations, or as a result of your written authorization.

To exercise these rights, make the request in writing. Ask the receptionist for the proper form. We have the right to deny your request in certain limited circumstances.

Questions and Complaints
If you believe your privacy rights have been violated, you may file a complaint with this organization or the U.S. Secretary of the Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer at 256-739-4030. All complaints must be submitted in writing. You will not be penalized for filing a complaint. Please also contact the Privacy Officer if you need further information.