Hampton Roads Orthopaedics & Sports Medicine. Notice of Privacy Practices

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1 This is being prvided t yu as a requirement f the privacy regulatins issued under the Health Insurance Prtability and Accuntability Act f 1996 (HIPAA). This ntice describes hw HROSM may use and disclse medical infrmatin abut yu t carry ut treatment, payment, r health care peratins and fr ther purpses that are permitted r required by law. It als describes yur rights t access and cntrl medical infrmatin abut yu. Yur medical infrmatin (i.e. prtected health infrmatin fr purpses f HIPAA) is infrmatin abut yu, including yur demgraphic infrmatin that may identify yu and that relates t yur past, present and future physical r mental health cnditin. We are required by law t maintain the privacy f yur medical infrmatin, and we must abide by the terms f this ntice. In this ntice, we prvide descriptins f the different ways that we may use and disclse yur medical infrmatin. In sme cases, an example is prvided t describe the types and uses and disclsures f yur medical infrmatin that may be made at HROSM. In additin t the privacy prtectins prvided under the federal law (which are described in mre detail belw) and except in certain limited circumstances, Virginia law requires us t get yur written cnsent (r, under sme statues r rules, written cnsent frm yur attrney, guardian, r upn curt rder) befre we can use r disclse yur infrmatin if yu qualify as a patient that: Suffers frm a sexually transmitted diseases Is eligible t receive benefits frm the State f Virginia fr certain develpmental disabilities r mental retardatin; The Virginia Medicaid prgram has asked us t serve as a Case Management Service Prvider fr: receives rehabilitative services thrugh the Virginia Medicaid prgram, is eligible t receive certain benefits under the Virginia Medicaid s Preventive Health Educatin prgram, is eligible t receive certain Children s Specialty Clinic services under the Virginia Medicaid prgram; Uses and Disclsures f Prtected Health Infrmatin Fr Treatment: We may use and disclse medical infrmatin abut yu t prvide yu with medical treatment r services. We may disclse medical infrmatin abut yu t dctrs, nurses, technicians, residents, physical therapists, r ther health care prfessinals wh are invlved in taking care f yu. Fr example, we may disclse yur medical infrmatin t anther dctr r health care prvider (such as a specialist, yur primary care physician, a pharmacist, r a clinical labratry) wh, at the directin f yur HROSM dctr, is invlved in yur treatment r case. These uses r disclsures f yur medical infrmatin may als be limited by the Virginia Requirements. Fr Payment: We may use and disclse medical infrmatin abut yu s that the treatment and services yu receive may be billed t and payment may be cllected frm yu, an insurance cmpany r therwise. Fr example, yur insurance cmpany may need t knw certain infrmatin abut the diagnstic test (i.e. fluid aspiratin) yu received s they will pay us r reimburse yu fr the test r prcedure. We may als use r disclse medical infrmatin abut yu t btain prir apprval r t determine whether yur insurance cmpany will cver a prpsed treatment. These uses r disclsures f yur medical infrmatin may als be limited by the Virginia Requirements. Fr Health Care Operatins: We may use and disclse medical infrmatin abut yu fr yur health care peratins. This is necessary t make sure that all f ur patients receive quality care and t supprt the business peratin f ur practice. These uses r disclsures f yur medical infrmatin may als be limited by the Virginia Requirements. A few examples f ur health care peratins are quality imprvement, dctr/emplyee review activities, cmpliance and the training f medical residents and ther health care prfessinals. Als included in health care peratins are the day-t-day tasks that are required t keep ur practice lcatins functining and t prvide yu with quality care. Fr example, in ur receptin area we may use a sign-in sheet at the registratin desk where yu will be asked t sign yur name and indicate yur dctr. We may als call yur name in the receptin area when yur dctr is ready t see yu. In additin, we may cntact yu (i.e. by telephne r mail) t remind yu abut an appintment, t prvide instructins prir t a diagnstic test r prcedure, t prvide infrmatin abut ther treatment alternatives r ther health-related benefits that may be f interest t yu, r t discuss yur accunt. In such cases, we may leave a message n yur answering machine, if available. 1

2 The HROSM departments that may have a reasn t cmmunicate with yu regarding yur care include the fllwing: receptin, diagnstic testing, clinical services, research, business ffice, quality imprvement. As anther part f health care peratins, we may use and disclse medical infrmatin abut yu t ur business assciates. Our business assciates, such as transcriptin services, cllectin agency, and call answering service, just t name a few, wh perfrm services n behalf f ur practice. Whenever an arrangement between ur practice and a business assciate invlves the use r disclsure f medical infrmatin abut yu, we will have a written cntract with that business assciate that will require such business assciates t agree t prtect the privacy f yur medical infrmatin. Uses and Disclsures f Prtected Health Infrmatin Nt Discussed In This Ntice Uses and disclsures f yur medical infrmatin that have nt been described in this ntice will nt be made withut yur written permissin. If yu prvide us with permissin t use r disclse yur medical infrmatin yu, yu may revke that permissin, in writing, at any time. If yu revke yur permissin, we will n lnger use r disclse medical infrmatin abut yu fr the reasns cvered by such permissins. Hwever, yu understand that we are unable t take back any actins that we have already taken with yur permissin, and that we are required t retain ur recrds f the care we prvided t yu. Other Permitted and Required Uses and Disclsures That May Be Made With Yur Agreement r Opprtunity t Object Yu have the pprtunity t agree r bject t the use r disclsure f all r parts f medical infrmatin abut yu in the situatins discussed in the fllwing paragraph. If yu are nt present r able t agree r bject t the use r disclsure f yur medical infrmatin in such instances, then yur dctr may, using his r her prfessinal judgment, use r disclse yur medical infrmatin if believed t be in yur best interest. These uses r disclsures f yur medical infrmatin may als be limited by the Virginia Requirements. Individuals invlved in yur care r payment fr yur care: Unless yu bject, we may release medical infrmatin abut yu t a friend, family member, r any ther persn yu identify wh is invlved in yur medical care. We may als give infrmatin t smene wh helps pay fr yur care. We may use r disclse medical infrmatin abut yu t ntify r t assist in ntifying a family member, persnal representative r any ther persn that is respnsible fr yur care f yur lcatin, general cnditin, r death. In additin, we may disclse infrmatin abut yu t an entity assisting in a disaster relief effrt s that yur family can be ntified abut yur lcatin, general cnditin, r death. Research: We may use and disclse medical infrmatin abut yu fr research purpses under certain circumstances. Hwever, ther than btaining medical infrmatin in preparatin fr a research prgram r prtcl, yur specific permissin is generally required if such research will invlve the use r disclsure f yur medical infrmatin. Our research is als generally subject t the special apprval f an Institutinal Review Bard, which amng ther things, tries t balance the research need with the patient s need fr privacy f their medical infrmatin. These uses r disclsures f yur medical infrmatin may als be limited by the Virginia Requirements. Other Permitted and Required Uses and Disclsures That May Be Made Withut Yur Authrizatin r Opprtunity t Agree r Object: Unless the Virginia Requirements requires therwise, we may use r disclse yur prtected health infrmatin, in the certain situatins, withut yur specific permissin r withut giving yu an pprtunity t agree r bject. Amng these situatins are the fllwing: As required by law: We are permitted t discuss medical infrmatin abut yu when required t d s by federal, state, r lcal law. 2

3 T Avert a Serius Threat t Health r Safety: In certain circumstances, we may use and disclse medical infrmatin abut yu when necessary t prevent a serius threat t yur health r safety r the health r safety f the public r anther persn. Military and Veterans: If yu are a member f the Armed Frces, in certain circumstances we may release yur medical infrmatin t an apprpriate gvernment bdy. Wrkers Cmpensatin: We may release medical infrmatin abut yu t cmply with wrkers cmpensatin (r similar) laws. Inmates: If yu are an inmate f a crrectinal institutin r under the custdy f a law enfrcement fficial, we may in certain circumstances release medical infrmatin abut yu t the crrectinal institutin r law enfrcement fficial. Public Health Activities: We may disclse medical infrmatin abut yu fr public health activities. These activities generally include, withut limitatin, the fllwing: T prevent r cntrl disease, injury r disability, t reprt birth and deaths, child abuse and neglect, reactins t medicatins r prblems with prducts, t ntify peple f recalls n prducts that they may be using, t ntify a persn wh may have been expsed t a disease r may be at risk fr cntracting r spreading a disease r cnditin, and t ntify the apprpriate gvernment authrity if we believe a patient has been the victim f abuse, neglect r dmestic vilence. Health Oversight Activities: We may disclse medical infrmatin t a health versight agency fr activities related t the mnitring f the health care system, gvernment prgrams r cmpliance with civil rights laws. These versight activities include, fr example, audits, investigatins, inspectins, and licensure. Laws and Disputes: In certain circumstances we may disclse medical infrmatin abut yu in respnse t a subpena, discvery request r ther lawful rder frm a curt. Law Enfrcement: We may release medical infrmatin abut yu if asked t d s by a law enfrcement fficial as part f law enfrcement activities in certain circumstances. Crners, Medical Examiners, and Funeral Directrs: If authrized by law, we may release medical infrmatin t a crner r medical examiner. We may als release medical infrmatin t a funeral directr, as cnsistent with applicatin law, in rder t permit the funeral directr t carry ut his/her duties. Als, medical infrmatin may be used and disclsed fr rgan, eye r tissue dnatin purpses. Prtective Services fr the President, Natinal Security and Intelligence Activities: We may disclse medical infrmatin abut yu t authrized federal fficials s they may withut limitatin (i) prvide prtectin t the President, ther authrized persns r freign heads f state r cnduct special investigatins, r (ii) cnduct lawful intelligence, cunter-intelligence, r ther natinal security activities authrized by law. Yur Rights Regarding Medical Infrmatin Abut Yu Yu have the fllwing rights regarding medical infrmatin we maintain abut yu: Right t Inspect and Cpy: Yu have the right t inspect and cpy medical infrmatin that relates t yu. T inspect and cpy such medical infrmatin yu must submit yur request in writing t ur Privacy Officer at the address belw. If yu request a cpy f the infrmatin, we may charge yu a reasnable fee fr the csts f cpying, mailing r ther supplies assciated with yur request. We may deny yur request t inspect and cpy in sme circumstances. If yu are denies access t medical infrmatin, yu may in certain circumstances, request that the denial be reviewed. In such cases, anther licensed health care prfessinal chsen 3

4 by HROSM will review yur request and the denial. The persn cnducting the review will nt be the persn wh denied yur request. We will cmply with the utcme f the review. Right t Amend: If yu feel that medical infrmatin that we have abut yu is incrrect r incmplete, yu may ask us t amend the infrmatin. In certain circumstances, yu have the right t amend yur medical infrmatin. T request an amendment, yur request must be made in writing and submitted t ur Privacy Officer at the address belw. In additin, yu must prvide a reasn that supprts yur request. We may deny yur request fr an amendment in certain circumstances. Rights t an Accunting f Disclsures: Yu have the right t review an accunting f certain disclsures that we have made. T request an accunting f disclsures yu must submit yur request in writing t ur Privacy Officer at the address belw. Yur request must state a time perid that may nt be lnger than six (6) years and may nt include dates befre April 14, The first list yu request within a 12-mnth perid will be free. Fr additinal lists within a single 12-mnth perid, we may charge yu fr the csts f prviding the lists. We will ntify yu f the cst invlved and yu may chse t withdraw r mdify yur request at that time befre any csts are incurred. Right t Request Restrictins: Yu have the right t request a restrictin r limitatin n hw we use r disclse certain medical infrmatin abut yu, including hw we use r disclse yur medical infrmatin in payment r health care peratins. We are nt required t agree t yur request. If we d agree, we will cmply with yur request unless the infrmatin is needed t prvide yu emergency treatment. T request restrictins yu must make yur request in writing t ur Privacy Officer at the address belw. In yur request, yu must prvide what infrmatin yu wish t limit and whether yu want t limit ur use, disclsure r bth and t whm yu want the limits t apply. Right t Request Cnfidential Cmmunicatins: Yu have the right t request that we cmmunicate with yu abut medical matters in a certain manner r at a certain lcatin. Fr example, yu can ask that we nly cntact yu at wrk r by mail. T request cnfidential cmmunicatins, yu must make yur request in writing t ur Privacy Officer at the address belw. We will nt ask yu fr yur reasn. We will accmmdate all reasnable requests. Yur request must specify hw r where yu wish t be cntacted. Right t a Paper Cpy f this Ntice: Yu have the right t a paper cpy f this ntice at any time. Even if yu have agreed t receive this ntice electrnically, yu are still entitled t a paper cpy f this ntice. T btain a paper cpy f this ntice, yu must submit yur request in writing t ur Privacy Officer at the address belw r simply ask fr a cpy at the receptin/check-in desk at HROSM. Changes t This Ntice: We reserve the right t change this ntice at any time. We reserve the right t make the revised r changed ntice effective fr medical infrmatin as well as any infrmatin we receive in the future. We will pst a cpy f the current ntice. This ntice will cntain n the first page, In the bttm right hand crner, the effective date. Cmplaints: If yu believe yur privacy right has been vilated yu may file a cmplaint with us r with the Secretary f the Department f Health and Human Services. T file a cmplaint with HROSM, cntact the Privacy Officer at the address belw. All cmplaints must be submitted in writing. Yu will nt be penalized fr filing a cmplaint. We will deal with all cmplaints in a reasnable and efficient manner. Other Uses f Medical Infrmatin: Other uses and disclsures f medical infrmatin nt cvered by this ntice r the laws that apply t us will be made nly with yur written permissin. If yu prvide us permissin t use r disclse medical infrmatin abut yu, yu may revke that permissin, in writing, at any time. If yu revke yur permissin, we will n lnger use r disclse medical infrmatin abut yu fr the reasns cvered by yur written authrizatin; Yu understands that we are unable t take back any disclsures we have already made with yur permissin, and that we are required t retain ur recrds f care and services that we prvided t yu. 4

5 Attentin: Privacy Officer Hamptn Rads Orthpaedics & Sprts Medicine 730 Thimble Shals Blvd., Suite 130 Newprt News, VA

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