| Uses and Disclosures of Health Information
Treatment
We will use and disclose your health information to provide,
coordinate, and manage health care and related services for you. For example
we will disclose information to a specialist to whom you have been referred
including but not limited to a home health agency and/or physical therapy
and other agencies or physician's offices or laboratories involved
in your care or who will become involved in your care, to ensure the provider
has enough information to diagnose and/or treat you.
Payment:
Your protected health information will be used, as needed, to obtain
payment for your health care services. This may include certain activities
that your health insurance plan may undertake before it approves or pays
for the health care services we recommend for you such as; making a determination
of eligibility or coverage for insurance benefits, reviewing services provided
to you for medical necessity, and undertaking utilization review activities.
For example, obtaining approval for a hospital stay may require that your
relevant protected health information be disclosed to the health plan to
obtain approval for the hospital admission.
Healthcare Operations:
We will use and disclose your health information
to conduct the business activities of this office. These activities include,
but are not limited to, quality assessment and improvement activities, review
of the performance and qualifications of employees, evaluating practitioner
and provider performance, conducting training programs, accreditation, certification,
licensing or credentialing activities.
We may use a sign-in sheet at the registration desk where you will be asked
to sign your name. We may also call you by name in the waiting room when
we are ready to see you. We will share your protected health information with business associates
that perform specific functions for our practice such as billing and transcription.
When a business arrangement of this type requires the use of your information,
we will have a written contract with the third party to protect the privacy
of your protected health information.
Others Involved in Your Health Care:
We must disclose your health information
to you as described in the Patient Rights section of this Notice. We may
disclose your health information to a family member or other person to the
extent necessary to help with your health care or with payment for your
health care, but only if you agree. If we determine it is in your best interest
based on our professional judgment or experience with common practices,
we may allow another person to pick up filled prescriptions, medical supplies,
x-rays or other forms of health information.
We may use or disclose protected health information to notify or assist
in notifying a family member, a personal representative or any other person
responsible for your care of your location, your general condition or death.
If you are present prior to the use or disclosure of your protected health
information, we will provide you with the opportunity to object to such
uses or disclosures. Finally, we may use or disclose your protected health
information to an authorized public or private entity to assist in disaster
relief efforts and to coordinate uses and disclosures to family members
or others involved in your health care.
Emergencies:
In the event of your incapacity or in emergency circumstances,
we may use or disclose your protected health information to treat you.
Uses and Disclosures of Protected Health Information Based upon Your Written
Authorization:
Other uses and disclosures of your protected health information
will be made only with your written authorization, unless otherwise permitted
or required by law as described below. You may revoke this authorization,
at any time, in writing, except to the extent that an action has already
been taken in reliance on the authorization.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:
Required By Law:
We may use or disclose your protected health information to the extent that law requires the use or disclosure. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
We must make disclosures to you and, when required, to the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the Privacy Rule, Section 164.500 et. seq.
Public Health:
We may disclose your protected health information for public health activities
and purposes to a public health authority that is permitted by law to collect
or receive the information. The disclosure will be made for the purpose
of controlling disease, injury or disability. Additionally, we may disclose
your protected health information, if authorized by law, to a person who
may have been exposed to a communicable disease or may otherwise be at risk
of contracting or spreading the disease or condition.
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.
Abuse or Neglect:
We may disclose your protected health information to a
public health authority that is authorized by law to receive reports of
child abuse or neglect. In addition, we may disclose your protected health
information if we believe that you have been a victim of abuse, neglect
or domestic violence to the governmental entity or agency authorized to
receive such information. In this case, the disclosure will be made consistent
with the requirements of applicable federal and state laws.
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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.
Law Enforcement:
We may also disclose protected health information, so long
as applicable legal requirements are met, for law enforcement purposes.
These law enforcement purposes include (1) legal processes and otherwise
required by law, (2) limited information requests for identification and
location purposes, (3) pertaining to victims of a crime, (4) suspicion that
death has occurred as a result of criminal conduct, (5) in the event that
a crime occurs on the premises of the practice, and (6) medical emergency
(not on the Practice’s premises) and it is likely that a crime has
occurred.
Military Activity and National Security:
When the appropriate conditions
apply, we may disclose, to military authorities, protected health information
of individuals who are Armed Forces personnel. We may also disclose your
protected health information to authorized federal officials for conducting
national security and intelligence activities including for the provision
of protective services to the President or others legally authorized.
Workers' Compensation:
We may disclose your protected health information
as authorized to comply with workers' compensation laws and other
similar legally established programs.
Your Rights
Your rights with respect to your protected health information and how you
may exercise those rights are outlined below.
You have a right to obtain a copy and/or inspect your health information:
Health information includes treatment records, billing records and any other
records used by us to make decision about your treatment. You may obtain
a form from our office to request access. A reasonable cost-based fee will
be charged for expenses such as staff time, copies and postage. Contact
us as indicated at the end of this Notice to obtain information about our
fees or if you have any questions about your access.
You have a right to request a restriction on the use and disclosure of your
protected health information:
You may ask us not to use or disclose some
part of your protected health information for the purposes of treatment,
payment or operations. You may also request that we not disclose some part
of your information to family and others who may be involved in your care
or for notification purposes as otherwise described in this Notice. We are
not required to agree to the restrictions but if we do, we are obligated
to abide by the agreement except in cases of emergency. You may request
a restriction by sending your request in writing to our Privacy Contact.
You have a right to request to receive confidential communications by alternative
means or at an alternative location.
We will accommodate reasonable requests.
We may also 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 request an explanation from you
as to the basis for the request. Please make this request in writing to
our Privacy Contact.
You may have the right to request an amendment to your protected health
information.
You may request that we amend protected health information
about you. Your request must be in writing with an explanation as to why
the information should be amended. In certain cases, we may deny your request
for an amendment. If we deny your request for amendment, you have the right
to file a statement of disagreement with us. We may prepare a rebuttal to
your statement and will provide you with a copy of any such rebuttal.
You have the right to receive an accounting of certain disclosures we have
made, if any, of your protected health information.
This right applies to
disclosures made by our Business Associates or us. It excludes disclosures
for treatment, payment or healthcare operations as described in this Notice
of Privacy Practices, to you, to family members or friends involved in your
care, for notification purposes or as a result of an authorization signed
by you. You have the right to receive specific information regarding these
disclosures that occurred after April 14, 2003 for up to the previous 6
years. You may request a shorter timeframe. The right to receive this information
is subject to certain exceptions, restrictions and limitations. If you request
an accounting more than once in a 12 month period, we will charge you a
reasonable cost-based fee for responding to the additional request.
You have the right to obtain a paper copy of this notice from us, upon request,
even if you have agreed to accept this notice electronically.
Questions and Complaints
If you have any questions, concerns or want more information about our privacy practices please contact us using the information below.
If you are concerned that we may have violated your privacy rights or you disagree with a decision we have made regarding your access to your health information or any other request you have made in the exercise of your rights, you may send your complaint to us using the address on the front of this brochure. You may also submit a written complaint to the Secretary of Health and Human Services. Contact us for the address of the Department of Health and Human Services.
We support your right to the privacy of your health information and we will not retaliate against you in any way for filing a complaint.
Gill Orthopaedic Clinic, PA
Phone (704) 342-3544
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