HIPAA Privacy Practices
Us Orthotics & Prosthetics, INC.
NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION 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 provided to you as a requirement of the Health
Insurance Portability and Accountability Act (HIPAA).
We are strongly committed to protecting your medical information, also referred
to as “Protected Health Information”. We create a medical record
about your care because we need the record to provide you with appropriate treatment
and to comply with various legal requirements. We transmit some medical information
about your care in order to obtain payment for the services you receive, and
we use certain information in our day-to-day operations. This Notice will let
you know about the various ways we use and disclose your Protected Health Information.
This Notice describes your rights and our obligations with respect to the use
or disclosure of your Protected Health Information.
ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE
You will be asked to provide a signed acknowledgement of receipt of this Notice.
Our intent is to make you aware of the possible uses and disclosures of your
Protected Health Information and your privacy rights. The delivery of our services
will in no way be conditioned upon your signed acknowledgement. If you decline
to provide a signed acknowledgement, we will continue to provide your treatment,
and will use and disclose your Protected Health Information for the purposes
described in this Notice.
OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION
“Protected health information” is individually identifiable health
information. This information relates to your past, present, or future physical
or mental health or condition and related health care services; to the past,
present or future payment for such health care services; and includes demographic
information
such as your age, address or email address. Us Orthotics & Prosthetics
is required by law to do the following:
• Make sure that your Protected Health Information is kept private.
• Give you this Notice of our legal duties and privacy practices related
to the use and disclosure of your Protected Health Information.
• Follow the terms of the Notice currently in effect.
• Describe how we will communicate any changes in this Notice to you.We
reserve the right to change this Notice. Its effective date is at the top of
the first page and at the bottom of the last page. We reserve the right to make
the revised Notice effective for Protected Health Information we already have
about you, as well as any Protected Health Information we create or receive in
the future. You may obtain another Notice of Privacy Practices by asking your
practitioner for a copy at your next appointment, or by sending a written request
for
a copy to Us Orthotics and Prosthetics at the
address listed below.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The following categories describe the different types of uses and disclosures
of your Protected Health Information that we are permitted or required to make.
We have also provided some examples of the types of uses and disclosures that
fall within a category. However, not every use or disclosure in a category will
be listed.
Uses and Disclosures for Treatment, Payment and Health Care Operations Treatment
We will use and disclose your Protected Health Information to provide, coordinate,
or manage your health care and any related treatment. This includes the coordination
or management of your health care with a third party. For example, we would disclose
your Protected Health Information, as necessary, to the physician that referred
you to us. We will also disclose Protected Health Information to other health
care providers who may be treating you.
Payment
We may use and disclose your Protected Health Information in order to bill and
obtain payment for health care services provided to you. 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.
We may also tell your health plan about an orthotic or prosthetic device you
are going to receive to obtain prior approval or to determine whether your plan
will cover the device.
Health Care Operations
We may use or disclose your Protected Health Information in connection with our
business operations. These operations include, but are not limited to, quality
assessment activities, development of clinical guidelines, reviewing the qualifications
and performance of practitioners and other health care professionals, training
activities, legal services and auditing functions, business planning and development
and business management and general administrative activities of our facilities.
We may share your Protected Health Information with third party “business
associates” that perform various activities (e.g., collections, transcription
services) for our facilities. Whenever an arrangement between our facility and
our business associate involves the use or disclosure of your Protected Health
Information, we will have a written contract that contains terms that will protect
the privacy of your Protected Health Information.
Treatment Alternatives
We may use or disclose your Protected Health Information to provide you with
information about treatment alternatives or other health-related products and
services that may be of interest to you.
Appointment Reminders
We may use or disclose your Protected Health Information to contact you to remind
you of your appointment.
Sign In Sheets
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 your practitioner
is ready to see you.
Sale of the Practice
If we decide to sell this practice or merge or combine with another practice,
we may share your Protected Health Information with prospective buyers or new
owners.
Other Permitted or Required Uses and Disclosures Without Written Authorization
Others Involved in Your Health Care
Unless you object, or in the event that you are not present or are incapacitated
or in an emergency, we may disclose to a member of your family, a relative, a
close friend, or any other person that you identify, your Protected Health Information
as it directly relates to that person's involvement in your health care, or payment
for such care. Additionally, we may use or disclose Protected Health Information
to notify or assist in notifying your family member, your personal representative,
or any other person responsible for your care, of your general condition, status
and location. Finally, we may also use or disclose your Protected Health Information
to an entity assisting in disaster relief efforts so that your family member,
your personal representative or other person responsible for your care can be
notified about your general condition, status and location.
Required By Law
We may use or disclose your Protected Health Information to the extent that the
use or disclosure is required by Federal, State or local law.
Public Health
We may disclose your Protected Health Information for public health activities
to public health authorities who are legally authorized to receive such information.
These activities include, but are not limited to, preventing or controlling disease,
injury or disability; reporting vital events; and conducting public surveillance,
public health investigations, and public health interventions, including notifying
persons who may have been exposed to a communicable disease or may otherwise
be at risk of contracting or spreading a disease or condition.
Health Oversight
We may disclose Protected Health Information to a health oversight agency for
activities authorized by law, such as audits, investigations, and inspections;
licensure and disciplinary actions; and civil, administrative and criminal proceedings
or actions. Oversight agencies seeking this information include government agencies
that oversee the health care system, government benefit programs, other government
regulatory programs and compliance with the 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,
if we believe that you have been a victim of abuse, neglect or domestic violence,
we may disclose your Protected Health Information to a governmental entity or
agency authorized by law to receive reports of abuse, neglect or domestic violence,
including a social service or protective services agency. We will only make this
disclosure if you agree or when required or authorized by law.
Food and Drug Administration
We may disclose your Protected Health Information to a person or company required
by the Food and Drug Administration to report adverse events, product defects
or problems or biologic product deviations; to track products; to enable product
recalls, repairs or replacements; or to conduct post marketing surveillance,
as required.
Legal Proceedings
We may disclose Protected Health Information about you in response to an order
by a court or administrative tribunal. We may also disclose Protected Health
Information about you in response to a subpoena, discovery request or other lawful
process by a party to a judicial or administrative proceeding, but only if efforts
have been made to notify you about the subpoena, discovery request or lawful
process, or to obtain an order from the court or administrative tribunal protecting
the information requested.
Law Enforcement
We may disclose your Protected Health Information in response to a court order,
a court-ordered subpoena, warrant or summons, or similar process authorized by
law. Also, in response to a request from a law enforcement official, we may disclose
Protected Health Information for the purpose of identifying or locating a suspect,
fugitive, material witness or missing person; or pertaining to a known or suspected
victim of a crime. Finally, we may disclose Protected Health Information to a
law enforcement official: (1) to report a death that we suspect may be the result
of criminal conduct; (2) to report criminal conduct on our premises; or (3) in
the event of a medical emergency (not on our premises), to report a crime, the
location of the crime or victims, or the identity, description or location of
the person who committed the crime.
Limited Data Sets
We may use or disclose your Protected Health Information as part of a “limited
data set”. A limited data set contains information regarding all or a portion
of our patients, with most individual identifiers, except for dates of birth
or dates of service and city, state and zip codes, removed. We may use or disclosure
your Protected Health Information as part of a limited data set for the purposes
of research, public health, accreditation, or for quality or other health care
operations. When we disclose a limited data set to a third party, we will first
obtain a written agreement from that party stipulating that it will not re-identify
the information or contact the individuals.
Research
Under certain circumstances, we may disclose your Protected Health Information
to researchers when their research has been approved by an Institutional Review
Board or a privacy board that has reviewed the research proposal and established
protocols to ensure the privacy of your Protected Health Information. We may
also disclose your Protected Health Information to persons who are preparing
to conduct a research project provided that they do not remove such information
from our premises.
Serious Threat to Health or Safety
We may use and disclose your Protected Health Information if we believe that
the use or disclosure is necessary to prevent or lessen a serious and imminent
threat to the health or safety of a person or the public. Under certain circumstances,
we may also disclose Protected Health Information if it is necessary for law
enforcement authorities to identify or apprehend an individual.
Military Activity and National Security
If you are a member of the armed forces, we may release Protected Health Information
about you as required by military command authorities. We may also release Protected
Health Information about foreign military personnel to the appropriate foreign
military authority. Finally, we may release Protected Health Information about
you to authorized federal officials so that they may: (1) conduct intelligence,
counter-intelligence, and other national security activities authorized by law;
or (2) provide protection to the President, other authorized persons or foreign
heads of state, or conduct special investigations.
Workers’ Compensation
We may disclose your Protected Health Information as authorized to comply with
workers’ compensation laws and other similar legally established programs
that provide benefits for work-related illnesses and injuries.
Inmates
If you are an inmate of a correctional institution or under the custody of a
law enforcement official, we may release Protected Health Information about you
to the correctional institution or law enforcement official if necessary: (1)
for provision of health care to you; (2) to protect your health and safety or
the health and safety of others; (3) for law enforcement on the premises of the
correctional institution; or (4) for the administration and maintenance of the
safety and security of the correctional institution.
Parental Access
Some state laws concerning minors permit or require disclosure of Protected Health
Information to parents, guardians, and persons acting in a similar legal status.
We will comply with the applicable law of the state where the treatment is provided
and will make disclosures in accordance with such law.
Uses and Disclosures Upon Written Authorization
All other uses and disclosures of your Protected Health Information that are
not described above will be made only with your written authorization. You may
revoke your authorization, at any time, in writing. You understand that we cannot
take back any use or disclosure we may have made under the authorization before
we received your written revocation, and that we are required to maintain a record
of the medical care that has been provided to you. The authorization is a separate
document, and you will have the opportunity to review any authorization before
you sign it. With the exception of research-related treatment, we will not condition
your treatment on whether or not you sign any authorization.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
Following is a statement of your rights with respect to your Protected Health
Information and a brief description of how you may exercise these rights.
You Have the Right to Inspect and Copy
You may inspect and obtain a copy of your Protected Health Information contained
in your medical and billing records and any other records that Us Orthotics & Prosthetics
uses for making decisions about you, for as long as we maintain the Protected
Health Information.
To inspect and copy your medical information, you must submit a written request
to the Privacy Official at the office(s) where we have provided you with health
care services, or to the Us Orthotics & Prosthetics Privacy Officer at
the address listed below. 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.
We may deny your request in limited situations. For example, you may not inspect
or copy psychotherapy notes; or information compiled in reasonable anticipation
of, or use in, a civil, criminal, or administrative action or proceeding; and
certain other specified Protected Health Information defined by law. In some
circumstances, you may have a right to have this decision reviewed by a licensed
health care professional. The person conducting the review will not be the person
who initially denied your request. We will comply with the decision in any review.
Please contact the Us Orthotics & Prosthetics Privacy Officer at the
address listed below if you have questions about access to your Protected Health
Information.
Right to Request Restrictions
You may ask us not to use or disclose any part of your Protected Health Information
for the purposes of treatment, payment or health care operations. You may also
request that any part of your Protected Health Information not be disclosed to
family members, relatives, friends or other persons who may be involved in your
care, or for notification or disaster relief efforts, as described in this Notice.
Your request must state the specific restriction requested and to whom you want
the restriction to apply.
Us Orthotics & Prosthetics is not required to agree to a restriction
that you may request.
If we do agree to the requested restriction, we may not use or disclose your
Protected Health Information in violation of that restriction unless it is needed
to provide emergency treatment. You may request a restriction by submitting a
written request to the Privacy Official at the office(s) where we have provided
you with health care services, or to the Us Orthotics & Prosthetics Privacy
Officer at the address listed below.
Right to Request Confidential Communications
You may request that we communicate with you using alternative means or at an
alternative location. We will not ask you the reason for your request. We will
accommodate reasonable requests, when possible. You may make this request by
submitting a written request to the Privacy Official at the office(s) where we
have provided you with health care services, or to the Us Orthotics & Prosthetics
Privacy Officer at the address listed below.
Right to Request Amendment
You may request an amendment of your Protected Health Information contained in
your medical and billing records and any other records that Us Orthotics & Prosthetics
uses for making decisions about you, for as long as we maintain the Protected
Health Information. You must make your request for amendment in writing to the
Privacy Official at the office(s) where we have provided you with health care
services, or to the Us Orthotics & Prosthetics Privacy Officer at the
address listed below, and provide the reason or reasons that support your request.
We may deny any request that is not in writing or does not state a reason supporting
the request.
We may deny your request for an amendment of any information that:
1. Was not created by us, unless the person that created the information is no
longer available to amend the information;
2. Is not part of the Protected Health Information kept by or for us;
3. Is not part of the information you would be permitted to inspect or copy;
or
4. Is accurate and complete.
If we deny your request for amendment, we will do so in writing and explain the
basis for the denial. You have the right to file a written statement of disagreement
with us. We may prepare a rebuttal to your statement and will provide you with
a copy of any such rebuttal. Please contact the Privacy Official at the office(s)
where we have provided you with health care services, or to the Us Orthotics & Prosthetics
Privacy Officer at the address listed below.
Right to an Accounting of Disclosures
This right only applies to disclosures for purposes other than treatment, payment
or health care operations as described in this Notice of Privacy Practices It
also excludes disclosures: (1) to you; (2) to your family members, relatives,
friends or other persons who may be involved in your care, or for notification
or disaster relief efforts; (3) for national security or intelligence purposes;
(4) to correctional institutions or law enforcement officials; (5) that occurred
prior to April 13, 2002; (6) made incident to a permitted or required use or
disclosure, as described in this Notice; and (7) made pursuant to an authorization.
The right to receive an accounting of disclosures is subject to certain other
exceptions, restrictions and limitations. You must submit a written request for
disclosures in writing to the Privacy Official at the office(s) where we have
provided you with health care services, or to the Us Orthotics & Prosthetics
Privacy Officer at the address listed below. You must specify a time period,
which may not be longer than six years from the date of the request and cannot
include any date before April 14, 2003. You may request a shorter timeframe.
Your request should indicate the form in which you want the list (i.e., on paper,
etc). You have the right to one free request within any 12-month period, but
we may charge you for any additional requests in the same 12-month period. We
will notify you about the charges you will be required to pay, and you are free
to withdraw or modify your request in writing before any charges are incurred.
Right to Obtain a Paper Copy of this Notice
You have the right to a paper copy of this Notice. Even if you have agreed to
receive this Notice electronically, you are still entitled to a paper copy of
this Notice. You may obtain a paper copy of this Notice by asking your practitioner
for a copy at your next appointment, sending a written request for a paper copy
to the Us Orthotics & Prosthetics Privacy Officer at the address listed
below, or sending a request for a paper copy via email to HIPAA@Us Orthotics & Prosthetics.com.
COMPLAINTS
You may complain to us or to the Secretary of the U. S. Department of Health
and Human Services if you believe your privacy rights have been violated by us.
You may file a complaint with us by writing or phoning Us Orthotics & Prosthetics
at:
Us Orthotics & Prosthetics.
30 Town and Country Drive
Suite 103
Fredericksburg, VA 22405
You may contact Us Orthotics & Prosthetics for further
information about the complaint process or for additional information about any
of the other matters identified in this Notice.
We will not retaliate against you in any way for filing a complaint, either with
us or with the Secretary.
This Notice is effective in its entirety as of April 14, 2003.
HIPAA Privacy Practices
|
 |
30 Town and Country Drive
Suite
103
Fredericksburg, VA 22405 (540) 899.2655
(800) 333.4102
fax: 540.899.2767
Office hours:
Monday – Friday 8am to 5pm |
