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Notice of Privacy Practices
Orthopaedics Northeast, P.C.
We are providing you with this Notice of Privacy Practices as required by HIPAA Regulations. Although we certainly wish to protect your privacy, there are many circumstances which require us to disclose your protected health information.
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.
If you have any questions about this Notice please contact:
our Privacy Contact who is Jo-Anne Cahill at 978.794.1946 Ext.
18
This Notice of Privacy Practices describes how we may use and
disclose your protected health information to carry out treatment,
payment or health care operations and for other purposes that
are permitted or required by law. It also describes your rights
to access and control your protected health information. "Protected
health information" is information about you, including demographic
information, that may identify you and that relates to your
past, present or future physical or mental health or condition
and related health care services.
We are required to abide by the terms of this Notice of Privacy
Practices. We may change the terms of our notice, at any time.
The new notice will be effective for all protected health information
that we maintain at that time. Upon your request, we will provide
you with any revised Notice of Privacy Practices by accessing
our website http://www.orthonortheast.com, calling the office
and requesting that a revised copy be sent to you in the mail
or asking for one at the time of your next appointment.
1. Uses and Disclosures of Protected Health
Information
We are required to ask you to sign a HIPAA form acknowledging that you have received this Notice of Privacy Practices and that you are aware that your physician will use or disclose your protected health information as described in this Section 1. Your protected health information may be used and disclosed by your physician, our office staff and others outside of our
office that are involved in your care and treatment for the
purpose of providing health care services to you. Your protected
health information may also be used and disclosed to pay your
health care bills and to support the operation of the physician's
practice.
Following are examples of the types of uses and disclosures
of your protected health care information that the physician's
office is permitted to make once you have signed our consent
form. These examples are not meant to be exhaustive, but to
describe the types of uses and disclosures that may be made
by our office once you have provided consent.
Treatment: We will use and disclose
your protected health information 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 that has already obtained your permission to have access
to your protected health information. For example, we would
disclose your protected health information, as necessary, to
a home health agency that provides care to you. We will also
disclose protected health information to other physicians who
may be treating you when we have the necessary permission from
you to disclose your protected health information. For example,
your protected health information may be provided to a physician
to whom you have been referred to ensure that the physician
has the necessary information to diagnose or treat you.
In addition, we may disclose your protected health information
from time-to-time to another physician or health care provider
(e.g., a specialist or laboratory) who, at the request of your
physician, becomes involved in your care by providing assistance
with your health care diagnosis or treatment to your physician.
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 may use
or disclose, as-needed, your protected health information in
order to support the business activities of your physician's
practice. These activities include, but are not limited to,
quality assessment activities, employee review activities, training
of medical students, licensing, marketing and fundraising activities,
and conducting or arranging for other business activities.
For example, we may disclose your protected health information
to medical school students that see patients at our office.
In addition, we may use a sign-in sheet at the registration
desk where you will be asked to sign your name and indicate
your 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 protected health information, as necessary, to
contact you to remind you of your appointment.
We will share your protected health information with third party
"business associates" that perform various activities (e.g.,
billing, transcription services) for the practice. Whenever
an arrangement between our office and a 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.
We may use or disclose your protected health information, as
necessary, to provide you with information about treatment alternatives
or other health-related benefits and services that may be of
interest to you. We may also use and disclose your protected
health information for other marketing activities. For example,
your name and address may be used to send you a newsletter about
our practice and the services we offer. We may also send you
information about products or services that we believe may be
beneficial to you. You may contact our Privacy Contact to request
that these materials not be sent to you.
We may use or disclose your demographic information and the
dates that you received treatment from your physician, as necessary,
in order to contact you for fundraising activities supported
by our office. If you do not want to receive these materials,
please contact our Privacy Contact and request that these fundraising
materials not be sent to you.
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 your physician or the physician's practice has taken an
action in reliance on the use or disclosure indicated in the
authorization.
Other Permitted and Required Uses and Disclosures That May
Be Made, and Your Opportunity to Object
We may use and disclose your protected health information in
the following instances. You have the opportunity to agree or
object to the use or disclosure of all or part of your protected
health information. If you are not present or able to agree
or object to the use or disclosure of the protected health information,
then your physician may, using professional judgment, determine
whether the disclosure is in your best interest. In this case,
only the protected health information that is relevant to your
health care will be disclosed.
Others Involved in Your Healthcare:
Unless you object, we may disclose to a member of your family,
a relative, a close friend or any other person you identify,
your protected health information that directly relates to that
person's involvement in your health care. If you are unable
to agree or object to such a disclosure, we may disclose such
information as necessary if we determine that it is in your
best interest based on our professional judgment. We may use
or disclose protected health information to notify or assist
in notifying a family member, personal representative or any
other person that is responsible for your care of your location,
general condition or death. 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 or other individuals involved
in your health care.
Emergencies: We may use or disclose
your protected health information in an emergency treatment
situation. If this happens, your physician shall try to obtain
your consent as soon as reasonably practicable after the delivery
of treatment. If your physician or another physician in the
practice is required by law to treat you and the physician has
attempted to obtain your consent but is unable to obtain your
consent, he or she may still use or disclose your protected
health information to treat you.
Communication Barriers: We may
use and disclose your protected health information if your physician
or another physician in the practice attempts to obtain consent
from you but is unable to do so due to substantial communication
barriers and the physician determines, using professional judgment,
that you intend to consent to use or disclosure under the circumstances.
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
the use or disclosure is required by law. The use or disclosure
will be made in compliance with the law and will be limited
to the relevant requirements of the law. You will be notified,
as required by law, of any such uses or disclosures.
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. We may also disclose your protected health information,
if directed by the public health authority, to a foreign government
agency that is collaborating with the public health authority.
Communicable Diseases: 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.
Health Oversight: 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.
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, biologic product
deviations, track products; to enable product recalls; to make
repairs or replacements, or to conduct post marketing surveillance,
as required.
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.
Coroners, Funeral Directors, and Organ
Donation: We may disclose protected health information
to a coroner or medical examiner for identification purposes,
determining cause of death or for the coroner or medical examiner
to perform other duties authorized by law. We may also disclose
protected health information 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. Protected health information may be used
and disclosed for cadaveric organ, eye or tissue donation purposes.
Research: We may disclose your
protected health information to researchers when their research
has been approved by an institutional review board that has
reviewed the research proposal and established protocols to
ensure the privacy of your protected health information.
Criminal Activity: Consistent with
applicable federal and state laws, we may 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. 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:
When the appropriate conditions apply, we may use or disclose
protected health information of individuals who are Armed Forces
personnel (1) for activities deemed necessary by appropriate
military command authorities; (2) for the purpose of a determination
by the Department of Veterans Affairs of your eligibility for
benefits, or (3) to foreign military authority if you are a
member of that foreign military services. 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: Your protected
health information may be disclosed by us as authorized to comply
with workers' compensation laws and other similar legally-established
programs.
Inmates: We may use or disclose
your protected health information if you are an inmate of a
correctional facility and your physician created or received
your protected health information in the course of providing
care to you.
Required Uses and Disclosures:
Under the law, we must make disclosures to you and when required
by the Secretary of the Department of Health and Human Services
to investigate or determine our compliance with the requirements
of Section 164.500 et. seq.
2. Your Rights
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
your protected health information. This means you may
inspect and obtain a copy of protected health information about
you that is contained in a designated record set for as long
as we maintain the protected health information. A "designated
record set" contains medical and billing records and any other
records that your physician and the practice 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 protected health
information that is subject to law that prohibits access to
protected health information. Depending on the circumstances,
a decision to deny access may be reviewable. In some circumstances,
you may have a right to have this decision reviewed. Please
contact our Privacy Contact if you have questions about access
to your medical record.
You have the right to request a restriction
of your protected health information. This means you
may ask us not to use or disclose any part of your protected
health information for the purposes of treatment, payment or
healthcare operations. You may also request that any part of
your protected health information not be disclosed 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.
Your physician is not required to agree to a restriction that
you may request. If physician believes it is in your best interest
to permit use and disclosure of your protected health information,
your protected health information will not be restricted. If
your physician does 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. With this in mind, please discuss any restriction
you wish to request with your physician. You may request a restriction
by submitting it in writing to: Orthopaedics Northeast, P.C.
575 Turnpike Street Suite 11 North Andover, MA 01845 with your
signature and a photocopy of your driver's license.
You have the right to request to receive
confidential communications from us 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 cont act. 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 have your physician
amend your protected health information. This means you
may request an amendment of protected health information about
you in a designated record set for as long as we maintain this
information. 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 and we
may prepare a rebuttal to your statement and will provide you
with a copy of any such rebuttal. Please contact our Privacy
Contact to determine if you have questions about amending your
medical record.
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
for purposes other than treatment, payment or healthcare operations
as described in this Notice of Privacy Practices. It excludes
disclosures we may have made to you, for a facility directory,
to family members or friends involved in your care, or for notification
purposes. You have the right to receive specific information
regarding these disclosures that occurred after April 14, 2003.
You may request a shorter timeframe. The right to receive this
information is subject to certain exceptions, restrictions and
limitations.
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.
3. Complaints
You may complain to us or to the Secretary of Health and Human
Services if you believe your privacy rights have been violated
by us. You may file a complaint with us by notifying our privacy
contact of your complaint. We will not retaliate against you
for filing a complaint.
You may contact our Privacy Contact, Jo-Anne Cahill at 978.794.1946
Ext. 18 for further information about the complaint process.
This notice was published and becomes effective on April 1,
2003.
Download a copy of our Privacy
Practices in Adobe Acrobat format.
*The above form is an Adobe Acrobat® PDF file. If you need the
free Adobe Acrobat® Reader, click
here to download.
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