THIS NOTICE DESCRIBE HOW MEDICAL INFORMATION ABOUT YOU MAYBE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The terms of this Notice of Privacy Practices apply to Premier Orthopaedics and Sports Medicine Associates, Ltd., and its employees(collectively “Premier”). Premier will share personal health information of patients as necessary to carry out treatment, payment, and health care operations as permitted by law and for the purposes described below.
We are required by the law to maintain the privacy of our patients’ personal health information and to provide patients with notice of our legal duties and privacy practices with the respect to personal health information. We are required to abide by the terms of this Notice for as long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make a new Notice effective for all personal health information maintained by Premier. We are also required to inform you that there may be a provision of State law that relates to the privacy of your health information that may be more stringent that a standard or requirement under the Federal Health Insurance Portability and Accountability Act. A copy of any revised Notice of Privacy Practices or information
pertaining to a specific State law may be obtained by mailing request to the Privacy Officer, Premier Orthopaedics, 3809 West Chester Pike, Suite 150, Newtown Square, PA 19073.
USES AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION
Authorization: Except as outlined below, we will not use or disclose your personal health information for any purpose other than treatment, payment or health care operations and as described in this Notice unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization.
Uses and Disclosures for Treatment: We will use and disclose your personal health information as necessary for your treatment.Doctors and nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to your course of treatment that may include procedures, medications, tests, medical history etc. They will also disclose your personal information to other providers who treat you.
Uses and Disclosures for Payment: We will use and disclose your personal health information as necessary for payment purposes.During the normal course of business operations, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you. We may use your information to prepare a bill to send to you or to the person responsible for your payment.
Uses and Disclosures for Health Care Operations: We will use and disclose your personal health information as necessary, and as permitted by law, for our health care operations, which may include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your personal health information for purposes of improving clinical treatment and patient care.
Individuals Involved in Your Care: We may from time to time disclose your personal health information to designated family, friends, and others who are involved in your care or with payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited personal health information with individuals you have not specifically designated. We may also disclose limited personal health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that maybe involved in some aspect of caring for you.
Business Associates: Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, outcomes data collection, legal services, etc. At times it may be necessary for us to provide your personal health information to one or more of these outside persons or organizations who assist us with our health care operations.In all cases, we require these associates to appropriately safeguard the privacy of your information.
Appointments and Services: We may contact you to provide appointment or information about your treatment or other health-related benefits and services that maybe of interest to you. You have the right to request and we will accommodate reasonable requests by you to receive communications regarding your personal health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, we will accommodate reasonable requests. You also have the right to request that we not send you any future marketing materials and we will use our best efforts to honor such request. You may make your requests by sending your name and address to Privacy Officer, Premier Orthopaedics, 3809 West
Chester Pike, Suite 150, Newtown Square, PA 19073.
Research: In limited circumstances, we may use and disclose your personal health information for research purposes. In all cases where your specific authorization is not obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board or Privacy Board that oversees the research or by representations of the researchers that limit their use and disclosure of patient information.
Prohibited Disclosures: We will never share your personal health information without your written authorization for marketing purposes,to sell the information, or if the personal health information includes psychotherapy notes.
Other Permitted Uses and Disclosures: We are permitted and/or required by law to make certain other uses and disclosures of your personal health information without your consent or authorization for the following:
• Any purpose required by law;
• Public health activities, such as required of disease, injury, birth and death, or required public health investigations;
• If we suspect child abuse or neglect; if we believe you to be a victim of abuse, neglect or domestic violence;
• To the Food and Drug Administration to report adverse events, product defects, or to participate in product recalls;
• To your employer when we have provided health care to you at the request of your employer;
• To a government oversight agency conducting audits, investigations, or civil criminal proceedings;
• Court or administrative ordered subpoena or discovery request;
• To law enforcement officials as required by law to report wounds and injuries and crimes;
• To coroners and/or funeral directors’ consistent with’ law;
• If necessary, to arrange an organ or tissue donation from you or a transplant for you;
• If you are a member of the military, we may also release your personal health information for national security or intelligence activities; and
• To workers’ compensation agencies for workers’ compensation benefits determinations.
Electronic communications: The sharing of your PHI for treatment, payment, and health care operations as described in this Notice may happen electronically. Electronic communications enable fast, secure access to your information for those participating in and coordinating your care to improve the overall quality of your health and prevent delays in treatment.
RIGHTS THAT YOU HAVE REGARDING YOUR PERSONAL HEALTH INFORMATION
Confidential Communications: You have the right to request that we communication with you in a specific way (for example, by using a home or cell phone) or to send mail to a different address, and we will agree to all reasonable requests.
Access to Your Personal Health Information: You have the right to request an electronic or paper copy and/or to inspect much of the personal health information that we retain on your behalf. Requests for access must be made in writing and signed by you or your legal representative. You may obtain a “Patient Access to Health Information Form” from the front office person. You will be charged a reasonable copying fee and actual postage and supply costs for your personal health information. If you request additional copies you will be charged a fee for copying and postage.
Amendments to Your Personal Health Information: You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments, but we will give each request careful consideration. All amendment requests must be in writing, signed by you or legal representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made, we may notify others who work with us if we believe that such notification is necessary. You may obtain an “Amendment Request Form” from the front office person or individual responsible for medical records.
Accounting for Disclosures of Your Personal Health Information: You have the right to receive a list (an “accounting”) of certain disclosures made by us of your personal health information after April 14, 2003. You can ask for an accounting of the times we’ve shared your personal health information for six years prior to the date of your request. We will include all disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you authorized us to make). Requests must be made in writing and signed by you or your legal representative. “Accounting Request Forms” are available from the front office person or individual responsible for medical records. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period. You will be notified of the fee at the time of your request.
Restrictions on Use and Disclosure of Your Personal Health Information: You have the right to request restrictions on uses and disclosures of your personal health information for treatment, payment; or health care operations. We are not required to agree to your restriction request, but will attempt to accommodate reasonable requests when appropriate. However, if you pay for a service or item outof-pocket in full and request that we not share information about the service or item with your health plan or health insurer, we are required to agree to your request if the disclosure is for the purpose of payment or health care operations and is not required by law. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction by sending such termination notice to the individual responsible for medical records.
Right to Receive a Copy of this Notice: You have the right to receive a paper copy of this Notice, even if you have agreed to receive this Notice electronically.
Complaints: If you believe your privacy rights have been violated, you can file a complaint in writing with the Privacy Officer. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing by sending a letter to the Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints. We will not retaliate against you for filing a complaint. For Further Information: If you have questions or need further assistance regarding this Notice, you may contact the Privacy Officer by email at email@example.com,by telephone at 1-855-ORTHO24, or by writing to Privacy Officer, Privacy Officer, Premier Orthopaedics, 3809 West Chester Pike, Suite
150, Newtown Square, PA 19073.
EFFECTIVE: May 6, 2019