THIS NOTICE DESCRIBES HOW
MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This
Notice of Privacy Practices is being provided to you as a requirement
of a federal law, the Health Insurance Portability and Accountability
Act (HIPAA).
Each time you visit a hospital, physician,
or other health care provider, a record of your visit is made. Typically,
this record contains your symptoms, examination, test results, diagnoses,
treatment, and a plan for future care or treatment. This health
information often referred to as your medical record, serves as
a basis for planning your care and treatment. Your medical record
is an essential means of communication between the many health care
professionals who contribute to your care. Understanding what is
in your record and how your health information is used and may be
disclosed allows you to be an informed health care consumer.
This Notice of Privacy Practices describes
how we may use and disclose your protected health information (PHI).
Your “protected health information” (PHI) refers to the information
contained in your medical record regarding your physical
or mental health. This also includes demographic information
used to identify you. This Notice of Privacy Practices also describes
your rights to access and control your PHI.
Uses and Disclosures of Protected Health
Information
Des Moines Orthopaedic Surgeons (DMOS)
may use your PHI for purposes of providing treatment, obtaining
payment for treatment, and conducting health care operations. Your
PHI may be used or disclosed only for these purposes unless
we have obtained your written authorization or the use or disclosure
is otherwise permitted by the HIPAA privacy regulations or state
law. Disclosures of your PHI for the purposes described in this
Notice of Privacy Practices may be made in writing, electronically,
orally, or by facsimile.
We will use or disclose your health
information to provide treatment. We will use
and disclose your PHI 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 PHI. For example,
we may disclose your PHI to a pharmacy to fill a prescription or
to a laboratory to perform a blood test. We may also disclose PHI
to other physicians who may be treating you or consulting with DMOS
with respect to your care. In some cases, we may also disclose your
PHI to an outside treatment provider for purposes of the treatment
activities of the other provider.
We will use or disclose your health
information to obtain payment for the services we provide.
For example, we may need to disclose health information
to your health insurance company to get prior approval for surgery,
to determine whether you are eligible for benefits, or to determine
if a particular service is covered under your health plan. We may
also need to disclose your PHI to your health insurance company,
in order to obtain payment for the services we provide to you. In
addition, your health insurance company may require information
so they can confirm the services we provided were medically necessary.
We may also disclose health information and demographic information
to another provider involved in your care for the other provider’s
payment activities. An example of this would be the outpatient surgery
center where your surgery is being performed.
We will use or disclose your health
information, as necessary, for our own health care operations.
These activities include, but are not limited to, quality assessment
activities, employee review activities, licensing or credentialing
activities, legal services, maintaining compliance programs, training
of medical students, marketing activities, business management and
general administrative activities. For example, our quality improvement
committee may use information in your medical record to assess the
care and outcomes in your case and others like it. This information
will then be used in an effort to continually improve the quality
of the care and service we provide. We may also disclose PHI to
medical school students training under our supervision. In addition,
we may use your name and address to send you information about our
practice and the services we offer. In certain situations, we may
also disclose patient information to another provider or health
plan for their health care operations.
As part of treatment, payment and health care
operations, we may also use or disclose your PHI for the following
purposes: to remind you of your appointment date, to inform you
of potential treatment alternatives or options, to inform you of
health-related benefits or services that may be of interest to you.
Federal privacy rules allow us to use or
disclose your PHI without your permission or authorization
for a number of reasons including the following:
When Legally Required.
We will disclose your PHI when we are required to do so by any federal,
state or local law. The use or disclosure will be made in compliance
with the law and will be limited to the relevant requirements of
the law.
When There Are Risks to Public Health.
We may disclose your PHI for the following public activities and
purposes:
- To prevent, control, or report disease, injury
or disability as permitted by law.
- To report vital events such as birth or death
as permitted or required by law.
- To conduct public health surveillance, investigations
and interventions as permitted or required by law.
- To collect or report adverse events and product
defects, track FDA regulated products, enable product recalls,
repairs or replacements to the FDA and to conduct post marketing
surveillance.
- To notify a person who has been exposed to a
communicable disease or who may be at risk of contracting or spreading
a disease as authorized by law.
- To report to an employer information about an
individual who is a member of the workforce as legally permitted
or required.
To Report Suspected Abuse, Neglect
Or Domestic Violence. We may notify government
authorities if we believe that a patient is the victim of abuse,
neglect or domestic violence. We will make this disclosure only
when specifically required or authorized by law or when the patient
agrees to the disclosure.
To Conduct Health Oversight Activities.
We may disclose your PHI to a health oversight agency for activities
including audits; civil, administrative, or criminal investigations,
proceedings, or actions; inspections; licensure or disciplinary
actions; or other activities necessary for appropriate oversight
as authorized by law. 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. We will not disclose your health information
under this authority if you are the subject of an investigation
and your health information is not directly related to your receipt
of health care or public benefits.
In Connection With Judicial And Administrative
Proceedings. We may disclose your PHI in the course
of any judicial or administrative proceeding in response to a court
order as expressly authorized by such order. In certain circumstances,
we may disclose your PHI in response to a subpoena to the extent
authorized by state law if we receive satisfactory assurances that
you have been notified of the request or that an effort was made
to secure a protective order.
For Law Enforcement Purposes.
We may disclose your PHI to a law enforcement official for law enforcement
purposes as follows:
- As required by law for reporting of certain types
of wounds or other physical injuries.
- Pursuant to court order, court-ordered warrant,
subpoena, summons or similar process.
- For the purpose of identifying or locating a
suspect, fugitive, material witness or missing person.
- Under certain limited circumstances, when you
are the victim of a crime.
- If the facility has a suspicion that your health
condition was the result of criminal conduct.
- In an emergency to report a crime.
To Coroners, Funeral Directors, and
for Organ Donation. We may
disclose your PHI to a coroner or medical examiner for identification
purposes; to determine cause of death or for the coroner or medical
examiner to perform other duties authorized by law. We may also
disclose PHI to a funeral director, as authorized by law, in order
to permit the funeral director to carry out their duties. PHI may
be used and disclosed for organ, eye or tissue donation purposes.
For Research Purposes.
We may use or disclose your PHI for research when the use or disclosure
for research has been approved by an institutional review board
that has reviewed the research proposal to ensure the privacy of
your PHI.
In the Event of a Serious Threat
to Health or Safety. We may, consistent with applicable
law and standards of ethical conduct, use or disclose your PHI if
we believe, in good faith, that such 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.
For Specified Government Functions.
In certain circumstances, federal regulations authorize the facility
to use or disclose your PHI to facilitate specified government functions
relating to military and veterans activities, national security
and intelligence activities, protective services for the President
and others, medical suitability determinations, correctional institutions,
and law enforcement custodial situations.
For Worker's Compensation.
DMOS may release your health information to comply with worker's
compensation laws or similar programs.
Uses and Disclosures of PHI with Your Opportunity
to Agree or Object
We may disclose to a member of your family, a relative,
a close friend or any other person you identify, your PHI that directly
relates to that person’s involvement in your health care or payment
related to your health care. We may also disclose your PHI to notify
or assist in notifying a family member, personal representative
or any other person that is responsible for your care concerning
your location or condition. You have the opportunity to verbally
agree to or object to the use or disclosure of all or part of your
PHI. If you are not present or able to agree or object to the use
or disclosure of your PHI, then DMOS may, using professional judgement,
determine whether the disclosure is in your best interests. In this
case, only the PHI that is relevant to your health care will be
disclosed.
Other uses and disclosures of your PHI
will be made only with your written authorization, unless otherwise
permitted or required by law as described above. You
may revoke your authorization in writing at any time, except to
the extent that DMOS has taken an action in reliance on the use
or disclosure indicated in the authorization.
Your Rights --You have the following rights
regarding your protected health information:
The right to inspect and copy your
protected health information. You may inspect
and obtain a copy of your PHI that is contained in the medical record
for as long as we maintain the record.
Under federal law, however, you may not
inspect or copy the following records: psychotherapy notes; information
compiled in reasonable anticipation of, or for use in, a civil,
criminal, or administrative proceeding; and any health information
that is subject to a law that prohibits access to PHI.
We may deny your request to inspect or copy your
PHI if, in our professional judgment, we determine that the access
requested is likely to endanger your life or safety or that of another
person, or that it is likely to cause substantial harm to another
person referenced within the information. You have the right to
request a review of this decision.
To inspect and copy your medical information, you
must submit a written request to the Privacy Officer whose contact
information is listed on the last page of this Notice of Privacy
Practices. 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.
Please contact our Privacy Officer if you have
questions about access to your medical record.
The right to request a restriction
on uses and disclosures of your protected health information.
You may ask us not to use or disclose certain parts of
your PHI for the purposes of treatment, payment or health care operations.
You may also request that we not disclose your health information
to family members or friends who may be involved in your care. Your
request must state the specific restriction requested and to whom
you want the restriction to apply.
DMOS is not required to agree to a restriction
that you may request. We will notify you if we deny your request
to a restriction. If we do agree to the requested restriction, we
may not use or disclose your PHI in violation of that restriction
unless it is needed to provide emergency treatment. Under certain
circumstances, we may terminate our agreement to a restriction.
You may request a restriction by contacting the Privacy Officer.
The right to request to receive
confidential communications from us by alternative means or at an
alternative location. You have the right to request
that we communicate with you in certain ways. We will accommodate
reasonable requests. We may 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
require you to provide an explanation for your request. Requests
must be made in writing to our Privacy Officer.
The right to request amendments
to your protected health information. You may
request an amendment of your health information contained in the
medical record 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. Requests
for amendment must be in writing and must be directed to our Privacy
Officer. In this written request, you must also provide a reason
to support the requested amendments.
The right to receive an accounting.
You have the right to request an accounting of certain disclosures
we have made of your PHI. This does not apply to disclosures made
for the purpose of treatment, payment or health care operations
as described in this Notice of Privacy Practices. We are also not
required to account for disclosures that you requested, disclosures
that you agreed to by signing an authorization form, disclosures
for a facility directory, to friends or family members involved
in your care, or certain other disclosures we are permitted to make
without your authorization. The request for an accounting must be
made in writing to our Privacy Officer. The request should specify
the time period sought for the accounting. We are not required to
provide an accounting for disclosures that take place prior to April
14, 2003. Accounting requests may not be made for periods of time
in excess of six years. We will provide the first accounting you
request during any 12-month period without charge. Subsequent accounting
requests may be subject to a reasonable cost-based fee.
The right to obtain a paper copy
of this notice. Upon request, we will provide
a separate paper copy of this notice even if you have already received
a copy.
Our Duties
DMOS is required by law to maintain the privacy
of your PHI and to provide you with this Notice of Privacy Practices
outlining our privacy practices. We are required to abide by the
terms of this Notice. We reserve the right to change the terms of
this Notice and to make the new Notice provisions effective for
all PHI that we maintain. Upon your request, we will provide you
with any revised Notice of Privacy Practices via the mail or at
the time of your next appointment. We will also post a copy of the
current Notice at our offices and on our website www.dmos.com.
Complaints
You have the right to express complaints to DMOS
and to the Secretary of Health and Human Services if you believe
that your privacy rights have been violated. You may file a complaint
with DMOS by contacting our Privacy Officer verbally or in writing,
using the contact information below. We encourage you to express
any concerns you may have regarding the privacy of your information.
You will not be retaliated against in any way for filing a complaint.
Contact Person
Information regarding matters covered by this Notice
can be requested by contacting the Privacy Officer. If you feel
that your privacy rights have been violated by DMOS, you may submit
a complaint to our Privacy Officer by sending it to:
Des Moines Orthopaedic Surgeons, P.C.
6001 Westown Parkway
West Des Moines, IA 50266
ATTN: Privacy Officer
The Privacy Officer can be contacted by telephone
at 515-224-1414.
This Notice is effective April 14, 2003. |
