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You are here: Home » Forms & Policies » Privacy Notice
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Privacy Notice
Notice of Privacy Practices for Protected Health Information
Appalachian Orthopaedic Associates
Revised October 2006
Notice of Privacy Practices for 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!
Our office is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and plans for future care or treatment. It also includes billing documents for those services.
Examples of uses of your health information for treatment purposes are:
• An AOA employee obtains information about your past medical history or treatment and records it in a health record.
• During the course of your treatment, the physician determines he would like the opinion of another physician about some aspect of your case. For instance, he may want to discuss your treatment options with one of our other orthopedic surgeons or ask a radiologist to look at your X-rays. He will share the information with such specialists and obtain their input.
• During the course of your treatment, the physician determines you would benefit from physical therapy. He will share information with the physical therapist which will help in developing your PT program.
Example of use of your health information for payment purposes:
• We submit requests for payment to your health insurance company. The health insurance company requests information from us regarding your medical condition and the treatment you received to determine if they will pay for your care. We will provide information to them about you and the care given.
Example of Use of Your Information for Health Care Operations:
• We may do audits of our patients’ records to try to improve how we care for our patients or to assure we are billing correctly. We will share information about you with the employees doing the audits.
• We may obtain services from business associates such as quality assessment, quality improvement, outcome evaluation, protocol and clinical guidelines development, training programs, credentialing, medical review, legal services, and insurance. We will share information about you with such business associates as necessary to obtain these services. However, we will require all our business associates to respect your privacy rights.
Your Health Information Rights
The health and billing records we maintain are the physical property of the doctor’s office. You have the following rights with respect to your Protected Health Information
1. Request a restriction on certain uses and disclosures of your health information by delivering a written request to our office. We are not required to grant the request, but we will comply with any request granted.
2. Obtain an additional paper copy of the Notice of Privacy Practices for Protected Health Information ("Notice") by making a request at our office.
3. Except in certain circumstances, you have a right to inspect and copy your health record and billing record. You may exercise this right by delivering a written request to our office using the form we will provide to you. You may appeal a denial of access to your protected health information.
4. Right to request that your health care record be amended to correct incomplete or incorrect information by delivering a written request to our office using the form we will provide to you. We are not required to make such amendments, but we will inform you of the reason your request was denied. You may file a statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information.
5. Right to receive an accounting of disclosures of your health information by delivering a written request to our office using the form we will provide to you. An accounting will not include internal uses of information for treatment, payment, or operations, disclosures made to you, authorized by you, or disclosures made to family members or friends in the course of providing care.
6. Right to confidential communication by requesting that communication of your health information is made using alternative means or at an alternative location by delivering a written request to our office using the form we will give you.
If you want to exercise any of the above rights, please contact:
Kingsport Office: Office Manager, 2202 John B Dennis Hwy, Suite 100, Kingsport, TN 37660 (423) 245-3161
Bristol Hospital Office: Office Manager, 1 Medical Park, Suite 300E, Bristol TN 37620 (423) 844-6450
Midway Office: Office Manager, 260 Midway Medical Park, Bristol TN (423) 968-4446
Johnson City Office: Office Manager, 3 Professional Park, Suite 21 Johnson City TN 37604 (423) 434-6300
ARSM-Bristol: Office Manager, 1 Medical Park, Suite 300E, Bristol TN 37620 (423) 844-6450
ARSM-Johnson City: Office Manager, 3 Professional Park, Suite 21 Johnson City, TN 37604 (423) 434-6300
You may contact them either in person or in writing during normal business hours. They will provide you with assistance on the steps to take to exercise your rights.
Our Responsibilities
The office is required to:
• Maintain the privacy of your health information as required by law.
• Provide you with a “Notice” as to our duties and privacy practices regarding the information we collect and maintain about you.
• Abide by the terms of this “Notice”.
• Notify you if we cannot accommodate a requested restriction or request.
• Accommodate your reasonable requests regarding methods to communicate health information to you.
• Accommodate your request for an accounting of disclosures.
We reserve the right to amend, change, or eliminate provisions in our privacy and access practices and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our “Notice”. You are entitled to receive a copy of the revised notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact the manager listed above at the location where your records are stored.
Additionally, if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the complaint to Compliance Officer, Appalachian Orthopaedic Associates, 4105 Fort Henry Drive, Suite 300, Kingsport, TN 37663. You may also file a complaint by mailing or e-mailing it to the Secretary of Health and Human Services whose street address is:
Department of Health and Human Services
Office of Civil Rights
200 Independence Ave. S.W.
Washington, D.C. 20201
• We cannot, and will not, require you to waive the right to file a complaint with the Secretary of Health and Human Services as a condition of receiving treatment from the office.
• We cannot, and will not, retaliate against you for filing a complaint with the Secretary of Health and Human Services.
Following is a List of Other Uses and Disclosures Allowed by the Privacy Rule
Patient Contact:
We may contact you to provide you with appointment reminders, with information about treatment alternatives, or with information about other health-related benefits and services that may be of interest to you.
You have the right to object to any of the following:
Unless you object, appointment, scheduling and normal or expected Laboratory results or X-ray reports may be left on your home phone answering machine or with an adult family member who answers that number.
Unless you object, we will give your spouse the same information that we would give directly to you.
Unless you object, we will telephone or fax prescriptions to the pharmacy you designate and discuss with the pharmacist any information which will help ensure the medication is used properly and safely.
Unless you object, we will usually allow a family member or friend with proper identification to pick up a written prescription for you at our office.
Unless you object, we may use or disclose your protected health information to notify, or assist in notifying, a family member, personal representative, or other person responsible for your care about your location, your general condition, or your death.
Unless you object, or in an emergency using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person's involvement in your care or in payment for such care.
Unless you object, we may use and disclose your protected health information to assist in disaster relief efforts.
We are required to release information in the following instances:
PUBLIC HEALTH ACTIVITIES
Controlling Disease - As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Child Abuse & Neglect - We may disclose protected health information to public authorities as allowed by law to report child abuse or neglect.
Food and Drug Administration (FDA) - We may disclose to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC VIOLENCE
We can disclose protected health information to governmental authorities to the extent the disclosure is authorized by statute or regulation and if, in the exercise of professional judgment, the doctor believes the disclosure is necessary to prevent serious harm to the individual or other potential victim.
OVERSIGHT AGENCIES
Federal law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities that may include audits, civil, administrative or criminal investigations, inspections, licensures or disciplinary actions, and for similar reasons related to the administration of healthcare.
JUDICIAL/ADMINISTRATIVE PROCEEDINGS
In the course of any judicial or administrative proceeding, we may disclose only the expressly authorized portion of your PHI as allowed or required by law. In addition, your PHI may be released in response to a subpoena, discovery request or other lawful process as directed by a proper court order or administrative tribunal.
LAW ENFORCEMENT
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by court order, including laws that require reporting of certain types of wounds or other physical injury.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS
We may disclose your protected health information to funeral directors or coroners, consistent with applicable law, to allow them to carry out their duties.
ORGAN PROCUREMENT ORGANIZATIONS
Consistent with applicable law, we may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of donation and transplant.
RESEARCH
We may disclose 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.
THREAT TO HEALTH AND SAFETY
We may disclose your protected health information, consistent with applicable law, to prevent or lessen a serious or imminent threat to the health or safety of a person or the public.
FOR SPECIALIZED GOVERNMENTAL FUNCTIONS
We may disclose your protected health information for specialized government functions as authorized by law such as to Armed Forces personnel, for national security purposes, or to public assistance program personnel.
CORRECTIONAL INSTITUTIONS
If you are an inmate of a correctional institution, we may disclose to the institution or its agents the protected health information necessary for your health and the health and safety of other individuals.
WORKERS COMPENSATION
If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.
Other Uses and Disclosures
• Other uses and disclosures, besides those identified in this “Notice”, will be made only as otherwise authorized by law or with your written authorization, which you may revoke at any time, except to the extent release of the information or the action has already been taken.
Website
• An up-to-date copy of this document may be found on our website at www.appalachianortho.com.
Effective Date: April 15, 2003 |
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