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NOTICE
OF PRIVACY PRACTICES
As Required by the Privacy Regulations Created as a Result
of the Health Insurance Portability and Accountability
Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU
(AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED,
AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE
HEALTH INFORMATIO
PLEASE REVIEW
THIS NOTICE CAREFULLY.
A: OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy
of your individually identifiable health information
(IIHI). In conducting our business, we will create
records regarding you and the treatment and services
we provide to you. We are required by law to maintain
the confidentiality of health information that identifies
you. We also are required by law to provide you with
this notice of our legal duties and the privacy practices
that we maintain in our practice concerning your IIHI.
By federal and state law, we must follow the terms
of the notice of privacy practices that we have in
effect at the time.
We realize that these laws are complicated,
but we must provide you with the following important
information:
- How we may use and
disclose your IIHI
- Your privacy rights in your IIHI
- Our obligations concerning the use and disclosure
of your IIHI
The terms of this notice apply to all records containing
your IIHI that are created or retained by our practice.
We reserve the right to revise or amend this Notice of
Privacy Practices. Any revision or amendment to this
notice will be effective for all of your records that
our practice has created or maintained in the past, and
for any of your records that we may create or maintain
in the future. Our practice will post a copy of our current
Notice in our office in a visible location at all times,
and you may request a copy of our most current Notice
at any time.
B: IF YOU HAVE QUESTIONS
ABOUT THIS NOTICE, PLEASE CONTACT
Privacy Officer
Midwest Orthopaedic Consultants, S.C.
10719 W. 160th Street
Orland Park, Illinois 60467
(708) 226-3300
Effective Date of
this Notice 4/14/2003
C: WE MAY USE AND DISCLOSE YOUR
INDIVIDUALLY IDENTIFIABLE HEALTH
INFORMATION (IIHI) IN THE FOLLOWING
WAYS
The following categories describe the different ways
in which we may use and disclose your IIHI.
1. Treatment. Our practice may use your IIHI to treat
you. For example, we may ask you to have laboratory tests
(such as blood or urine tests), and we may use the results
to help us reach a diagnosis. We might use your IIHI
in order to write a prescription for you, or we might
disclose our IIHI to a pharmacy when we order a prescription
for you. Many of the people who work for our practice
-- including, but not limited to, our doctors and nurses
– may use or disclose your IIHI in order to treat you
or to assist others in your treatment. Additionally,
we may disclose your IIHI to others who may assist in
your care, such as your spouse, children or parents.
2.
Payment. Our practice may use and disclose your IIHI in order to bill and collect
payment for the services and items you may receive from us. For example, we may
contact your health insurer to certify that you are eligible
for benefits (and for what range of benefits), and we
may provide your insurer with details regarding your
treatment to determine if your insurer will cover, or
pay for, your treatment. We also may use and disclose
your IIHI to obtain payment from third parties that may
be responsible for such costs, such as family members.
Also, we may use your IIHI to bill you directly for services
and items.
3. Health Care Operations.
Our practice may use and disclose your IIHI to operate
our business. As examples of the ways in which we may
use and disclose your information for our operations,
our practice may use your IIHI to evaluate the quality
of care you received from us, or to conduct cost-management
and business planning activities for our practice.
4.
Appointment Reminders. Our practice may use and disclose
your IIHI to contact you and remind you of an appointment.
5.
Treatment Options. Our practice may use and disclose
your IIHI to inform you of potential treatment options
or alternatives.
6. Health-Related Benefits and Services.
Our practice may use and disclose your IIHI to inform
you of health-related benefits or services that may be
of interest to you.
7. Release of Information to Family/Friends.
Our practice may release your IIHI to a friend or family
member that is involved in your care, or who assists
in taking care of you. For example, a parent or guardian
may ask that a babysitter take their child to the pediatrician’s
office for treatment of a cold. In this example, the
babysitter may have access to this child’s medical information.
8. Disclosures Required By Law. Our practice will use
and disclose your IIHI when we are required to do so
by federal, state or local law.
D. USE AND DISCLOSURE
OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
The following categories describe unique scenarios in
which we may use or disclose your identifiable health
information:
1. Public Health Risks.
Our practice may disclose your IIHI to public health
authorities that are authorized by law to collect information
for the purpose of:
- maintaining vital records, such
as births and deaths
- reporting child abuse or neglect
- preventing or controlling disease, injury or disability
- notifying a person regarding potential exposure
to a communicable disease
- notifying a person regarding a potential risk for
spreading or contracting a disease or condition
- reporting reactions to drugs or problems with products
or devices
- notifying individuals if a product or device they
may be using has been recalled
- notifying appropriate government agency(ies) and
authority(ies) regarding the potential abuse or neglect
of an adult patient (including domestic violence);
however, we will only disclose this information if
the patient agrees or we are required or authorized
by law to disclose this information
- notifying your employer under limited circumstances
related primarily to workplace injury or illness or
medical surveillance.
2. Health Oversight
Activities. Our practice may disclose your IIHI to a
health oversight agency for activities authorized by
law. Oversight activities can include, for example, investigations,
inspections, audits, surveys, licensure and disciplinary
actions; civil, administrative, and criminal procedures
or actions; or other activities necessary for the government
to monitor government programs, compliance with civil
rights laws and the health care system in general.
3.
Lawsuits and Similar Proceedings. Our practice may use
and disclose your IIHI in response to a court or administrative
order, if you are involved in a lawsuit or similar proceeding.
We also may disclose your IIHI in response to a discovery
request, subpoena, or other lawful process by another
party involved in the dispute, but only if we have made
an effort to inform you of the request or to obtain an
order protecting the information the party has requested.
4.
Law Enforcement. We may release IIHI if asked to do so
by a law enforcement official:
- Regarding a crime victim
in certain situations, if we are unable to obtain the
person’s agreement
- Concerning a death we believe has resulted from criminal
conduct
- Regarding criminal conduct at our office
- In response to a warrant, summons, court order, subpoena
or similar legal process
- To identify/locate a suspect material witness, fugitive
or missing person
- In an emergency, to report a crime (including the location
or victim(s) of the crime, or the description, identity
or location of the perpetrator)
5. Deceased Patients. Our practice may release IIHI
to a medical examiner or coroner to identify a deceased
individual or to identify the cause of death. If necessary,
we also may release information in order for funeral
directors to perform their jobs.
6. Organ and Tissue
Donation. Our practice may release your IIHI to organizations
that handle organ, eye or tissue procurement or transplantation,
including organ donation banks, as necessary to facilitate
organ or tissue donation and transplantation if you are
an organ donor.
7. Research. Our practice may use and
disclose your IIHI for research purposes in certain limited
circumstances. We will obtain your written authorization
to use your IIHI for research purposes except when: (a)
our use of disclosure was approved by an Institutional
Review Board or a Privacy Board (b) we obtain the oral
or written agreement of a researcher that (i) the information
being sought is necessary for the research study; (ii)
the use or disclosure of your IIHI is being used only
for the research and (iii) the researcher will not remove
any of your IIHI from our practice; or (c) the IIHI sought
by the researcher only relates to descendants and the
researcher agrees either orally or in writing that the
use or disclosure is necessary for the research and,
if we request it, to provide us with proof of death prior
to access to the IIHI of the descendants.
8.
Serious Threats to Health or Safety. Our practice may
use and disclose your IIHI when necessary to reduce or
prevent a serious threat to your health and safety or
the health and safety of another individual or the public.
Under these circumstances, we will only make disclosures
to a person or organization able to help prevent the
threat.
9. Military. Our practice may disclose your IIHI
if you are a member of U.S. or foreign military forces
(including veterans) and if required by the appropriate
authorities.
10. National Security. Our practice may
disclose your IIHI to federal officials for intelligence
and national security activities authorized by law. We
also may disclose your IIHI to federal officials in order
to protect the President, other officials or foreign
heads of state, or to conduct investigations.
11. Inmates.
Our practice may disclose your IIHI to correctional institutions
or law enforcement officials if you are an inmate or
under the custody of a law enforcement official. Disclosure
for these purposes would be necessary: (a) for the institution
to provide health care services to you, (b) for the safety
and security of the institution, and/or (c) to protect
your health and safety or the health and safety of other
individuals.
12. Workers’ Compensation. Our practice
may release your IIHI for workers’ compensation and similar
programs.
E: YOUR RIGHTS REGARDING YOUR IIHI
You have the following rights regarding the IIHI that
we maintain about you:
1. Confidential
Communications. You have the right to request that our
practice communicate with you about your health and related
issues in a particular manner or at a certain location.
For instance, you may ask that we contact you at home,
rather than work. In order to request a type of confidential
communication, you must make a written request to our
Privacy Officer specifying the requested method of contact,
or the location where you wish to be contacted. Our practice
will accommodate reasonable requests. You do not need
to give a reason for your request.
2. Requesting Restrictions.
You have the right to request a restriction in our use
or disclosure of your IIHI for treatment, payment or
health care operations. Additionally, you have the right
to request that we restrict our disclosure of your IIHI
to only certain individuals involved in your care or
the payment of your care, such as family members and
friends. We are not required to agree to your request;
however, if we do agree, we are bound by our agreement
except when otherwise required by law, in emergencies,
or when the information is necessary to treat you. In
order to request a restriction in our use or disclosure
of your IIHI, you must make your request in writing to
our Privacy Officer. Your request must describe in a
clear and concise fashion:
a.
the information you wish restricted;
b. whether you are requesting to limit our practice’s
use, disclosure or both; and
c. to whom you want the limits to apply.
3. Inspection
and Copies. You have the right to inspect and obtain
a copy of the IIHI that may be used to make decisions
about you, including patient medical records and billing
records, but not including psychotherapy notes. You must
submit your request in writing to our Privacy Officer
in order to inspect and/or obtain a copy of your IIHI.
Our practice may charge a fee for the costs of copying,
mailing, labor and supplies associated with your request.
Our practice may deny your request to inspect and/or
copy in certain limited circumstances, however, you may
request a review of our denial. Another licensed health
care professional chosen by us will conduct reviews.
4.
Amendment. You may ask to amend your health information
if you believe it is incorrect or incomplete, and you
may request an amendment for as long as the information
is kept by or for our practice. To request an amendment,
your request must be made in writing and submitted to
our Privacy Officer. You must provide us with a reason
that supports your request for amendment. Our practice
will deny your request if you fail to submit your request
(and the reason supporting your request) in writing.
Also, we may deny your request if you ask us to amend
information that is in our opinion: (a) accurate and
complete; (b) not part of the IIHI kept by or for the
practice; (c) not part of the IIHI which you would be
permitted to inspect and copy; or (d) not created by
our practice, unless the individual or entity that created
the information is not available to amend the information.
5.
Accounting of Disclosures. All of our patients have the
right to request an “accounting of disclosures”. An “accounting
of disclosures” is a list of certain non-routine disclosures
our practice has made of your IIHI for non-treatment
or operations purposes. Use of your IIHI as part of the
routine patient care in our practice is not required
to be documented. For example, doctor sharing information
with the nurse; or the billing department using your
information to file your insurance claim. In order to
obtain an accounting of disclosures, you must submit
your request in writing to our Privacy Officer. All requests
for an “accounting of disclosures” must state a time
period, which may not be longer than six (6) years from
the date of disclosure and may not include dates before
April 14, 2003. The first list you request within a 12-month
period is free of charge, but our practice may charge
you for additional lists within the same 12-month period.
Our practice will notify you of the costs involved with
additional requests, and you may withdraw your request
before you incur any costs.
6. Right to a Paper Copy of This Notice. You are entitled
to receive a paper copy of our notice of privacy practices.
You may ask us to give you a copy of this notice at any
time. To obtain a paper copy of this notice, contact
our Privacy Officer at 708-226-3300.
7. Right to File
a Complaint. If you believe your privacy rights have
been violated, you may file a complaint with our practice
or with the Secretary of the Department of Health and
Human Services. To file a complaint with our practice,
contact our Privacy Officer at 708-226-3300. All complaints
must be submitted in writing. You will not be penalized
for filing a complaint.
8. Right to Provide
an Authorization for Other Uses and Disclosures. Our
practice will obtain your written authorization for uses
and disclosures that are not identified by this notice
or permitted by applicable law. Any authorization you
provide to us regarding the use and disclosure of your
IIHI may be revoked at any time in writing. After you
revoke your authorization, we will no longer use or disclose
your IIHI for the reasons described in the authorization.
Please note, we are required to retain records of your
care.
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