PALM BEACH ORTHOPAEDIC INSTITUTE, P.A.
PRIVACY NOTICE
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.
This Privacy Notice is being provided to you as a requirement
of a federal law, the Health Insurance Portability and Accountability Act (HIPAA). This
Privacy Notice 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 in some
cases. Your "protected health information" means any written
and oral health information about you, including demographic data that can
be used to identify you. This is health information that is created or
received by your health care provider, and that relates to your past, present
or future physical or mental health or condition.
I. Uses
and Disclosures of Protected Health Information
Palm Beach Orthopaedic Institute (PBOI) may
use your protected health information for purposes of providing treatment,
obtaining payment for treatment, and conducting health care operations. Your
protected health information may be used or disclosed only for these purposes
unless PBOI has obtained your authorization or the use or disclosure is otherwise
permitted by the HIPAA privacy regulations or state law. Disclosures
of your protected health information for the purposes described in this Privacy
Notice may be made in writing, orally, or by facsimile.
A. 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 for treatment
purposes. For example, we may disclose your protected health information
to a pharmacy to fill a prescription or to a laboratory to order a blood test. We
may also disclose protected health information to physicians who may be treating
you or consulting with your PBOI physician with respect to your care. In
some cases, we may also disclose your protected health information to an outside
treatment provider for purposes of the treatment activities of the other provider.
B. Payment. Your
protected health information will be used, as needed, to obtain payment for
the services that we provide. This may include certain communications
to your health insurance company to get approval for the procedure that we
have scheduled. For example, we may need to disclose information to your
health insurance company to get prior approval for surgery. We may also
disclose protected health information to your health insurance company to determine
whether you are eligible for benefits or whether a particular service is covered
under your health plan. In order to get payment for the services we provide
to you, we may also need to disclose your protected health information to your
health insurance company to demonstrate the medical necessity of the services
or, as required by your insurance company, for utilization review. We
may also disclose patient information to another provider involved in your
care for the other provider’s payment activities. This may include
disclosure of demographic information to other health care providers for payment
of their services.
C. Operations. We
may use or disclose your protected health information, as necessary, for our
own health care operations to facilitate the function of PBOI and to provide
quality care to all patients. Health care operations include such activities
as: quality assessment and improvement activities, employee review activities,
training programs including those in which students, trainees, or practitioners
in health care learn under supervision, accreditation, certification, licensing
or credentialing activities, review and auditing, including compliance reviews,
medical reviews, legal services and maintaining compliance programs, and business
management and general administrative activities.
In certain situations, we may also disclose patient information
to another provider or health plan for their health care operations.
D. Other
Uses and Disclosures. As part of treatment,
payment and health care operations, we may also use or disclose your protected
health information for the following purposes: to remind you of your surgery
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.
II. Uses
and Disclosures Beyond Treatment, Payment, and Health Care Operations Permitted
Without Authorization or Opportunity to Object
Federal privacy rules allow us to use or disclose your
protected health information without your permission or authorization for
a number of reasons including the following:
A. When
Legally Required. We will disclose your protected health information
when we are required to do so by any federal, state or local law.
B. When
There Are Risks to Public Health. We may disclose your protected
health information 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.
C. 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.
D. To
Conduct Health Oversight Activities. We may disclose your
protected health information 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. 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.
E. In
Connection With Judicial And Administrative Proceedings. We
may disclose your protected health information in the course of any judicial
or administrative proceeding in response to an order of a court or administrative
tribunal as expressly authorized by such order. In certain circumstances,
we may disclose your protected health information 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.
F. For
Law Enforcement Purposes. We may disclose your protected health
information 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.
- To a law enforcement official if the facility has a suspicion
that your health condition was the result of criminal conduct.
- In an emergency to report a crime.
G. To
Coroners, Funeral Directors, and for Organ Donation. We may
disclose protected health information 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 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.
H. For
Research Purposes. We may use or disclose your protected health
information for research when the use or disclosure for research has been
approved by an institutional review board that has reviewed the research
proposal and research protocols to address the privacy of your protected
health information.
I. In
the Event of a Serious Threat to Health or Safety. We may,
consistent with applicable law and ethical standards of conduct, use or disclose
your protected health information if we believe, in good faith, that such
use or disclosure is necessary to prevent or lessen a serious and imminent
threat to your health or safety or to the health and safety of the public.
J. For
Specified Government Functions. In certain circumstances,
federal regulations authorize the facility to use or disclose your protected
health information 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.
K. For
Worker's Compensation. The facility may release your health
information to comply with worker's compensation laws or similar programs.
III. Uses
and Disclosures Permitted without Authorization but with Opportunity to Object
We may disclose your protected health information to your
family member or a close personal friend if it is directly relevant to the
person’s involvement
in your surgery or payment related to your surgery. We can also disclose
your information in connection with trying to locate or notify family members
or others involved in your care concerning your location, condition or death.
You may object to these disclosures. If you do not object
to these disclosures or we can infer from the circumstances that you do not
object or we determine, in the exercise of our professional judgment, that
it is in your best interests for us to make disclosure of information that
is directly relevant to the person’s
involvement with your care, we may disclose your protected health information
as described.
IV. Uses
and Disclosures which you Authorize
Other than as stated above, we will not disclose your health
information other than with your written authorization. You may revoke
your authorization in writing at any time except to the extent that we have
taken action in reliance upon the authorization.
V. Your
Rights
You have the following rights regarding your health information:
A. The
right to inspect and copy your protected health information. You
may inspect and obtain a copy of your protected health information 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 surgeon and the
facility 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 for use in, a
civil, criminal, or administrative action or proceeding; and protected health
information that is subject to a law that prohibits access to protected health
information. Depending on the circumstances, you may have the right to
have a decision to deny access reviewed.
We may deny your request to inspect or copy your protected
health information 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 Privacy Notice. 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.
B. 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 protected health information 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 or for notification purposes as described in this Privacy
Notice. Your request must state the specific restriction requested
and to whom you want the restriction to apply.
The facility 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 the facility
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. Under certain circumstances, we may terminate
our agreement to a restriction. You may request a restriction by contacting
the Privacy Officer.
C. 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.
D. The
right to request amendments to your protected health information. 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. 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.
E. The
right to receive an accounting. You have the right to request
an accounting of certain disclosures of your protected health information
made by the facility. This right applies to disclosures for purposes
other than treatment, payment or health care operations as described in this
Privacy Notice. 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.
F. 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 of the notice or have agreed to accept this notice electronically.
VI. Our Duties
The facility is required by law to maintain the privacy
of your health information and to provide you with this Privacy Notice of
our duties and privacy practices. We
are required to abide by terms of this Notice as may be amended from time to
time. We reserve the right to change the terms of this Notice and to
make the new Notice provisions effective for all future protected health information
that we maintain. If the facility changes its Notice, we will provide
a copy of the revised Notice by sending a copy of the revised Notice via regular
mail or through in-person contact.
VII. Complaints
You have the right to express complaints to the facility
and to the Secretary of Health and Human Services if you believe that your
privacy rights have been violated. You may complain to the facility
by contacting the facility’s
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
The facility’s contact person for all issues regarding
patient privacy and your rights under the federal privacy standards is the
Privacy Officer. 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 this facility you may submit a complaint to our Privacy Officer by sending
it to:
Palm Beach Orthopaedic Institute
3401 PGA Blvd. Suite 500
Palm Beach Gardens, FL 33410
ATTN: Privacy Officer
The Privacy Officer can be contacted by telephone at (561) 694-7776.
IX. Effective Date
This Notice is effective April 14, 2003.
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