Effective December 7, 2009
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.
Western Orthopaedics PC is committed to protecting the privacy of your health care information. The following statement describes your rights, policies that protect the privacy of your medical records and circumstances in which your health information may be disclosed.
Western Orthopaedics PC's responsibilities under the federal privacy standard
Western Orthopaedics PC will honor your rights and our responsibilities as required by the Federal Privacy Standard. We will not disclose your health information without your consent or authorization, except as described in this notice or otherwise required by law. The federal privacy standard applies to your health information in any form — electronic, facsimile, hard copy or oral communications. We will:
•Maintain the privacy of your health information, including the use of reasonable physical, administrative and technical safeguards.
•Provide this notice of privacy practices for your review. You may request additional copies at any time.
•Commit each employee to respect and protect your privacy and confidentiality.
•Provide the minimum necessary information appropriate for the use or disclosure of your health information.
•Abide by the terms of the privacy notice which is currently in effect.
Use and disclosure of health information for treatment, payment and health care operations
The following categories describe different ways that we use and disclose medical information. For each category of uses and disclosures we will explain what we mean and give an example. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of these categories.
•Treatment — We may use medical information about you to provide or arrange for medical treatment or services. We will provide your primary care physician, physical therapist, consulting physician or other health care professional with copies of your health care records to assist them in treating you.
•Payment — We may use and disclose medical information about you so that the treatment and services you receive from Western Orthopaedics may be billed and payment may be made. We will bill your insurance company for services rendered. The information on or sent with your bill may include information that identifies you, your diagnosis, treatment received and/or other health information.
•Health Care Operations — We may use and disclose medical information about you for our business operations. Members of the medical staff, the quality assurance team and other committees may use information in your health record to assess the care and outcomes in our clinic. We will use this information in an effort to constantly improve the quality and effectiveness of healthcare and services we provide.
Additional Routine Disclosures:
•Business Associates — We provide some services through contracts with business associates. Examples include suppliers of certain orthopedic devices or durable medical equipment, a transcription service to transcribe dictations and other services. When we use these services we may disclose your health information to the business associate so that they can perform the function we have contracted with them to do. To protect your information we require the business associate to appropriately safeguard your information. •Communication with your family — Our health care professionals, using their best judgment, may disclose to a family member, other relative, close friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care. Please notify us if you do not want your health information shared with family or friends. We require written permission from you to release copies of any of your medical records to family or friends.
•Research — Western Orthopaedics recognizes the value of research in health care. We may disclose your information for use in research when it has been approved by the institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. Your authorization is required if you agree to participate as a subject in a particular study.
•Continuity of Care/Marketing — We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Please notify us if you do not want to receive this type of information.
•Food and Drug Administration (FDA) : We will disclose to the FDA health information relative to adverse effects with respect to food, drugs, supplements or product defects to assist them in monitoring product safety.
•Worker's Compensation — We will disclose health information to the extent authorized by and to the extent necessary to comply with the laws relating to worker's compensation and other similar programs established by law.
•Correctional Institution — Should you be an inmate of a correctional institution, we will disclose to the institution health information necessary for your health and the health and safety of other individuals.
•The Federal Department of Health and Human Services (DHHS) and other Oversight Agencies — We must disclose your health information to various oversight agencies as necessary for them to determine our compliance with their standards.
Additional disclosures that are permitted or required without your permission
•Disclosures required by state or federal law including disclosures regarding abuse, neglect and domestic violence.
•Disclosures to a public health authority for public health activities such as the reporting of disease, injury or vital events.
•Disclosures for health oversight activities such as civil, administrative and criminal investigations.
•Disclosures in response to judicial and administrative proceedings.
•Disclosures for law enforcement activities such as reporting of certain types of wounds or compliance with a subpoena.
•Disclosures to coroners and medical examiners regarding decedents.
•Disclosures for organ and tissue donation purposes.
•Disclosures to avert a threat to the health or safety of a person or the general public.
•Disclosures for special government functions such as military activities.
Other uses and disclosures will be made only with your written authorization. You may revoke this authorization by providing written notice as provided below. You are entitled to an accounting of non-routine disclosures of your health information as provided.
Your rights under the federal privacy standard
Your health records are the physical property of Western Orthopaedics, however, you have certain rights with regard to the information contained in your records:
•The right to obtain additional copies of this notice — A copy of this notice is posted in the office for your review and you may obtain additional copies from any Western employee.
•The right to inspect or receive a copy of your health record — You must give reasonable notice of your request to review or receive a copy of your record. In some circumstances, we may deny you access to your health record, but we will explain why and what your rights are, including how to seek review. A reasonable fee will be charged to cover the cost of copying your records.
•The right to request a correction of your health record — Western Orthopaedics does not have to grant this request, if; for example, we did not create the record as in the case of a consultation report. If we deny your request for correction, we will notify you why, how you can attach a statement of disagreement and how to request a review.
•The right to request a restriction on uses and disclosures of your health information for treatment, payment and health care operations — Western Orthopaedics may elect not to comply with this request.
•The right to obtain an accounting of "non-routine" uses and disclosure — those other than for treatment, payment and health care operations. We must receive this request in writing and we will provide an accounting within 60 days as required by law. You may request an accounting as far back as 6 years but not for disclosures prior to the 4/14/03 compliance date. The accounting must include the date of each disclosure, name and address to whom the disclosure was made, a brief description of information disclosed and a brief statement of the purpose of the disclosure or a copy of your written request for disclosure. The first accounting in any 12-month period is free, thereafter, we reserve the right to charge a reasonable cost based fee.
•The right to revoke your consent or authorization to use or disclose health information — except to the extent we have already acted on it. You must provide written notice of your revocation to Western Orthopaedics.
•The right to receive communications somewhere other than your primary address or phone number — You must give us at least one mailing address and telephone number where you wish to receive communications.
How to get more information or report a problem
If you have questions, need additional information or would like to report a problem or concern, you may contact the Western Orthopaedics Privacy Officer at (303) 321-1333 or you may send your concerns in writing to:
Western Orthopaedics, PC
1830 Franklin Street, #450
Denver, CO 80218
Complaints or concerns may also be directed to the Secretary of the Department of Health and Human Services. Western Orthopaedics will not retaliate against any individual for filing a complaint or concern. We reserve the right to change our practices and to make new provisions effective for all individually identifiable health information we maintain. We will notify you of changes in the Privacy Notice and the effective date by mailing a copy to the address you have provided or by posting the changes in the lobby of our clinics and on the Western Orthopaedics Web site. If Western Orthopaedics PC sells, merges or changes ownership, your personal health information will be transferred to the new owners.
Page updated Monday 12-07-09