NOTICE OF PRIVACY PRACTICES
For
Tidewater Prosthetic Center, INC.
(referred to in this document as "the facility")
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 Notice of Privacy Practices is being provided to you as a
requirement of the Health Insurance Portability and Accountability Act
(HIPAA). This 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 of your written and oral health information,
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 and future physical or
mental health or condition.
I. Uses and Disclosures of Protected Health Information
The facility 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 the Facility 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 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 physician or physical therapist to coordinate your
treatment. We may use your information within our facility to fit and
manufacture your orthosis or prosthesis. 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 insurer or
Medicare to get coverage approval for the orthotic or prosthetic device
that we recommend. We may also disclose protected health information to
your 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 your services, we may also need to
disclose your protected health information to your 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.
C.Operations. We may use or disclose your
protected health information, as necessary, for our own health care
operations in order to facilitate the function of the facility 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.
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 your treatment, payment and healthcare operations, we may
also use or disclose your protected health information for the
following purposes:
To remind you of an appointment.
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 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 this 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 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 proceedings in response to an order of a
court or administrative tribunal as expressly authorized by such order
or in response to a signed authorization (in a format approved by the
Michigan Court Administrator).
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 death was the result of criminal conduct.
In an emergency in order 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 or privacy 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, the 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 a person's
involvement in your care or payment related to your care. We can also
disclose your information in connection with trying to locate or notify
family members or other 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
practitioner 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 pages of this 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 purpose 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 the notification purposes as described in this Notice of
Privacy Practices. 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 have the facility amend 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 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.
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 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 terms
of this Notice and to make the new Notice provisions effective for all
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.
VIII.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. Complaints against the
facility, can be mailed to the Privacy Officer by sending it to:
Jean Blackwell
6363 Center Drive
Building 6, Suite 100
Norfolk, VA 23502
ATTN: Privacy Officer
The Privacy Officer can be contacted by telephone at (757) 455-6415
