HIPAA NOTICE OF PRIVACY PRACTICES
(Health Information Portability and Accountability Act)
Version: 04142003.1
WE ARE REQUIRED BY LAW TO PROVIDE THIS NOTICE WHICH
DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION
PLEASE REVIEW IT CAREFULLY
We understand that health information about you and your
health care is personal. We are
committed to protecting health information about you. We create a record of the care and services you receive from
us. We need this record to provide you
with quality care and to comply with certain legal requirements. This Notice applies to all records about
your care that occurs at our office, and to all medical information we keep
about you, whether that information is created by us or is received from
others. We also describe your rights to
the health information we keep about you, and describe certain obligations we
have regarding the use and disclosure of your health information. (Your hospital may have different policies
and a different notice regarding your health information that is kept in the
hospital.)
We are required by law to:
make sure that health information that identifies you is
kept private
give you this notice of our legal duties and privacy
practices with respect to health information about you; and
follow the terms of the notice that is currently in effect.
FUTURE CHANGES TO OUR PRACTICES AND THIS NOTICE.
We reserve the right to change our privacy practices and to
make any such change applicable to your protected health information we
obtained about you before the change.
If a change in our practices is material, we will revise this Notice to
reflect the change. You may obtain a
copy of any revised Notice by contacting Orthopaedic Center of the Rockies at
970-493-0112. We will also make any
revised Notice available in our office.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT
YOU.
The law requires us to have your written authorization for
some uses and disclosures. In other
circumstances, the law allows us to use or disclose your protected health
information without your written authorization. We will use and disclose your health information to the fullest extent
authorized by law. This section gives
examples of each of these circumstances.
For Treatment: We may use health information about you to
provide you with health care treatment or services. We may disclose health information about you to physicians,
nurses, and other health care personnel who are involved in taking care of
you. They may work at our offices, at
the hospital if you are hospitalized under our supervision, or at another
doctor’s office, lab, pharmacy or other health care provider to whom we may
refer you for consultation, to take x-rays, to perform lab tests, to have
prescriptions filled, or for other treatment purposes. We may disclose health information about you
to an entity assisting in a disaster relief effort so that your family can be
notified about your condition, status and location. We may also use and disclose your health information to contact
you as a reminder that you have an appointment for treatment at our office, to
tell you about or recommend possible treatment options or alternatives, or
about health-related benefits or services that may interest you.
For Payment: We may use and disclose health information
about you so that the treatment services you receive from us may be billed to
and payment collected from you, an insurance company or a third party. For example, we may need to give your health
information about your office visit so your health plan will pay us or
reimburse you for the visit. We may
also tell your health plan about a treatment you are going to receive to obtain
prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations: We may also use or disclose your health
information for business-related
activities, such as to operate our office.
For example, we may use your health information to evaluate the quality
of care you received from us, or to evaluate the performance of those involved
with your care. We may also provide
your health information to our attorneys, accountants and other consultants to
make sure we are complying with the laws that affect us. We may also use and disclose your health
information to contact you in connection with our fundraising efforts.
Uses and Disclosures
that Require Us to Give You the Opportunity to Object: Unless you object, we may provide relevant
portions of your health information to a
family member, friend or other
person you indicate is involved in your health care or in helping you get
payment for your health care. In an
emergency or when you are not capable of agreeing or objecting to these
disclosures, we will disclose health information as we determine is in your
best interest.
As Required by Law: When Required by Law. We disclose health information when we are
required to do so by federal, state or local law.
To Avert Serious
Threat to Health or Safety: We may
use and disclose health information about you when necessary to prevent a
serious threat to your health and safety or the health and safety of the public
or another person. For example, we
disclose health information when we report suspected child abuse, the
occurrence of certain diseases, or adverse reactions to a drug or medical
device.
Military and Veterans: If you are a member of the armed forces or
separated/discharged from military services, we may release health information
about you as required by military command authorities or the Department of
Veterans Affairs as may be applicable.
We may also release health information about foreign military personnel
to the appropriate foreign military authorities.
For Reports About
Victims of Abuse, Neglect or Domestic Violence: We will disclose your health information in these reports only if
we are required or authorized by law to do so, or if you otherwise agree.
To Health Oversight
Agencies: We will provide health
information as requested to government agencies who have authority to audit or
investigate our operations.
For Lawsuits and
Disputes: If you are involved in a
lawsuit or dispute, we may disclose your health information in response to a
subpoena or other lawful request, but only if efforts have been made to tell
you about the request or to obtain a court order that will protect the health
information requested.
To Law Enforcement: We may release protected health information
if asked to do so by a law enforcement official, in the following
circumstances: (a) in response to a
court order, subpoena, warrant, summons or similar process; (b) to identify or
locate a suspect, fugitive, material witness or missing person; (c) about the
victim of a crime if, under certain limited circumstances, we are unable to
obtain the person's agreement; (d) about a death we believe may be due to
criminal conduct; (e) about criminal conduct at our facility; and (f) in
emergency circumstances, to report a crime, its location or victims, or the
identity, description or location of the person who committed the crime.
To Coroners, Medical
Examiners and Funeral Directors: We
may disclose health information about you to facilitate the duties of these
individuals.
To Organ Procurement
Organizations: We may disclose
health information about you to
facilitate organ donation and transplantation.
Medical Research:
We may disclose your health information without your written
authorization to medical researchers who request it for approved medical
research projects; however, with very limited exceptions such disclosures must
be cleared through a special approval process before any personal health
information is disclosed to the researchers.
For Specialized
Government Functions: For example, we may disclose your health information
to authorized federal officials for intelligence and national security
activities that are authorized by law, or so that they may provide protective
services to the President or foreign heads of state or conduct special
investigations authorized by law.
To Workers'
Compensation or Similar Programs:
We may provide your health information to these programs in order for
you to obtain benefits for work-related injuries or illness.
Inmates: If you are an inmate of a correctional
institution or under the custody of a law enforcement official, we may release
health information about you to the correctional institution or law enforcement
official This release would be
necessary (1) for the institution to provide you with health care, (2) to
protect your health and safety or the health and safety of others; or (3) for
the safety and security of the correctional institution.
Minors: We may disclose a minor
patient’s health information to a parent or guardian, but we may deny the
parent’s access to the minor patient’s health information in some situations.
For some types of health information, there may be
additional restrictions on our uses or disclosures described above. For example, drug and alcohol abuse patient
treatment information, HIV test results, mental health information, and genetic
testing results are given greater protections under Colorado laws.
OTHER USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
Other uses and disclosures of your health information that
are not covered by this Notice or the laws that apply to us will be made only
with your written authorization. If you
give us written authorization for a use or disclosure of your health
information, you may revoke that authorization, in writing, at any time. If you revoke your authorization we will no
longer use or disclose your health information for the purposes specified in
the written authorization, except that we are unable to take back any
disclosures we have already made with your permission, and are required to
retain certain records of the uses and disclosures made when the authorization
was in effect.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information
we maintain about you:
The Right to Request Limits on Uses and
Disclosures of Your Health Information: You have the right to ask us to limit how we use and disclose
your health information, as long as you are not asking us to limit uses and
disclosures that we are required or authorized to make to the Secretary of the
federal Department of Health Services, related to our facility's patient
directory, or any of the disclosures described in the sections above. A Request for Restriction on Uses and Disclosures
of Health Information by Orthopaedic Center of the Rockies form must be
completed and submitted to the Privacy Officer. Forms may be requested by contacting our Medical Records
Supervisor at 970-493-0112. In your
request, you must tell us what information you want to limit and to whom you
want the limits to apply.
We are not required to agree to your request for restrictions if it is
not feasible for us to ensure our compliance or believe it will negatively
impact the care we may provide you. If we do agree, we will put it in writing and
will abide by the agreement except when you require emergency treatment.
The Right to Choose
How We Communicate With You: You
have the right to request that we communicate with you about health matters in
a certain way or at a certain location.
For example, you can ask that we only contact you at work or by mail to
a post office box. A Request for
Confidential Communications form must be completed and submitted to our Privacy
Officer. Forms are available by
contacting the Medical Records Supervisor at 970-493-0112. We will not ask you for the reason for
your request. We will accommodate all
reasonable requests as long as it is not disruptive to our operations. Your request must specify how or where you wish
to be contacted.
The Right to Inspect
or Request a Copy Your Health Information. Except for limited circumstances, you may look at or request a
copy of your protected health information if you ask in writing to do so. Any such request must be addressed to our
Medical Records Supervisor. In certain situations we may deny your request, but
if we do, we will tell you in writing of the reasons for the denial and explain
your right to have the denial reviewed.
If you request a copy of your health information, x-rays or
similar test results, we may charge a fee for the costs of copying, mailing or
other supplies and services associated with your request.
The Right to Correct
or Update Your Health Information.
If you believe that the health information we have about you is
incomplete or incorrect, you may ask us to amend it. A Request to Amend or Correct Health Information form must be
completed and submitted to our Privacy Officer. Forms are available by contacting the Medical Records Supervisor
at 970-493-0112. The request must tell
us why you think the amendment is appropriate.
We will not process your request if it is not submitted on the
appropriate form or does not tell us why you think the amendment is
appropriate. We will inform you in
writing as to whether the amendment will be made or denied. If we agree to make the amendment, we will
ask you who else you would like us to notify of the amendment.
We may deny your request if you ask us to amend information
that:
was not created by us, unless the person who created the
information is no longer available to make the amendment;
is not part of the health information we keep about you;
is not part of the health information that you would be
allowed to see or copy; or
is determined by us to be accurate and complete.
If we deny the requested amendment, we will tell you in
writing how to submit a statement of disagreement or complaint, or to request
inclusion of your original amendment request in your health information.
The Right to Get a
List of the Disclosures We Have Made:
You have the right to get a list of instances in which we have disclosed
your health information. The list will
not include, for example, disclosures we have made for our treatment, payment
and health care operations purposes, or those made directly to you or your
family or friends. Neither will the
list include disclosures we have made with your written authorization, for
national security purposes or to law enforcement personnel, disclosure of any
limited data set, or disclosures made before April 14, 2003.
You may request a list of disclosures by completing and
submitting a Request for an Accounting of Disclosures of Health Information
form to our Medical Records Supervisor.
Forms may be obtained by contacting our Medical Records Supervisor at
970-493-0112. Your request must state a
time period which may not be longer than six years and may not include dates
prior to April 14, 2003. The first list
you request within a 12-month period will be free. For additional lists, we may charge you for the costs of
providing the list. We will notify you
of the cost and you may choose to withdraw or modify your request before costs
are incurred. We will mail you a list
of disclosures in paper form within 30 days of your request or notify you if we
are unable to supply the list within that time period and by what date we can
supply the list; but this date will not exceed a total of 60 days from the date
you make the request.
COMPLAINTS:
If you believe your privacy rights have been violated, you
may file a complaint with us or with the Secretary of the federal Department of
Health and Human Services. To file a
complaint with us, put your complaint in writing and address it to our Privacy
Officer at Orthopaedic Center of the Rockies, 2500 East Prospect Road, Fort
Collins, Colorado 80525. We will not retaliate against you for
filing a complaint. You may also
contact our Privacy Officer if you have questions or comments about our privacy
practices.
ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE:
We will request that you sign a separate form or notice
acknowledging you have received a copy of this notice. If you choose, or are not able to sign, a
staff member will sign their name, date.
This acknowledgement will be filed with your records.
