NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (this “Notice”) of Associated Orthopedic and Sports Medicine, hereafter referred to in this statement as (“AOSM”), is being provided to you in accordance with the requirements of the Standards for Privacy of Individually Identifiable Health Information of the Health Insurance Portability and Accountability Act (the “HIPAA Privacy Rules”). The HIPAA Privacy Rules are federal laws that seek to ensure the privacy and confidentiality of your health information. The HIPAA Privacy Rules require AOSM to take certain actions to protect the privacy of your health information. This Notice has been prepared to advise you of the uses and disclosures of your Protected Health Information (as defined below) that may be made by AOSM and to advise you of your rights and AOSM’s legal duties relating to the privacy of your Protected Health Information.
What is Protected Health Information?
“Protected Health Information” means information created or received by AOSM and transmitted or maintained in written, electronic, or any other form that (A) relates to (i) your past, present or future health condition, (ii) the provision of health care to you, or (iii) your past, present, or future payment for the provision of health care; and (B) individually identifies you or could reasonably be used to identify you.
Will AOSM have access to my Protected Health Information?
Yes. Your Protected Health Information will be obtained by your AOSM physician, AOSM’s office staff and others outside of AOSM that are involved in your care and treatment for the purpose of providing health care services to you.
When may AOSM use or disclose my Protected Health Information?
The law permits AOSM to use or disclose Protected Health Information to carry out “treatment,” “payment” and other “health care operations.” AOSM is not required to obtain an authorization from you or to notify you each time it uses or discloses your Protected Health Information for treatment, payment or health care operations purposes. The following are examples of the types of uses and disclosures of your Protected Health Information that AOSM is permitted to make, but the examples are not meant to be exhaustive.
Treatment: “Treatment” means the provision, coordination, or management of health care and related services by health care providers, including the coordination or management of health care by a health care provider with a third party (such as an insurer of AOSM), consultation between providers with respect to a patient, and the referral of a patient for health care from one provider to another. For example, (i) AOSM may disclose your Protected Health Information, as necessary, to a home health agency that provides care to you, (ii) AOSM may disclose Protected Health Information to other physicians who may be treating you, or (iii) your Protected Health Information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, AOSM may disclose your Protected Health Information from time to time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your AOSM physician, becomes involved by providing assistance with your health care diagnosis or treatment. Another example is that AOSM might disclose certain Protected Health Information to facilitate a pharmacy’s filling of your prescription. Your Protected Health Information and results of your diagnostic testing will be available in your medical record to all health care professionals who may provide treatment or who may be consulted by staff members.
Payment: Your Protected Health Information will be used, as needed, to obtain “payment” for your health care services provided by AOSM. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services AOSM recommends for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. Another example is obtaining approval for a hospital stay, which may require that your relevant Protected Health Information be disclosed to the health plan to obtain approval for the hospital admission.
Health Care Operations: “Health Care Operations” means those other functions and activities that AOSM performs in connection with providing health care. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, credentialing, underwriting, auditing functions, budgeting and financial reporting, and conducting or arranging for other business and administrative activities. For example, AOSM may disclose your Protected Health Information to medical school students that are in training and seeing patients at our offices. In addition, AOSM may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. AOSM may also call you by name in the waiting room when your physician is ready to see you. AOSM will share your Protected Health Information with third party “business associates” that perform various activities (e.g., billing and transcription services) for AOSM. Whenever an arrangement between AOSM and a business associate involves the use or disclosure of your Protected Health Information, AOSM will have a written contract with the business associate that contains terms that will protect the privacy of your Protected Health Information.
Additional Uses of Information:
AOSM may use or disclose your Protected Health Information to provide you with appointment reminders or information about your treatment alternatives or other health-related benefits and services that may be of interest to you. AOSM may also contact you for charitable purposes.
Additional Uses of Information:
For uses or disclosures of Protected Health Information that are not made for treatment, payment, or health care operations purposes and for which no exception applies, the law requires AOSM to obtain your written approval for AOSM’s disclosure of your Protected Health Information to a particular person or entity for a particular purpose (“Authorization”). You may revoke an Authorization at any time, but a revocation is not effective if AOSM has already reasonably relied on your Authorization to make a particular use or disclosure. Additionally, if you request that AOSM make a use or disclosure of your Protected Health Information to a third party, AOSM may require that you sign an Authorization that permits AOSM to honor your request.
While AOSM does not anticipate using or disclosing your Protected Health Information for marketing purposes, under the HIPAA Privacy Rules, AOSM may only make such uses or disclosures with your Authorization, unless AOSM communicates with you in person or provides you with some promotional gift of nominal value, in which case your Authorization would not be required.
When might AOSM use or disclose my Protected Health Information without my Authorization?
As discussed above, AOSM is not required to obtain your Authorization to use or disclose your Protected Health Information for treatment, payment or health care operations purposes. Additionally, there are some limited exceptions in which the law allows AOSM to use or disclose your Protected Health Information for purposes other than treatment, payment, or health care operations and without your Authorization. Most of these uses or disclosures are permitted to promote the Government’s need to ensure a safe and healthy society. In some cases, you may be given an opportunity to agree or object before the use or disclosure is made; in other cases, you may not be given this opportunity. Whenever AOSM makes these types of uses and disclosures, AOSM will make every effort to ensure that it meets any necessary prerequisites and will not use or disclose your Protected Health Information more than is otherwise permitted under the law.
The types of uses or disclosures of Protected Health Information that may be made without your Authorization and without giving you the opportunity to object include those: required by law; for public health activities; for FDA-related purposes; to avert communicable or spreading diseases; to an employer to conduct medical surveillance evaluations, to address work-related illness/workplace injuries and for workers’ compensation purposes; for health oversight purposes (such as when the Government requests certain information from AOSM to determine its compliance with applicable laws); when a judge or administrative tribunal orders the release of such Protected Health Information; to properly assist law enforcement agencies to carry out their duties; as required by law for reporting certain types of wounds or other physical injuries; pursuant to a request from a law enforcement official if the individual is a victim of a crime; for purposes of identifying or locating a suspect, fugitive, material witness, or missing person; to a coroner or medical examiner for purposes of identifying a deceased person; to a funeral director as necessary to carry out services; for cadaveric organ, eye and tissue donations (where appropriate); to carry out clinical research that involves treatment where the proper authority has determined the importance for doing so and compliance with the research authorization requirements are followed; to prevent serious and imminent threats to the health or safety of a person; for reporting to correctional institutions/law enforcement officials acting in a custodial capacity; and for certain military/security purposes.
There are also several types of uses or disclosures of Protected Health Information that AOSM may make without your Authorization as long as, whenever possible, you are given an opportunity to agree or object before AOSM makes the use or disclosure. These exceptions are very limited and generally involve the release of a limited amount of Protected Health Information, and include, but are not limited to, the following purposes: to maintain a AOSM directory of individuals; to disclose for directory purposes your information to members of the clergy or others who ask for you by name; to aid your family members, close personal friends, or persons identified by you to assist in your care, payment of care, or to aid them in locating you and notifying them of your condition; or disclosures to disaster relief personnel in order to locate you in the event of an emergency. If you are not available to agree or object to the use or disclosure of Protected Health Information due to your incapacity or an emergency circumstance, then AOSM may, in the exercise of its professional judgment, determine whether the disclosure is in your best interests and, if so, disclose only the Protected Health Information that is relevant to your health care.
What are my rights under the privacy standards?
You have the right to request additional restrictions relating to AOSM’s use or disclosure of your Protected Health Information beyond those otherwise required under the HIPAA Privacy Rules. Although AOSM is not legally required to grant these requests, it is your right to make such a request. For additional information or to obtain the proper form for making such a request, please contact AOSM’s Privacy Officer.
AOSM may communicate your Protected Health Information to you in a variety of ways, including by mail or telephone. If you believe that AOSM’s communications to you by the usual means will endanger you or your health care and you would like AOSM to make its communications that involve Protected Health Information to you at an alternate location, you may contact AOSM’s Privacy Officer (referenced on the last page of this Notice) to obtain the appropriate request form. AOSM will only accommodate reasonable requests and may require information as to how payment, if any, will be handled.
Subject to certain limitations, you have the right to request and obtain access to inspect and copy your Protected Health Information maintained by AOSM unless the information is not required to be accessible under the HIPAA Privacy Rules or other applicable law.
AOSM may charge you a reasonable, cost-based fee for copying (including the cost of supplies and labor) any Protected Health Information required to be copied to adequately respond to your access request, as well as any postage costs and costs associated with preparing an explanation or summary of the Protected Health Information necessary to adequately respond to your access request (unless otherwise precluded by applicable State or other law). If you would like to request access to your Protected Health Information, please notify AOSM’s Privacy Officer so that you can complete the appropriate forms.
You have the right to request that AOSM amend your Protected Health Information. AOSM reserves the right to deny or partially deny requests for amendments that are not required to be granted under the HIPAA Privacy Rules. For example, AOSM may deny a request for amendment when the Protected Health Information at issue is accurate and complete. If you would like to request an amendment of your Protected Health Information, please notify AOSM's Privacy Officer so that you can complete the appropriate forms.
You have the right to request and obtain a proper accounting of disclosures AOSM has made of your Protected Health Information in the six years prior to the date on which the accounting is requested. AOSM is not required, however, to account for all uses and disclosures of Protected Health Information that AOSM makes. For example, AOSM is not required to provide an accounting for disclosures made for treatment, payment, or health care operations purposes or for disclosures made with your Authorization. Additionally, AOSM reserves the right to limit its accountings to disclosures made after the compliance date of the HIPAA Privacy Rules.
AOSM will provide you with your first accounting at no charge to you. If you request any additional accountings within a 12-month period, AOSM may charge you a reasonable, cost-based fee. At the time that you request a subsequent accounting, AOSM will provide you with information regarding the fees, and you will have the opportunity to withdraw or modify your request if you wish to do so. If you would like to request an accounting of your Protected Health Information, please notify AOSM's Privacy Officer so that you can complete the appropriate forms.
You have the right to request and receive a paper copy of this Notice. If you received this Notice via the Internet or electronic mail and would like to receive a paper copy, please contact AOSM’s Privacy Officer.
If I have an objection to the way my Protected Health Information is being handled, may I file a complaint?
Yes. AOSM has procedures in place for receiving and resolving complaints. If you believe that AOSM has violated your privacy rights or has acted inconsistently with its obligations under the HIPAA Privacy Rules, you may file a complaint by contacting AOSM’s Privacy Officer by writing a letter addressed to AOSM, Attention: Privacy Officer, 4301 W. Plano Pkwy Suite 100, Plano, Texas 75093 or by calling 972.985.1072 to request a complaint form.
AOSM requests that you attempt to resolve your complaint with AOSM using these complaint procedures since AOSM is in the best position to respond to your complaint. However, if you believe AOSM has violated your privacy rights, you may also file a complaint with the Office of Civil Rights (“OCR”) at the United States Department of Health and Human Services (“HHS”). You may contact the HHS OCR at: Medical Privacy, Complaint Division, Office of Civil Rights, United States Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201, Voice Hotline Number (800) 368-1019, Internet Address www.hhs.gov/ocr.
May AOSM amend this Notice?
Yes. AOSM may change the terms of this Notice, at any time. The new notice will be effective for all Protected Health Information that AOSM maintains at that time. Upon your request, AOSM will provide you with any revised Notice of Privacy Practices. You may request a revised Notice of Privacy Practices by accessing our website at AOSM.com, calling the office and requesting that a revised copy be sent to you in the mail, or asking for one at the time of your next appointment.
What if I have additional questions that are not answered in this Notice?
If you have any questions, concerns, or issues relating to the privacy of your Protected Health Information that is not covered in this Notice, please contact AOSM’s Privacy Officer (referenced below).
How do I contact AOSM’s Privacy Officer?
You may contact AOSM’s Privacy Officer by writing to Privacy Officer, Privacy Officer, 4301 W. Plano Pkwy, Suite 100, Plano, Texas 75093 or by calling 972.985.1072.