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.
Understanding your Health Record/Information
Each time you visit a hospital, physician,
or other healthcare provider, a record of your visit is made.
Typically, this record contains your symptoms, examination and
test results, diagnoses, treatment, and a plan for future care
or treatment. This information, which we refer to as your health
or medical record, is an essential part of the health care we
provide for you. It serves as a:
• Basis for planning your care and treatment
• Means of communication among the many health professionals
who contribute to your care
• Legal document describing the care you received
• Means by which you or a third party payer can verify that
services billed were actually provided
• Tool in educating health professionals
• Source of data for medical research
• Source of data for facility planning and marketing
• Tool with which we can assess and continually work to
improve the care we render and the outcomes we achieve
Your health record contains personal health
information, the confidentiality of which is protected under both
state and federal law. Understanding we expect to use and disclose
your health information helps you to:
• Ensure its accuracy
• Better understand who, what, when, where, and why your
health care providers and others may access your health information
• Maker more informed decisions when authorizing disclosure
to others.
Although your health record is the physical
property of the healthcare practitioner or facility that compiled
it, the information belongs to you.
Under the Federal Privacy Rules, 45 CFR Part 164, you have the
right to:
• Receive notice of the uses and disclosures we expect
to make of your health information, including a paper copy of
the notice if requested, as provided in Rule 520.
• Request additional restrictions on uses and disclosures
of your health information (though we are not required to agree
to any such request), or request that we send you confidential
communications by alternative means or at alternative locations,
as provided 45 CFR 164.522
• Inspect and obtain a copy of your health record as provided
in Rule.524.
• Request that your health record be amended as provided
in Rule 526.
• Obtain an accounting of disclosures of your health information
made after _____________, 20______, for purposes other than treatment,
payment, or health care operations, as provided in Rule.528
Please direct requests to: The Orthopedic Center, 17 Riverside
Street, Ste. 101, Nashua, NH 03062
We are required by the Federal Privacy Rules
to:
• Maintain the privacy of your health information,
• Provide you with a notice as to our legal duties and privacy
practices with respect to health information we collect and maintain
about you
• Abide by the terms of this notice, subject to the following
reservation of rights.
We reserve the right to change our health
information practices and the terms of this notice, and to make
the new provisions effective for all protected health information
we maintain, including health information created or received
prior to the effective date of any such revised notice. Should
our health information practices change, we will post and/or provide
a revised notice. We will not use or disclose your health information
without your consent or authorization, except as described in
this notice. Uses and Disclosures for Treatment, Payment and Health
Operations, Based on Your Consent.
We will use your health information for
treatment.
For example: Information obtained by a nurse, physician, or other
member of your healthcare team will be recorded in your record
and used to determine the course of treatment that should work
best for you. Your physician will document in your record his
or her expectations of the members of your healthcare team. Members
of your healthcare team will then record the actions they took
and their observations. In that way, the physician will know how
you are responding to treatment. We will also provide your primary
care physician or a subsequent healthcare provider with copies
of various reports that should assist him or her in treating you
once you’re discharged from this hospital. We may also send
relevant portions of your medical record to specialists to whom
you are being referred for care, or to physicians whom your providers
here may want to consult on a care issue. We may use and disclose
health information about you (for example, by calling you or sending
you a letter) to remind you that you have an appointment with
us for treatment, or that it is time for you to schedule a regular
checkup with us, or to provide you with information bout treatment
alternatives.
We will use your health information
for payment.
For example: A bill may be sent to you or your insurance company
or health plan. The information on or accompanying the bill may
include information that identifies you, as well as your diagnosis,
procedures, and supplies used. We will use your health information
for regular health operations. For example: Members of the medical
staff, managers, or members of the quality improvement team may
use information in your health record to assess the care and outcomes
in your case and others like it. This information will then be
used in an effort to continually improve the quality and effectiveness
of the healthcare and service we provide.
Business Associates: We provide some services with business
associates, who are independent professionals that use patient
health information provided by us in order to perform these services.
Examples include physician services in the emergency department
and radiology, certain laboratory tests, and a copy service we
may use when making copies of your health record, or a billing
service. When these services are contracted, we may disclose your
health information to our business associate so that they can
perform the job we have asked them to do and bill you or your
insurer for services rendered. Other examples of business associates
include JCAHO (Joint Commission on Accreditation of Healthcare
Organizations), or independent accrediting agency, and state hospital
associations, to whom we disclose comparative statistics as required
by our certifying/accrediting agencies. To protect your health
information, however, we require the business associate to appropriately
safeguard your information.
Directory: Unless you notify
us (in writing) that you object, we will use your name, location
in the facility, general condition, and religious affiliation
in our facility director. This information may be provided to
members of your family, friends, members of the clergy and, except
for religious affiliation, to other people who ask for you by
name.
Family or friends involved in care:
Unless you object, (in writing) health professionals, using their
best judgment, may disclose to a family member, other relatives,
close personal friend or any other person you identify, health
information relevant to that person’s involvement in your
care or payment related to your care. This includes telephone
appointment reminder.
Marketing and Fundraising:
We may use or disclose your health information in connection with
limited marketing or fund-raising communications permitted under
the Federal Privacy Rules. Any such communication addressed to
you will contain instructions describing how you may “opt
out” of receiving further such communications.
Required Disclosures:The Federal
Privacy Rules require us to disclose your personal health information
in two instances: to you at your request under Rule 524 or Rule
28, and to the Secretary of Health and Human Services when requested
as part of an investigation or compliance review under Rule 502.
In addition, Rule 512 permits uses and disclosure
of your health information without your consent or authorization
for certain “national Priority” purposes, including:
• When required by state or federal law
• To state and federal public health authorities, including
state medical officers, the Food an Drug Administration (FDA),
and other agencies charged with preventing or controlling disease.
• To government authorities, including protective service
agencies, authorized to receive reports of abuse, neglect, or
domestic violence.
• To government health oversight agencies, such as the state
and federal Departments of Health and Human Services, Medicare/Medicaid
Peer Review Organizations (PRO’s), and other licensing authorities.
• When required or court order in a judicial or administrative
proceeding
• To law enforcement officials for certain law enforcement
purposes, including the reporting of certain types of wounds or
injuries, or pursuant to a warrant, subpoena, or other legal process,
or for the purpose of identifying or locating a subject fugitive,
material witness, missing person, or victim, provided that the
conditions in the rule are met.
• To coroners, medical examiners, or funeral directors for
purposes of identifying a deceased person or carrying out their
duties as required by law.
• To organ procurement organizations for purposes of organ
or tissue donation and transplantation, consistent with applicable
law.
• For research approved by an Institutional Review Board
(IRB) or Privacy Board that has reviewed by the research proposal
and established protocols to ensure the privacy of health information.
• When required to avert a serious threat to health or safety.
• When requested for certain specialized government functions
authorized by law, including military and similar situations.
• As authorized by law in connection with workers compensation
programs.
We expect to make other uses and disclosures
of your protected health information only on the basis of specific
written authorization forms signed by you. You have the right
to revoke any such authorization at any time, expect to the extent
we have already relied on it in making an authorized use or disclosure.
For More Information or to Report a Problem
If you believe your privacy rights have been violated, you can
file a complaint with the Director of Health Information Management
or the Privacy Officer at the above address, or with the Secretary
of Health and Human Services, Washington, DC. There will be no
retaliation for filing a complaint.
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