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Privacy
Policy
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Privacy Policy
October 29, 2008
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. If you have any
questions about this Notice please contact our Privacy Officer
@ (318) 425-8701.
This Notice of Privacy Practices 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. “Protected health information” is
information about you, including demographic information, that
may identify you and that relates to your past, present or
future physical or mental health or condition and related
health care services.
We are required to abide by the terms of this Notice of Privacy
Practices. We may change the terms of our notice, at any time.
The new notice will be effective for all protected health
information that we maintain at that time. Upon your request,
we will provide you with any revised Notice of Privacy
Practices by accessing our website www.BJCSportsMedicine.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.
1. Uses and
Disclosures of Protected Health Information
Uses and Disclosures of Protected
Health Information Based Upon Your Written
Consent
You will be asked by your physician to sign a consent form.
Once you have consented to use and disclosure of your protected
health information for treatment, payment and health care
operations by signing the consent form, your physician will use
or disclose your protected health information as described in
this Section 1. Your protected health information may be used
and disclosed by your physician, our office staff and others
outside of our office that are involved in your care and
treatment for the purpose of providing health care services to
you. Your protected health information may also be used and
disclosed to pay your health care bills and to support the
operation of the physician’s practice.
Following are examples of the types of uses and disclosures of
your protected health care information that the physician’s
office is permitted to make once you have signed our consent
form. These examples are not meant to be exhaustive, but to
describe the types of uses and disclosures that may be made by
our office once you have provided consent.
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 that has already obtained your
permission to have access to your protected health information.
For example, we would disclose your protected health
information, as necessary, to a home health agency that
provides care to you. We will also disclose protected health
information to other physicians who may be treating you when we
have the necessary permission from you to disclose your
protected health information. For example, 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, we 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
physician, becomes involved in your care by providing
assistance with your health care diagnosis or treatment to your
physician.
Payment:
Your protected health information will be used, as needed, to
obtain payment for your health care services. This may include
certain activities that your health insurance plan may
undertake before it approves or pays for the health care
services we recommend 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. For example, obtaining approval
for a hospital stay may require that your relevant protected
health information be disclosed to the health plan to obtain
approval for the hospital admission.
Healthcare
Operations: We may use or disclose, as-needed,
your protected health information in order to support the
business activities of your physician’s practice. These
activities include, but are not limited to, quality assessment
activities, employee review activities, training of medical
students, licensing, marketing and fundraising activities, and
conducting or arranging for other business activities.
For example, we may disclose your protected health information
to medical school students that see patients at our office. In
addition, we may use a sign-in sheet at the registration desk
where you will be asked to sign your name and indicate your
physician. We may also call you by name in the waiting room
when your physician is ready to see you. We may use or disclose
your protected health information, as necessary, to contact you
to remind you of your appointment.
We will share your protected health information with third
party “business associates” that perform various activities
(e.g., billing, transcription services) for the practice.
Whenever an arrangement between our office and a business
associate involves the use or disclosure of your protected
health information, we will have a written contract that
contains terms that will protect the privacy of your protected
health information.
We may use or disclose your protected health information, as
necessary, to provide you with information about treatment
alternatives or other health-related benefits and services that
may be of interest to you. We may also use and disclose your
protected health information for other marketing activities.
For example, your name and address may be used to send you a
newsletter about our practice and the services we offer. We may
also send you information about products or services that we
believe may be beneficial to you. You may contact our Privacy
Officer to request that these materials not be sent to you.
Uses and Disclosures
of Protected Health Information Based upon Your Written
Authorization
Other uses and disclosures of your protected health information
will be made only with your written authorization, unless
otherwise permitted or required by law as described below. You
may revoke this authorization, at any time, in writing, except
to the extent that your physician or the physician’s practice
has taken an action in reliance on the use or disclosure
indicated in the authorization.
Other Permitted and
Required Uses and Disclosures That May Be Made With Your
Consent, Authorization or Opportunity to
Object
We may use and disclose your protected health information in
the following instances. You have the opportunity to agree or
object to the use or disclosure of all or part of your
protected health information. If you are not present or able to
agree or object to the use or disclosure of the protected
health information, then your physician may, using professional
judgment, determine whether the disclosure is in your best
interest. In this case, only the protected health information
that is relevant to your health care will be disclosed.
Others Involved in Your
Healthcare: Unless you object, we may disclose
to a member of your family, a relative, a close friend or any
other person you identify, your protected health information
that directly relates to that person’s involvement in your
health care. If you are unable to agree or object to such a
disclosure, we may disclose such information as necessary if we
determine that it is in your best interest based on our
professional judgment. We may use or disclose protected health
information to notify or assist in notifying a family member,
personal representative or any other person that is responsible
for your care of your location, general condition or death.
Finally, we may use or disclose your protected health
information to an authorized public or private entity to assist
in disaster relief efforts and to coordinate uses and
disclosures to family or other individuals involved in your
health care.
Emergencies: We may use or
disclose your protected health information in an emergency
treatment situation. If this happens, your physician shall try
to obtain your consent as soon as reasonably practicable after
the delivery of treatment. If your physician or another
physician in the practice is required by law to treat you and
the physician has attempted to obtain your consent but is
unable to obtain your consent, he or she may still use or
disclose your protected health information to treat you.
Communication
Barriers: We may use and disclose your
protected health information if your physician or another
physician in the practice attempts to obtain consent from you
but is unable to do so due to substantial communication
barriers and the physician determines, using professional
judgment, that you intend to consent to use or disclosure under
the circumstances.
Other Permitted and
Required Uses and Disclosures That May Be Made Without Your
Consent, Authorization or Opportunity to
Object
We may use or disclose your protected health information in the
following situations without your consent or authorization.
These situations include:
Required By
Law: We may use or disclose your protected
health information to the extent that law requires the use or
disclosure. The use or disclosure will be made in compliance
with the law and will be limited to the relevant requirements
of the law. You will be notified, as required by law, of any
such uses or disclosures.
Public
Health: We may disclose your protected health
information for public health activities and purposes to a
public health authority that is permitted by law to collect or
receive the information. The disclosure will be made for the
purpose of controlling disease, injury or disability. We may
also disclose your protected health information, if directed by
the public health authority, to a foreign government agency
that is collaborating with the public health authority.
Communicable
Diseases: We may disclose your protected health
information, if authorized by law, to a person who may have
been exposed to a communicable disease or may otherwise be at
risk of contracting or spreading the disease or condition.
Health
Oversight: We may disclose protected health
information to a health oversight agency for activities
authorized by law, such as audits, investigations, and
inspections. Oversight agencies seeking this information
include government agencies that oversee the health care
system, government benefit programs, other government
regulatory programs and civil rights laws.
Abuse or Neglect:
We may disclose your protected health information to a public
health authority that is authorized by law to receive reports
of child abuse or neglect. In addition, we may disclose your
protected health information if we believe that you have been a
victim of abuse, neglect or domestic violence to the
governmental entity or agency authorized to receive such
information. In this case, the disclosure will be made
consistent with the requirements of applicable federal and
state laws.
Food and Drug
Administration: We may disclose your protected
health information to a person or company required by the Food
and Drug Administration to report adverse events, product
defects or problems, biologic product deviations, track
products; to enable product recalls; to make repairs or
replacements, or to conduct post marketing surveillance, as
required.
Legal
Proceedings: We may disclose protected health
information in the course of any judicial or administrative
proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure is
expressly authorized), in certain conditions in response to a
subpoena, discovery request or other lawful process.
Law
Enforcement: We may also disclose protected
health information, so long as applicable legal requirements
are met, for law enforcement purposes. These law enforcement
purposes include (1) legal processes and otherwise required by
law, (2) limited information requests for identification and
location purposes, (3) pertaining to victims of a crime, (4)
suspicion that death has occurred as a result of criminal
conduct, (5) in the event that a crime occurs on the premises
of the practice, and (6) medical emergency (not on the
Practice’s premises) and it is likely that a crime has
occurred.
Coroners, Funeral
Directors, and Organ Donation: We may disclose
protected health information to a coroner or medical examiner
for identification purposes, determining 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 cadaver organ, eye or tissue donation purposes.
Research:
We may disclose your protected health information to
researchers when an institutional review board that has
reviewed the research proposal and established protocols to
ensure the privacy of your protected health information has
approved their research.
Criminal
Activity: Consistent with applicable federal
and state laws, we may disclose your protected health
information, if we believe that the use or disclosure is
necessary to prevent or lessen a serious and imminent threat to
the health or safety of a person or the public. We may also
disclose protected health information if it is necessary for
law enforcement authorities to identify or apprehend an
individual.
Military Activity and
National Security: When the appropriate
conditions apply, we may use or disclose protected health
information of individuals who are Armed Forces personnel (1)
for activities deemed necessary by appropriate military command
authorities; (2) for the purpose of a determination by the
Department of Veterans Affairs of your eligibility for
benefits, or (3) to foreign military authority if you are a
member of that foreign military services. We may also disclose
your protected health information to authorized federal
officials for conducting national security and intelligence
activities, including for the provision of protective services
to the President or others legally authorized.
Workers’
Compensation: we may disclose your protected
health information as authorized to comply with workers’
compensation laws and other similar legally established
programs.
Inmates:
We may use or disclose your protected health information if you
are an inmate of a correctional facility and your physician
created or received your protected health information in the
course of providing care to you.
Required Uses and
Disclosures: Under the law, we must make
disclosures to you and when required by the Secretary of the
Department of Health and Human Services to investigate or
determine our compliance with the requirements of Section
164.500 et. seq.
2. Your
Rights
Following is a statement of your rights with respect to your
protected health information and a brief description of how you
may exercise these rights.
You have the right to
inspect and copy your protected health
information. This means you may inspect and
obtain a copy of protected health information about you 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 physician and the practice uses for making decisions about
you. The copy of a records set will be done along with a
processing fee as part of the federal guidelines allowing
offices to charge for the record set.
Under federal law, however, you may not inspect or copy the
following records; psychotherapy notes; information compiled in
reasonable anticipation of, or use in, a civil, criminal, or
administrative action or proceeding, and protected health
information that is subject to law that prohibits access to
protected health information. Depending on the circumstances, a
decision to deny access may be reviewable. In some
circumstances, you may have a right to have this decision
reviewed. Please contact our Privacy Officer if you have
questions about access to your medical record.
You have the right to request a
restriction of your protected health
information.This means you may ask us not to
use or disclose any part of your protected health information
for the purposes of treatment, payment or healthcare
operations. You may also request that any part of your
protected health information not be disclosed to family members
or friends who may be involved in your care or for 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.
Your physician is not required to agree to a restriction that
you may request. If physician believes it is in your best
interest to permit use and disclosure of your protected health
information, your protected health information will not be
restricted. If your physician 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. With this in mind,
please discuss any restriction you wish to request with your
physician. You may request a restriction by submitting a
written request to the Privacy Officer.
You have the right to request to receive
confidential communications from us by alternative means or at
an alternative location. We will accommodate reasonable
requests. We may also 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 request an explanation from you as to the
basis for the request. Please make this request in writing to
our Privacy Officer.
You may have the right to
have your physician amend your protected health
information. This means 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. Please contact our Privacy Officer to determine if
you have questions about amending your medical
record.
You have the
right to receive an accounting of certain disclosures we have
made, if any, of your protected health
information. This right applies
to disclosures for purposes other than treatment, payment or
healthcare operations as described in this Notice of Privacy
Practices. It excludes disclosures we may have made to you, for
a facility directory, to family members or friends involved in
your care, or for notification purposes. You have the right to
receive specific information regarding these disclosures that
occurred after April 14, 2003. You may request a shorter
timeframe. The right to receive this information is subject to
certain exceptions, restrictions and limitations.
You have the right to
obtain a paper copy of this notice from
us, upon request,
even if you have agreed to accept this notice
electronically.
3.
Complaints
You may complain to us or to the
Secretary of Health and Human Services if you believe your
privacy rights have been violated by us. You may file a
complaint with us by notifying our Privacy Officer of your
complaint. We will not retaliate against you for filing a
complaint.
Our Privacy Officer is Wayne
Smith. Wayne can be reached (318) 425-8701 if you
have any further questions or request for information about the
complaint process, or this privacy statement.
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