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 Privacy Notice is being provided to you as
a requirement of a federal law, the Health Insurance
Portability and Accountability Act (HIPAA). This
Privacy 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
of your protected health information in some cases.
Your “protected health information”
means any written and oral health information about
you, 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 or future
physical or mental health or condition.
I. Uses and Disclosures of Protecting Health Information
for You.
Coastal Orthopedics and Sports Medicine 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 Privacy Notice
may be made in writing, orally, or by facsimile.
If you are being treated for a work-related injury,
please note that the privacy practices outlined
in this notice are superseded by Florida state law.
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 pharmacy to fill a prescription,
to a laboratory to order or receive a blood test
or to a cardiologist to receive an EKG. We may also
disclose protected health information to physicians
who may be treating you or consulting with this
facility with respect to your care. 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 insurance company to get approval
for the procedure that we have scheduled. We may
also disclose protected health information to your
health 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 the services we provide you,
we may also need to disclose your protected health
to your health 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 to facilitate the function of Coastal
Orthopedics and Sports Medicine to provide quality
care to all patients. Health care operations include
such activities as: quality assessment/improvement
activities; employee review activities; training
programs including those in which students, trainees
or parishioners in health care learn under supervision;
accreditation, certification, licensing or credentialing
activities; review and auditing, including; compliance
reviews, medical reviews, legal services, legal
services and maintaining compliance programs, and
business management/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 treatment,
payment and health care operations, we may also
use or disclose your protected health information
for other purposes, such as to remind you of your
appointment or to see how you are doing after surgery.
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 or control disease, injury, or disability
- To report abuse or neglect
- 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 Suspected 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 the 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 under
this authority 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
proceeding in response to an order of a court or
administrative tribunal as expressly authorized
by such order. In certain circumstances, we may
disclose your protected health information in response
to a subpoena to the extent authorized by state
law if we receive satisfactory assurances that you
have been notified of the request or that an effort
was made to secure a protective order.
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
- To a law enforcement official if the facility
has a suspicion that your health condition was the
result of criminal conduct
- In an emergency 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/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 his 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 that has reviewed
the research proposal and research protocols to
address 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 and safety or to the health and safety
of the public.
J. For Specified Government Functions. In certain
circumstances, 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/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 the person’s
involvement in your care. We may also disclose your
information in connection with trying to locate
or notify family members or others 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 that 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 any authorization
taken prior to your revocation or change.
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
physician and the facility uses for making decisions
about you.
Under federal law, however, you may not inspect
or copy the following records: information compiled
in reasonable anticipation of, or for use in, a
civil, criminal or administrative action/proceeding
or 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 you or 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 our Medical Records
Department. 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 purposes 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 notification purposes as described
in this Privacy Notice.
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 specifications
of an alternative address or other method of contact.
We ill not require you to provide an explanation
for your request. Requests other than those accommodated
by our general release form must be mad in writing
to our Privacy Officer.
D. The Right to Request Amendments to Your Protected
Health Information. You may request an amendment
of protected health information about you, including
billing information, for as long as we maintain
this information. We may require that such requests
be put in writing, that a valid and legal reason
be supplied and that such requests be directed to
the Privacy Officer. 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. We may prepare a rebuttal
to your statement and we will provide you with a
copy of any such rebuttal. Requests for amendments
shall be handled in accordance with the timeliness
guidelines outlined in the Privacy Act. All revisions
or changes to a medical record must be done in consultation
with the physician and in accordance with applicable
state law on medical record amendments.
E. The Right to Receive an Accounting of Disclosures.
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 Privacy Notice.
We are also not required to account for: disclosures
that you requested; disclosures that you agreed
to by signing an authorization form; 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 of disclosures must be made in
writing to our Privacy Officer. The request should
specify the time period sought for the accounting
of disclosures. We are not required to provide accounting
for disclosure that take place prior to April 20,
2007. Accounting of Disclosures requests may not
be made for periods of time in excess of six years.
We will provide the first accounting for
disclosures you request during any 12-month period
without charge. Subsequent accounting for disclosures
requests maybe subject to a reasonable cost-based
fee.
E. 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 CPW is required by law to maintain the privacy
of your health information and to provide you with
this Privacy 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 the terms of this Notice and
to make the new Notice provisions effective for
all future protected health information that we
maintain.
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, in writing or via e-mail 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.
If you feel that your privacy rights have been violated
by this facility you may submit a complaint to our
Privacy Officer by sending it to:
Coastal Orthopedics and Sports Medicine
6015 Pointe West Boulevard Suite 100
Bradenton, Florida 34209
ATTN: Privacy Officer
The Privacy Officer can be contacted by telephone
at 941-782-0100 or via e-mail at AnneK@msmso.com
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