|
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.
NOTICE OF PRIVACY PRACTICES PURSUANT TO 45
C.F.R. 8 164.520
-
Our Duties
We are required by law to maintain the
privacy of your Protected Health Information (“Protected Health
Information”). We must provide you with notice of our legal duties and
privacy practices with respect to Protected Health Information and make
new privacy policies effective for all Protected Health Information that
we maintain. We will provide you with a copy of any current privacy
policy upon your written request, addressed to our Privacy Officer, at
our current address.
2.
Your Complaints
You may complain to us and to the Secretary
of the Department of Health and Human Services if you believe that you
privacy rights have been violated. You may file a complaint with us by
sending a certified letter addressed to “Privacy Officer” at our current
address, stating what Protected Health information you believe has been
used or disclosed improperly. You will not be retaliated against for
making a complaint. For further information you may contact our Privacy
Officer, at telephone number 518 382-7275 .
3.
Description and Examples of Uses and
Disclosures of Protected Health Information.
Here are some examples of how we may use or
disclose your protected Health Information. In connection with
treatment, we will, for example, allow a physician associated with us to
use your medical history, symptoms, injuries or diseases to treat your
current condition. In connection with payment, we will, for example,
allow our auditors, consultants, or attorneys access to your Protected
Health Information to determine if we billed you accurately for the
services we provide to you.
4.
Uses and Disclosures Which Require Your
Written Authorization
Uses and disclosures other than those
involving treatment, payment, and health care operations, as well as
those described in the following sections of this Notice, will only be
made by obtaining a written authorization from you. You may revoke this
authorization in writing at any time, except to the extent that we have
taken action in reliance upon you authorization.
5.
Uses and Disclosures Not Requiring Your
Written Authorization
The privacy regulations give us the right
to use and disclose your Protected Health Information if: (i) you are
inmate in a correctional institution; (ii) we have a direct or indirect
treatment relationship with you, (iii) we are so required or authorized
by law. The purpose for which we might use you Protected Health
Information would be to carry out treatment, payment, and health care
operations similar to those described in Paragraph 1.
6.
Uses of Protected Health Information to
Contact You
We may use your Protected Health
Information to contact you regarding appointment reminders or to contact
you with information about treatment alternatives or other
health-related benefits and services that, in our opinion, may be of
interest to you. We may use your Protected Health Information to contact
you in an effort to raise funds for our operations.
7.
Disclosures of Protected Health
Information for Billing Purposes
We may disclose your billing information to
any person that calls our billing staff or agents with billing questions
after we verify the identity of the person by requesting information
such as your social security number or health plan number.
8.
Disclosures for Directory and
Notification Purposes
If you are incapacitated or not present at
the time we may disclose your Protected Health Information (a) for use
in a facility directory, (b) to notify family or other appropriate
persons of your location or condition, and (c) to inform family, friends
or caregivers of information relevant to their involvement in your care
or payment for treatment. If you are present and not incapacitated, we
will make the above disclosures, as well as disclose any other
information to anyone you have identified, only upon your signed
consent, your verbal agreement, or the reasonable belief that you would
not object to such disclosure(s).
9.
Individual Rights
(i) You
may request us to restrict the uses and disclosures of your Protected
Health Information, but we do not have to agree to your request . (ii)
You have the right to request that we communicate with you regarding
your Protected Health Information in a confidential manner or pursuant
to an alternative means, such as by a sealed envelope rather that a
postcard, or by communicating to a specific phone number, or by sending
mail to a specific address. We are required to accommodate all
responsible requests in this regard. (iii) You have the right to request
that you will be allowed to inspect and copy your Protected Health
Information as long as it is kept as a designated record set, and as
long as you pay in advance for the administrative time and costs to make
arrangements to have the records inspected and copied. Certain records
are exempt from inspection and cannot be inspected or copied, so each
request will be reviewed in accordance with that standards published in
45 C.F.R & 164.524. (iv) You have the right to amend your Protected
Health Information for as long as the Protected Health Information is
maintained in the designated record set. We may deny your request for an
amendment if the Protected Health Information was not created by us, or
is not part of the designated record set, or would not be available for
inspection as described under section 45 C.F.R & 164.524 , or if the
Protected Health Information is already accurate and complete without
regard to the amendment. (v) You have the right to request, and
thereafter receive, an accounting of the disclosures of your Protected
Health Information for six years before the date on which you request
the accounting. An exception to this accounting are those disclosures
not allowed by law pursuant to section 164.528. Each request for an
accounting will be reviewed pursuant to the rules of section 164.528.
(vi) You also have a right to receive a copy of this Notice upon
request.
10.
Effective Data
The effective data of the Notice is April
14, 2003.
Name of
Provider SCHENECTADY REGIONAL ORTHOPEDIC ASSOCIATION |
