PRIVACY NOTICE
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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
1. 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
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