| Notice
of Privacy Practices
Northern
California Orthopedic Center
6403 Coyle Avenue, Suite 170, Carmichael, CA 95608
Privacy Officer: Rachel Pacini, Administrator
Phone: (916) 965-4000 extension 3009
Effective Date: April 14, 2003
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.
We understand the importance of privacy and are committed to maintaining
the confidentiality of your medical information. We make a record
of the medical care we provide and may receive such records from
others. We use these records to provide or enable other health care
providers to provide quality medical care, to obtain payment for
services provided to you as allowed by your health plan and to enable
us to meet our professional and legal obligations to operate this
medical practice properly. We are required by law to maintain the
privacy of protected health information and to provide individuals
with notice of our legal duties and privacy practices with respect
to protected health information. This notice describes how we may
use and disclose your medical information. It also describes your
rights and our legal obligations with respect to your medical information.
If you have any questions about this Notice, please contact our
Privacy Officer listed above.
TABLE OF CONTENTS
A. How this Medical Practice May Use or Disclose Your
Health Information
B. When This Medical Practice May Not Use or Disclose
Your Health Information
C. Your Health Information Rights
1. Right to Request Special Privacy Protections
2. Right to Request Confidential Communications
3. Right to Inspect and Copy
4. Right to Amend or Supplement
5. Right to an Accounting of Disclosures
6. Right to a Paper Copy of this Notice
D. Changes to this Notice of Privacy Practices
E. Complaints
A. How this Medical Practice May Use or
Disclose Your Health Information
This medical practice collects health information about you and
stores it in a chart and on a computer. This is your medical record.
The medical record is the property of this medical practice, but
the information in the medical record belongs to you. The law permits
us to use or disclose your health information for the following
purposes:
1. Treatment. We use medical information about
you to provide your medical care. We disclose medical information
to our employees and others who are involved in providing the care
you need. For example, we may share your medical information with
other physicians or other health care providers who will provide
services which we do not provide. Or we may share this information
with a pharmacist who needs it to dispense a prescription to you,
or a laboratory that performs a test. We may also disclose medical
information to members of your family or others who can help you
when you are sick or injured.
2. Payment. We use and disclose medical information
about you to obtain payment for the services we provide. For example,
we give your health plan the information it requires before it will
pay us. We may also disclose information to other health care providers
to assist them in obtaining payment for services they have provided
to you.
3. Health Care Operations. We may use and disclose
medical information about you to operate this medical practice.
For example, we may use and disclose this information to review
and improve the quality of care we provide, or the competence and
qualifications of our professional staff. Or we may use and disclose
this information to get your health plan to authorize services or
referrals. We may also use and disclose this information as necessary
for medical reviews, legal services and audits, including fraud
and abuse detection and compliance programs and business planning
and management. We may also share your medical information with
our "business associates", such as our billing service,
that perform administrative services for us. We have a written contract
with each of these business associates that contains terms requiring
them to protect the confidentiality of your medical information.
Although federal law does not protect health information which is
disclosed to someone other than another healthcare provider, health
plan or healthcare clearinghouse, under California law all recipients
of health care information are prohibited from re-disclosing it
except as specifically required or permitted by law. We may also
share your information with other health care providers, health
care clearinghouses or health plans that have a relationship with
you, when they request this information to help them with their
quality assessment and improvement activities, their efforts to
improve health or reduce health care costs, their review of competence,
qualifications and performance of health care professionals, their
training programs, their accreditation, certification or licensing
activities, or their health care fraud and abuse detection and compliance
efforts
4. Appointment Reminders. We may use and disclose
medical information to contact and remind you about appointments.
If you are not home, we may leave this information on your answering
machine or in a message left with the person answering the phone.
5. Sign in sheet. We may use and disclose medical
information about you by having you sign in when you arrive at our
office. We may also call out your name when we are ready to see
you.
6. Notification and communication with family.
We may disclose your health information to notify or assist in notifying
a family member, your personal representative or another person
responsible for your care about your location, your general condition
or in the event of your death. In the event of a disaster, we may
disclose information to a relief organization so that they may coordinate
these notification efforts. We may also disclose information to
someone who is involved with your care or helps pay for your care.
If you are able and available to agree or object, we will give you
the opportunity to object prior to making these disclosures, although
we may disclose this information in a disaster even over your objection
if we believe it is necessary to respond to the emergency circumstances.
If you are unable or unavailable to agree or object, our health
professionals will use their best judgment in communication with
your family and others.
7. Required by law. As required by law, we will
use and disclose your health information, but we will limit our
use or disclosure to the relevant requirements of the law. When
the law requires us to report abuse, neglect or domestic violence,
or respond to judicial or administrative proceedings, or to law
enforcement officials, we will further comply with the requirement
set forth below concerning those activities.
8. Public health. We may, and are sometimes required
by law to disclose your health information to public health authorities
for purposes related to: preventing or controlling disease, injury
or disability; reporting child, elder or dependent adult abuse or
neglect; reporting domestic violence; reporting to the Food and
Drug Administration problems with products and reactions to medications;
and reporting disease or infection exposure. When we report suspected
elder or dependent adult abuse or domestic violence, we will inform
you or your personal representative promptly unless in our best
professional judgment, we believe the notification would place you
at risk of serious harm or would require informing a personal representative
we believe is responsible for the abuse or harm.
9. Health oversight activities. We may, and are
sometimes required by law to disclose your health information to
health oversight agencies during the course of audits, investigations,
inspections, licensure and other proceedings, subject to the limitations
imposed by federal and California law.
10. Judicial and administrative proceedings. We
may, and are sometimes required by law, to disclose your health
information in the course of any administrative or judicial proceeding
to the extent expressly authorized by a court or administrative
order. We may also disclose information about you in response to
a subpoena, discovery request or other lawful process if reasonable
efforts have been made to notify you of the request and you have
not objected, or if your objections have been resolved by a court
or administrative order.
11. Law enforcement. We may, and are sometimes
required by law, to disclose your health information to a law enforcement
official for purposes such as identifying of locating a suspect,
fugitive, material witness or missing person, complying with a court
order, warrant, grand jury subpoena and other law enforcement purposes.
12. Coroners. We may, and are often required by
law, to disclose your health information to coroners in connection
with their investigations of deaths.
13. Organ or tissue donation. We may disclose your
health information to organizations involved in procuring, banking
or transplanting organs and tissues.
14. Public safety. We may, and are sometimes required
by law, to disclose your health information to appropriate persons
in order to prevent or lessen a serious and imminent threat to the
health or safety of a particular person or the general public.
15. Specialized government functions. We may disclose
your health information for military or national security purposes
or to correctional institutions or law enforcement officers that
have you in their lawful custody.
16. Worker’s compensation. We may disclose
your health information as necessary to comply with worker’s
compensation laws. For example, to the extent your care is covered
by workers' compensation, we will make periodic reports to your
employer about your condition. We are also required by law to report
cases of occupational injury or occupational illness to the employer
or workers' compensation insurer.
17. Change of Ownership. In the event that this
medical practice is sold or merged with another organization, your
health information/record will become the property of the new owner,
although you will maintain the right to request that copies of your
health information be transferred to another physician or medical
group.
18. Research. We may disclose your health information
to researchers conducting research with respect to which your written
authorization is not required as approved by an Institutional Review
Board or privacy board, in compliance with governing law.
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B.
When This Medical Practice May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, this medical
practice will not use or disclose health information that identifies
you without your written authorization. If you do authorize this
medical practice to use or disclose your health information for
another purpose, you may revoke your authorization in writing at
any time.
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C.
Your Health Information Rights
1. Right to Request Special Privacy Protections.
You have the right to request restrictions on certain uses and disclosures
of your health information, by a written request specifying what
information you want to limit and what limitations on our use or
disclosure of that information you wish to have imposed. We reserve
the right to accept or reject your request, and will notify you
of our decision. A request form may be obtained from our office
and must be forwarded to the Privacy Officer at the address above.
2. Right to Request Confidential Communications.
You have the right to request that you receive your health information
in a specific way or at a specific location. For example, you may
ask that we send information to a particular e-mail account or to
your work address. We will comply with all reasonable requests submitted
in writing which specify how or where you wish to receive these
communications. A request form may be obtained from our office and
must be forwarded to the Privacy Officer at the address above.
3. Right to Inspect and Copy.
You have the right to inspect and copy your health information,
with limited exceptions. To access your medical information, you
must submit a written request detailing what information you want
access to and whether you want to inspect it or get a copy of it.
We will charge a reasonable fee, as allowed by California law. We
may deny your request under limited circumstances. If we deny your
request to access your child's records because we believe allowing
access would be reasonably likely to cause substantial harm to your
child, you will have a right to appeal our decision. If we deny
your request to access your psychotherapy notes, you will have the
right to have them transferred to another mental health professional.
A request form may be obtained from our office and must be forwarded
to the Privacy Officer at the address above.
4. Right to Amend or Supplement.
You have a right to request that we amend your health information
that you believe is incorrect or incomplete. You must make a request
to amend in writing, and include the reasons you believe the information
is inaccurate or incomplete. We are not required to change your
health information, and will provide you with information about
this medical practice's denial. We may deny your request if we do
not have the information, if we did not create the information (unless
the person or entity that created the information is no longer available
to make the amendment), if you would not be permitted to inspect
or copy the information at issue, or if the information is accurate
and complete as is. You also have the right to request that we add
to your record a statement of up to 250 words concerning any statement
or item you believe to be incomplete or incorrect. A request form
may be obtained from our office and must be forwarded to the Privacy
Officer at the address above.
5. Right to an Accounting of Disclosures.
You have a right to receive an accounting of disclosures of your
health information made by this medical practice, except that this
medical practice does not have to account for the disclosures provided
to you or pursuant to your written authorization, or as described
in paragraphs 1 (treatment), 2 (payment), 3 (health care operations),
6 (notification and communication with family) and 16 (specialized
government functions) of Section A of this Notice of Privacy Practices
or disclosures for purposes of research or public health which exclude
direct patient identifiers, or which are incident to a use or disclosure
otherwise permitted or authorized by law, or the disclosures to
a health oversight agency or law enforcement official to the extent
this medical practice has received notice from that agency or official
that providing this accounting would be reasonably likely to impede
their activities. A request form may be obtained from our office
and must be forwarded to the Privacy Officer at the address above.
6. You have a right to a paper copy of
this Notice of Privacy Practices, even if you have previously requested
its receipt by e-mail.
If you would like to have a more detailed explanation of these rights
or if you would like to exercise one or more of these rights, contact
our Privacy Officer listed at the top of this Notice of Privacy
Practices.
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D.
Changes to this Notice of Privacy Practices
We reserve the right to amend this Notice of Privacy Practices at
any time in the future. Until such amendment is made, we are required
by law to comply with this Notice. After an amendment is made, the
revised Notice of Privacy Protections will apply to all protected
health information that we maintain, regardless of when it was created
or received and an amended copy will be given to you at your appointment
following the revision date. We will keep a copy of the current
notice posted in our reception area. We will also post the current
notice on our website.
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E.
Complaints
Complaints about this Notice of Privacy Practices or how this medical
practice handles your health information should be directed to our
Privacy Officer. All complaints must be submitted in writing to
our Privacy Officer at the address listed at the top of this form.
If you are not satisfied with the manner in which this office handles
a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Online at: http://cms.hhs.gov/hipaa/hipaa2/default.asp
Or on paper to:
Department of Health and Human Services
Office of Civil Rights, USDHHS,
50 United Nations Plaza, Room 322
San Francisco, CA 94103.
You will not be penalized for filing a complaint.
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