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During your treatment at Orthopedic Surgical
Consultants, P.A., doctors, nurses, and other caregivers
may gather information about your medical history and
your current health. This notice explains how that
information may be used and shared with others. It also
explains your privacy rights regarding this kind of
information. The terms of this notice apply to health
information created or received by Orthopedic Surgical
Consultants, P.A. We are required by law to: make sure
that medical information that identifies you is kept
private; give you this notice of our legal duties and
privacy practices with respect to medical information
about you; and follow the terms of the notice that is
currently in effect.
Your medical information may be used and disclosed
for the following purposes:
·
Treatment: We may use your information to provide,
coordinate, and manage your care and treatment. For
example, an Orthopedic Surgical Consultants, P.A.
physician will share your medical information with the
physician or entity that sent you to us for a
consultation or a referral. Likewise, an Orthopedic
Surgical Consultants, P.A. physician may share your
medical information with another physician for a
consultation or referral. We will get your written
consent prior to making disclosures outside Orthopedic
Surgical Consultants, P.A. for treatment purposes,
except in circumstances when it is not possible to get
your consent.
·
Payment: We may use and disclose medical
information about you so that the treatment and services
you receive may be billed to, and payment may be
collected from, you, an insurance company, or another
third party. For example, we may need to give your
health plan information about treatment you received at
Orthopedic Surgical Consultants, P.A. so your health
plan will pay us or reimburse you for the treatment. We
may also tell your health plan about a treatment you are
going to receive to obtain prior approval or to
determine whether your plan will cover the treatment.
We will get your written consent prior to making
disclosures for payment purposes.
· Health
Care Operations: We may use and disclose medical
information about you for Orthopedic Surgical
Consultants, P.A. health care operations. Health care
operations are the uses and disclosures of information
that are necessary to run Orthopedic Surgical
Consultants, P.A. and to make sure that all of our
patients receive quality care. For example, we may use
medical information to review our treatment and
services, and to evaluate the performance of our staff
and physicians in caring for you. We will get your
written consent before making disclosures to others
outside Orthopedic Surgical Consultants, P.A. for health
care operations purposes.
·
Office Procedures: Orthopedic
Surgical Consultants, P.A. physicians or staff will
leave messages on the answering machine of the phone
number(s) you give us, unless you request otherwise in
writing.
·
Appointment Reminders and Other Health Information:
We may use your medical information to send you
reminders about future appointments. We may also
contact you with information about new or alternative
treatments or other health care services.
· To
People Assisting in Your Care: Orthopedic Surgical
Consultants, P.A. will only disclose medical information
to those taking care of you, helping you to pay your
bills, or other close family members of friends if these
people need to know this information to help you, and
then only to the extent permitted by law. We may, for
example, provide limited medical information to allow a
family member to pick up a prescription for you.
Generally, we will get your written consent prior to
making disclosures about you to family or friends. If
you are able to make your own health care decisions,
Orthopedic Surgical Consultants, P.A. will ask your
permission before using your medical information for
these purposes. If you are unable to make health care
decisions, Orthopedic Surgical Consultants, P.A. will
disclose relevant medical information to family members
or other responsible people if we feel it is in your
best interest to do so, including in an emergency
situation.
·
Research: Federal law permits Orthopedic Surgical
Consultants, P.A. to use and disclose medical
information about you for research purposes, either with
your specific, written authorization or when the study
has been reviewed for privacy protection by an
Institutional Review Board or Privacy Board before the
research begins. In some cases, researchers may be
permitted to use information in a limited way to
determine whether the study or the potential
participants are appropriate. Minnesota law generally
requires that we get your general consent before we
disclose your health information to an outside
researcher. We will make a good faith effort to obtain
your consent or refusal to participate in any research
study, as required by law, prior to releasing any
identifiable information about you to outside
researchers.
· As
Required by Law: We will disclose medical
information about you when we are required to do so by
federal, state or local law.
· To
Avert a Serious Threat to Health or Safety: We may
use and disclose medical information about you when
necessary to prevent a serious threat to your health and
safety or the health and safety of the public or another
person. Any disclosure must be only to someone able to
help prevent the threat. In addition, Minnesota law
generally does not permit these disclosures unless we
have your written consent to do so or when the
disclosure is specifically required by law, including
the limited circumstances in which Orthopedic Surgical
Consultants, P.A. health care professionals have a “duty
to warn.”
-
To Business Associates: Some services are
provided by or to Orthopedic Surgical Consultants,
P.A. through contracts with business associates.
Examples include Orthopedic Surgical Consultants,
P.A.’s, attorneys, consultants, collection agencies,
and accreditation organizations. We may disclose
information about you to our business associate so
that they can perform the job we have contracted with
them to do. To protect the information that is
disclosed, each business associate is required to sign
an agreement to appropriately safeguard the
information and not to redisclose the information
unless specifically permitted by law.
Your medical information may be released in the
following special situations:
· Organ
and Tissue Donation: We may release your medical
information to organizations that handle organ
procurement or organ, eye or tissue transplantation, or
to an organ donation bank, as necessary to facilitate
organ or tissue donation and transplantation. The
information that Orthopedic Surgical Consultants, P.A.
may disclose is limited to the information necessary to
make a transplant possible.
·
Military and Veterans: If you are a member of the
armed forces, we will release medical information about
you as requested by military command authorities if we
are required to do so by law, or when we have your
written consent. We may also release medical
information about foreign military personnel to the
appropriate foreign military authority as required by
law or with written consent.
·
Workers’ Compensation: We may release medical
information about you for workers’ compensation or
similar programs. These programs provide benefits for
work-related injuries or illness. We are permitted to
disclose this information to the parties involved in the
claim without any specific consent, so long as the
information is related to a workers’ compensation claim.
· Public
Health: We may disclose medical information to
public health authorities about you for public health
activities. These disclosures generally include the
following:
- Preventing or controlling disease, injury or
disability;
- Reporting births and deaths;
- Reporting child abuse or neglect, or abuse of a
vulnerable adult;
- Reporting reactions to medications or problems
with products;
- Notifying people of recalls of products they may
be using;
- Notifying a person who may have been exposed to
a disease or may be at risk for contracting or
spreading a disease or condition; or
-
Reporting to the FDA as permitted or required
by law.
· Health
Oversight Activities: Orthopedic Surgical
Consultants, P.A. may disclose medical information to a
health oversight agency for health oversight activities
that are authorized by law. These oversight activities
include, for example, government audits, investigations,
inspections, and licensure activities. These activities
are necessary for the government to monitor the health
care system, government programs, and compliance with
civil rights laws. Minnesota law requires that
patient-identifying information (for example, your name,
social security number, etc.) be removed from most
disclosures for health oversight purposes, unless you
have provided us with written consent for the
disclosure.
·
Lawsuits and Disputes: If you are involved in a
lawsuit, dispute, or other judicial proceeding, we will
disclose medical information about you only in response
to a valid court order, administrative order, or a grand
jury subpoena, or with your written consent.
· Law
Enforcement: We may release medical
information if asked to do so by a law enforcement
official in response to a valid court order, grand jury
subpoena, or warrant, or with your written consent. In
addition, we are required to report certain types of
wounds, such as gunshot wounds and some burns. In most
cases, reports will include only the fact of injury, and
any additional disclosures would require your consent or
a court order.
We may also release information to law enforcement
that is not a part of the health record (in other words,
non-medical information) for the following
reasons:
- To identify or locate a
suspect, fugitive, material witness, or missing person;
- If you are the victim of a crime, if, under
certain limited circumstances, we are unable to obtain
your agreement;
- About a death we believe may be the result of
criminal conduct;
- About criminal conduct at our facility; and
- In emergency circumstances to report a crime; the
location of the crime or victims; or the identity,
description or location of the person who committed the
crime.
·
Coroners, Medical Examiners, and Funeral Directors:
We will release medical information to a coroner or
medical examiner in the case of certain types of death,
and we must disclose health records upon the request of
the coroner or medical examiner. This may be necessary,
for example, to identify you or determine the cause of
death. We may also release the fact of death and
certain demographic information about you to funeral
directors as necessary to carry out their duties. Other
disclosures from your health record will require the
consent of a surviving spouse, parent, a person
appointed by you in writing, or your legally authorized
representative.
·
National Security and Intelligence Activities: We
will release medical information about you to authorized
federal officials for intelligence,
counter-intelligence, and other national security
activities only as required by law or with your written
consent.
·
Protective Services for the President and Others:
We will disclose medical information about you to
authorized federal officials so they may provide
protection to the President, other authorized persons,
or foreign heads of state, or conduct special
investigations only as required by law or with your
written consent.
·
Inmates: If you are an inmate of a correctional
institution or under the custody of a law enforcement
official, we will release medical information about you
to the correctional institution or law enforcement
official only as required by law or with your written
consent.
You have the following rights regarding medical
information we maintain about you:
· Right
to Inspect and Copy: You have the right to inspect
and receive a copy of your medical information that is
used to make decisions about your care. Usually, this
includes medical and billing records maintained by
Orthopedic Surgical Consultants, P.A.
If you wish to inspect and copy medical information, you
must submit your request in writing to Mary Moren, R.N.,
Clinic Administrator. If you request a copy of the
information, we may charge a fee for the costs of
copying, mailing, or other supplies associated with your
request, to the extent permitted by state and federal
law.
We may deny your request to inspect and copy your
information in certain very limited circumstances. For
example, we may deny access if your physician believes
it will be harmful to your health, or could cause a
threat to others. In these cases, we may supply the
information to a third party who may release the
information to you. If you are denied access to medical
information, you may request that the denial be
reviewed. Another licensed health care professional
chosen by Orthopedic Surgical Consultants, P.A. will
review your request and the denial. The person
conducting the review will not be the person who denied
your request. We will comply with the outcome of the
review.
· Right
to Request Amendment: If you believe that medical
information we have about you is incorrect or
incomplete, you have the right to ask us to change the
information. You have the right to request an amendment
for as long as the information is kept by or for
Orthopedic Surgical Consultants, P.A.
To request a change to your information, your request
must be made in writing and submitted to Mary Moren,
R.N., Clinic Administrator. In addition, you must
provide a reason that supports your request.
Orthopedic Surgical Consultants, P.A. may deny your
request for an amendment if it is not in writing or does
not include a reason to support the request. In
addition, we may deny your request if you ask us to
amend information that:
- Was not created by Orthopedic Surgical
Consultants, P.A., unless the person or entity that
created the information is no longer available to make
the amendment;
- Is not part of the medical information kept by
or for Orthopedic Surgical Consultants, P.A.;
- Is not part of the information which you would
be permitted to inspect and copy; or
- Is accurate and complete.
· Right
to an Accounting of Disclosures: You have the right
to request an “accounting of disclosures.” This is a
list of the disclosures we made of medical information
about you. This list will not include
disclosures for treatment, payment, and health care
operations; disclosures that you have authorized or that
have been made to you; disclosures for facility
directories; disclosures for national security or
intelligence purposes; disclosures to correctional
institutions or law enforcement with custody of you;
disclosures that took place before April 14, 2003; and
certain other disclosures.
To request this list of disclosures, you must submit
your request in writing to Mary
Moren, R.N., Clinic Administrator. Your request
must state a time period for which you would like the
accounting. The accounting period may not go back
further than six years from the date of the request, and
it may not include dates before April 14, 2003. You may
receive one free accounting in any 12-month period. We
will charge you for additional requests.
· Right
to Request Restrictions: You have the right to
request a restriction or limitation on the medical
information we use or disclose about you. For example,
you could ask that we not use or disclose information
about treatment that you received to other physicians or
to your insurance company. We are not required to
agree to your request. If we do agree, we will
comply with your request unless the information is
needed to provide you emergency treatment.
To request restrictions, you must make your request in
writing to Mary Moren, R.N., Clinic Administrator. In
your request, you must tell us (1) what information you
want to limit; (2) whether you want to limit our use,
disclosure, or both; and (3) to whom you want the limits
to apply, for example, if you want to prohibit
disclosures to your spouse.
· Right
to Request Confidential Communications: You have
the right to request that we communicate with you about
medical matters in a certain way or at a certain
location. For example, you can ask that we only contact
you only at work or only by mail.
To request confidential communications, you must make
your request in writing to Mary Moren, R.N., Clinic
Administrator. We will not ask you the reason for your
request. We will accommodate all reasonable requests.
Your request must specify how or where you wish to be
contacted, and we may require you to provide information
about how payment will be handled.
· Right
to a Paper Copy of This Notice: You have the right
to receive a paper copy of this notice. You may ask us
to give you a copy of this notice any time. This notice
is on our website, www.osc-mn.com.
Changes to This Notice
The effective date of this notice is April 14, 2003. We
reserve the right to change this notice. We reserve the
right to make the revised or changed notice effective
for medical information we already have about you, as
well as any information we receive in the future. If
the terms of this notice are changed, Orthopedic
Surgical Consultants, P.A. will provide you with a
revised notice upon request, and we will post the
revised notice on our website and in designated
locations at Orthopedic Surgical Consultants, P.A.
Complaints
If you believe your privacy rights have been violated,
you may file a complaint with us or with the Secretary
of the Department of Health and Human Services. To file
a complaint with Orthopedic Surgical Consultants, P.A.,
contact Mary Moren, R.N., Clinic Administrator, at
952-931-9718. All complaints must be submitted in
writing. You will not be penalized for filing a
complaint.
Other Uses of Medical Information
Except as described above, Orthopedic Surgical
Consultants, P.A. will not use or disclose your
protected health information without a specific written
authorization from you. If you provide us with this
written authorization to use or disclose medical
information about you, you may revoke that
authorization, in writing, at any time. If you revoke
your authorization, we will no longer use or disclose
medical information about you for the reasons covered by
your written authorization, except to the extent we have
already relied on your authorization. We are unable to
take back any disclosures we have already made with your
permission, and we are required to retain our records of
the care that we provided to you. |
