Orthopaedic Center of
Illinois, Ltd. and Open MRI of
Illinois
Notice of Privacy Practices
|
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.
If
you have any questions about this
notice please contact our Privacy
Officer.
This
Notice of Privacy Practices
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 your protected health
information. “Protected health
information” is information about
you, including demographic
information that may identify you,
that relates to your past, present
or future physical or mental health
condition and related health
services.
We are
required to abide by the terms of
the Notice of Privacy Practices. We
may change the terms of our notice,
at any time. The new notice will be
effective for all protected health
information that we maintain at that
time. Upon your request, we will
provide you with any revised Notice
of Privacy Practices by accessing
our website (www.orthocenter.net),
calling the office and requesting
that a revised copy be sent to you
in the mail, or asking for one at
the time of your next appointment.
1.
Uses and Disclosures of Protected
Health Information
Uses and Disclosures of Protected
Health Information Based Upon Your
Written Consent
You
will be asked by your physician to
sign a consent form. Once you have
consented to use and disclosure of
your protected health information
for treatment, payment and health
care operations by signing the
consent form, your physician will
use or disclose protected health
information as described in Section
1. Your protected health
information may be used and
disclosed by your physician, our
office staff and others outside of
our office that are involved in your
care and treatment for the purpose
of providing health care services to
you. Your protected health
information may also be used and
disclosed to pay your health care
bills and to support the operation
of the physician’s practice.
Following are examples of the types
of uses and disclosures of your
protected health care information
that the physician’s office is
permitted to make once you have
signed our consent form. These
examples are not meant to be
exhaustive, but to describe the
types of uses and disclosures that
may be made by our office once you
have provided consent.
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 that has already
obtained your permission to have
access to your protected health
information. For example, we would
disclose your protected health
information, as necessary, to a home
health agency that provides care to
you. We will also disclose
protected health information to
other physicians who may be treating
you. For example, your protected
health information may be provided
to a physician to whom you have been
referred to ensure that the
physician has the necessary
information to diagnose and treat
you.
In
addition, we may disclose your
protected health information from
time-to-time to another physician or
health care provider (e.g., a
specialist or laboratory) who, at
the request of your physician,
becomes involved in your care by
providing assistance with your
health care diagnosis or treatment.
Payment:
Your
protected health information will be
used, as needed, to obtain payment
for your health care services. This
may include certain activities that
your health insurance plan may
undertake before it approves or pays
for the health care services we
recommend for you such as; making a
determination of eligibility or
coverage for insurance benefits,
reviewing services provided to you
for medical necessity, and
undertaking utilization review
activities. For example, obtaining
approval for a hospital stay may
require that your relevant protected
health information be disclosed to
the health plan to obtain approval
for the hospital admission.
Healthcare Operations:
We may
use or disclose, as needed, your
protected health information in
order to support the business
activities of your physician’s
practice. These activities include,
but are not limited to, quality
assessment activities, employee
review activities, training of
medical students, and conducting or
arranging for other business
activities.
For
example, we may disclose your
protected health information to
medical students that see patients
in our office. We may also call you
by name in the waiting room when
your physician is ready to see you.
We may disclose your protected
health information as necessary, to
contact you to remind you of your
appointment.
We
will share your protected health
information with third party
“business associates” that perform
various activities (e.g., billing,
transcription services) for the
practice. Whenever an arrangement
between our office and a business
associate involves the use or
disclosure of your protected health
information, we will have a written
contract that contains terms that
will protect the privacy of your
protected health information.
We may
use or disclose your protected
health information, as necessary, to
provide you with information about
treatment alternatives or other
health related benefits and services
that may be of interest to you. We
may also use and disclose your
protected health information for
other marketing activities. For
example, your name and address may
be used to send you a newsletter
about our practice and the services
we offer. We may also send you
information about products or
services that we believe may be
beneficial to you. You may contact
our Privacy Officer to request that
these materials not be sent to you.
Other
Permitted and Required Uses and
Disclosures That May Be Made With
Your Consent, Authorization or
Opportunity to Object
We may use and disclose your
protected health information in the
following instances. You have the
opportunity to agree or object to
the use and disclosure of all or
part of your protected health
information. If you are not present
or able to agree or object to the
use or disclosure of the protected
health information then your
physician may, using professional
judgement, determine whether the
disclosure is in your best
interest. In this case, only the
protected health information that is
relevant to your health care will be
disclosed.
Others Involved in Your Healthcare:
Unless you object, we may disclose
to a member of your family, a
relative, a close friend, or any
other person you identify, your
protected health information that
directly relates to that person’s
involvement in your health care. If
you are unable to agree or object to
such a disclosure, we may disclose
such information as necessary if we
determine that it is in your best
interest based on our professional
judgement. We may use or disclose
protected health information to
notify or assist in notifying a
family member, personal
representative or any other person
that is responsible for your care of
your location, general condition or
death. Finally, we may use or
disclose your protected health
information to an authorized public
or private entity to assist in
disaster relief efforts and to
coordinate uses and disclosures to
family or other individuals involved
in your healthcare.
Emergencies:
We may use or disclose your
protected health information in an
emergency treatment situation. If
this happens, your physician shall
try to obtain your consent as soon
as reasonably practicable after the
delivery of treatment. If your
physician or another physician in
the practice is required by law to
treat you and the physician has
attempted to obtain your consent but
is unable to obtain your consent, he
or she may still use or disclose
your protected health information to
treat you.
Communication Barriers:
We may use and disclose your
protected health information if your
physician or another physician in
the practice attempts to obtain
consent from you but is unable to do
so due to substantial communication
barriers and the physician
determines, using professional
judgement, that you intend to
consent to use or disclose under the
circumstances.
Other
Permitted and Required Uses and
Disclosures That May Be Made Without
Your Consent Or Authorization or
Opportunity to Object
We may use and disclose your
protected health information in the
following situations without your
consent or authorization. These
situations include:
Required By Law:
We may use or disclose your
protected health information to the
extent that the use or disclosure is
required by law. The use or
disclosure will be made in
compliance with the law and will be
limited to relevant requirements by
law.
Public Health:
We may disclose your protected
health information for public health
activities and purposes to a public
health authority that is permitted
by law to collect or receive the
information. The disclosure will be
made for the purpose of controlling
disease, injury or disability. We
may also disclose your protected
health information, if directed by
the public health authority, to a
foreign government agency that is
collaborating with the public health
authority.
Communicable Diseases:
We may disclose your protected
health information, if authorized by
law, to a person who may have been
exposed to a communicable disease or
may otherwise be at risk of
contracting or spreading the disease
or condition.
Health Oversight:
We may disclose protected health
information to a health oversight
agency for activities authorized by
law, such as audits, investigations,
and inspections. Oversight agencies
seeking this information include
government agencies that oversee the
health care system, government
benefit programs, other government
regulatory programs and civil rights
laws.
Abuse or Neglect:
We may use or disclose your
protected health information to a
public authority that is authorized
by law to receive reports of child
abuse or neglect. In addition, we
may disclose your protected health
information if we believe that you
have been a victim of abuse, neglect
or domestic violence to the
governmental entity or agency
authorized to receive such
information. In this case, the
disclosure will be made consistent
with the requirements of applicable
federal and state laws.
Food and Drug Administration:
We may disclose your protected
health information to a person or
company required by the Food and
Drug Administration to report
adverse events, product defects or
problems, biologic product
deviations, track products; to
enable product recalls; to make
repairs or replacements, or to
conduct post marketing surveillance,
as required.
Legal Proceedings:
We may disclose protected health
information in the course of any
judicial or administrative
proceeding, in response to an order
of a court or administrative
tribunal ( to the extent such
disclosure is expressly authorized),
in certain conditions in response to
a subpoena, discovery request or
other lawful process.
Law
Enforcement:
We may also disclose protected
health information, so long as
applicable legal requirements are
met, for law enforcement purposes.
These law enforcement purposes
include (1) legal processes and
otherwise required by law, (2)
limited information requests for
identification and location
purposes, (3) pertaining to victims
of crime, (4) suspicion that death
has occurred as a result of criminal
conduct, (5) in the event that a
crime occurs on the premises of the
practice, and (6) medical emergency
(not on the Practice’s premises) and
it is likely that a crime has
occurred.
Coroners, Funeral Directors, and
Organ Donation:
We may disclose protected health
information to a coroner or medical
examiner for identification
purposes, determining cause of death
or for the coroner or medical
examiner to perform other duties
authorized by law. We may also
disclose protected health
information to the funeral director,
as authorized by law, in order to
permit the funeral director to carry
out their 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
Research:
We may disclose your protected
health information to researchers
when their research has been
approved by an institutional review
board that has reviewed the research
proposal and established protocols
to ensure the privacy of your
protected health information.
Criminal Activity:
Consistent with applicable federal
and state laws, we may disclose your
protected health information, if we
believe that the use or disclosure
is necessary to prevent or lessen a
serious and imminent threat to the
health or safety of a person or the
public. We may also disclose
protected health information if it
is necessary for law enforcement
authorities to identify or apprehend
an individual.
Military Activity and National
Security:
When the appropriate conditions
apply, we may use or disclose
protected health information of
individuals who are Armed Forces
personnel (1) for activities deemed
necessary by appropriate military
command authorities; (2) for the
purpose of a determination by the
Department of Veterans Affairs of
your eligibility for benefits, or
(3) to foreign military authority if
you are a member of that foreign
military services. We may also
disclose your protected health
information to authorized federal
officials for conducting national
security and intelligence
activities, including for the
provision of protective services to
the President or others legally
authorized.
Worker’s Compensation:
Your protected health information
may be disclosed by us as authorized
to comply with worker’s compensation
laws and other similar
legally-established programs.
Inmates:
We may use or disclose your
protected health information if you
are an inmate of a correctional
facility and your physician created
or received your protected health
information in the course of
providing care to you.
Required Uses and Disclosures:
Under the law, we must make
disclosures to you when required by
the Secretary of Department of
Health and Human Services to
investigate or determine our
compliance with the requirements of
Section 164.500 et. Seq. of the
federal register
2.
Your Rights
Following is a statement of your
rights with respect to your
protected health information and a
brief description of how you may
exercise these rights.
You
have the right to inspect and copy
your protected health information.
This means you may inspect and
obtain a copy of protected health
information about you 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 practice uses for making
decisions about you.
Under federal law, however, you may
not inspect or copy the following
records; psychotherapy notes;
information compiled in reasonable
anticipation of, or use in, a civil,
criminal, or administrative action
or proceeding, and protected health
information that is subject to law
that prohibits access to protected
health information. Depending on
the circumstances, a decision to
deny access may be reviewable. In
some circumstances, you may have a
right to have this decision
reviewed. Please contact our
Privacy Officer if you have any
questions about access to your
medical record.
You
have the right to request a
restriction of your protected health
information.
This means you may ask us not to use
or disclose any part of your
protected health information for the
purposes of treatment, payment or
healthcare operations. In the event
of a restriction for the purpose of
payment you will become responsible
for your balance, if unpaid due to
your restriction. You may also
request that any part of your
protected health information not be
disclosed to family members or
friends who may be involved in your
care or for notification purposes as
described in the Notice of Privacy
Practices. Your request must state
the specific restriction requested
and to whom you want the restriction
to apply.
Your physician is not required to
agree to a restriction that you may
request. If the physician believes
it is in your best interest to
permit use and disclosure of your
protected health information, your
protected information will not be
restricted. If your physician 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. With this in mind,
please discuss any restriction you
wish to request with your
physician. You may request a
restriction by contacting the
Privacy Officer for assistance, or
by putting your specific restriction
request in writing and forwarding to
the Privacy Officer for proper
handling.
You
have the right to request to receive
confidential communications from us
by alternative means or at an
alternative location.
We will accommodate reasonable
requests. We may also condition
this accommodation by asking you for
information as to how payment will
be handled or specification of an
alternative address or other method
of contact. We will not request an
explanation from you as to the basis
for the request. Please make this
request in writing to our Privacy
Officer.
You
may have the right to have your
physician amend your protected
health information.
This means you may request an
amendment of protected health
information about you in a
designated record set for as long as
we maintain this information. 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 and we may
prepare a rebuttal to your statement
and will provide you with a copy of
any such rebuttal. Please contact
our Privacy Officer if you have any
questions about amending your
medical record.
You
have the right to receive an
accounting of certain disclosures we
have made, if any, of protected
health information.
This right applies to disclosures
for purposes other than treatment,
payment, or healthcare operations as
described in the Notice of Privacy
Practices. It excludes disclosures
we may have made to you, to family
members, or friends involved in your
care for notification purposes. You
have the right to receive specific
information regarding these
disclosures that occurred after
April 14, 2003. You may request a
shorter timeframe. The right to
receive this information is subject
to certain exceptions, restrictions
and limitations.
You
have the right to obtain a paper
copy of this notice from us,
upon request, even if you have
agreed to accept this notice
electronically.
3.
Complaints
You may complain to us or to the
Secretary of Health and Human
Services if you believe your privacy
rights have been violated by us.
You may file a complaint with us by
notifying our Privacy Officer of
your complaint. We will not
retaliate against you for filing a
complaint. You may contact our
Privacy Officer at 1-217-862-0624 or
www.orthocenter.net for further
information about the complaint
process.
This notice has been published and
becomes effective on January 1, 2003 |
