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Notice
of Privacy Policies
Privacy Officer: James R. Holfinger, DPM
7255 Old Oak Blvd., Suite C-308
Middleburg Hts., OH 44130
(440) 816-2735
Southwest Foot And Ankle Associates
Notice of Privacy Policies
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.
This notice describes Southwest Foot and Ankle Associates'
(SWFAA) practices relating to your medical information
and the practices of:
· Any health care professional authorized to enter
information into your medical record that is maintained
by SWFAA.
· All employees, volunteers or other Provider personnel
of SWFAA.
· Any other entities that have agreed to participate
with SWFAA for purposes of complying with the HIPAA regulations.
USES OR DISCLOSURES OF YOUR MEDICAL INFORMATION
SWFAA understands that medical information about you and
your health is personal, and SWFAA is committed to protecting
your medical information. SWFAA will create a record of
the care you receive from SWFAA. This record is necessary
in order to provide you with quality care and to comply
with legal requirements. This notice applies to all of the
records of your care generated by SWFAA or on the premises
of SWFAA.
This Notice will tell you about the ways in which SWFAA
may use and disclose your medical information. This Notice
also describes your rights and certain obligations of SWFAA
regarding the use and disclosure of your medical information.
SWFAA is required by HIPAA to:
- Maintain the privacy of your medical information in
compliance with legal requirements;
- Provide you with this Notice of SWFAA's legal duties
and privacy practices with respect to your medical information;
and
- Follow the terms of this Notice that are currently in
effect.
USE OR DISCLOSURE OF YOUR MEDICAL INFORMATION WITHOUT
YOUR CONSENT
HIPAA allows SWFAA to use or disclose your medical information
in order to:
- Provide you with services and treatment you require
or request
- Collect payment for those services
- Conduct other related health care operations otherwise
permitted or required by law
SWFAA is permitted to disclose your medical information
within and among its workforce and other entities that have
agreed to be bound by these policies. SWFAA is required
to limit such uses or disclosures to the minimal amount
of information that is reasonably necessary.
The following categories describe and give examples of
such uses and disclosures:
For Treatment: SWFAA may use medical information
about you to provide you with medical treatment or services.
SWFAA may disclose medical information about you to doctors,
nurses, technicians, volunteers, medical assistants, medical
students, residents, other SWFAA personnel or members of
its workforce who are involved in taking care of you. For
example, a doctor treating you for a broken ankle may need
to know if you have diabetes because diabetes may slow the
healing process. SWFAA may also disclose medical information
about you to people outside of SWFAA who may be involved
in your medical care, such as family members, clergy or
others whom SWFAA uses, or who you or another responsible
party has selected to provide services that are part of
your care.
For Payment: SWFAA may use and disclose medical
information about you so that the services you receive from
SWFAA can be billed to, and payment can be collected from,
you, an insurance company or third party payer. For example,
SWFAA may need to give your health plan information about
surgery you received so your health plan will pay SWFAA
for the surgery. SWFAA may also tell your health plan about
a treatment that you are going to receive to obtain prior
approval or to determine whether you plan will cover the
treatment.
For Health Care Operations: SWFAA may use and disclose
medical information about you for SWFAA operations. These
uses and disclosures are necessary to run SWFAA, to comply
with accreditation and other standards and to make sure
that all SWFAA patients receive quality care. For example,
SWFAA may use your medical information to review its treatment
and services and to evaluate the performance of SWFAA staff
in caring for you. SWFAA may disclose medical information
about you to doctors, nurses, technicians, volunteers, medical
assistants, medical students, residents, other SWFAA personnel
or members of its workforce for review, education, teaching
and learning purposes. SWFAA may combine medical information
about several SWFAA patients, or may combine the medial
information it has with the medical information from other
providers to compare how SWFAA is doing and to see where
SWFAA can make improvements in its care and services. SWFAA
may remove information that identifies you so others may
use it to study health care delivery without learning your
identity or the identity of any specific patient.
Individuals Involved In Your Care: SWFAA May release
medical information about you to a family member, or to
a personal representative or friend who is involved in your
medical care or who helps pay for your care. SWFAA may also
tell these persons about your condition or attempt to locate
or identify your family, representative or friends. SWFAA
may disclose medical information about you to an entity
assisting in a disaster relief effort so your family can
be notified about your status, location and condition. SWFAA
may make disclosures to a parent, guardian or other person
acting in place of a parent if such person has the authority
to act on behalf of a minor. SWFAA may also make disclosures
to a person appointed by you as your durable power of attorney
for health care.
Public Health Activities: SWFAA may disclose information
about you:
- To prevent or control disease, injury or disability
- To report births and deaths
- To report child abuse or neglect
- To collect or report reactions to medications, food
supplements or dietary supplements
- To collect or report product problems or defects
- To notify persons of recalls, replacements or repairs
relating to products they may be using
- To notify a person who may have been exposed to a disease
or may be at risk for contracting or spreading a disease
or condition
- To notify the appropriate government authority if SWFAA
believes an individual has been the victim of abuse, neglect
or domestic violence. SWFAA will only make this disclosure
if the individual agrees or when required or authorized
by law.
Health Oversight Activities: SWFAA may disclose
medical information to a health oversight agency for activities
authorized by law, and necessary for the government to monitor
the health care system, government programs and compliance
with civil rights laws.
As required by law: SWFAA will disclose medical
information about you when required to do so by federal,
state or local law.
To avert a serious threat to health or safety: Consistent
with Ohio law, SWFAA may use and disclose certain 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. SWFAA may use and disclose
medical information if necessary for law enforcement to
identify or apprehend and individual who has escaped from
a correctional institution or from custody.
Workers' Compensation: SWFAA may release information
about you to an agency responsible for administering and/or
adjudicating claims for Workers' Compensation or similar
programs.
Law Enforcement or Judicial or administrative proceedings:
SWFAA may disclose medical information for the following:
- To report certain types of wounds or injuries
- In response to a court order or court-ordered subpoena
or discovery request
- In response to an administrative request, if certain
standards are satisfied
- In response to a law enforcement official's request
for the purpose of identifying or locating a suspect,
fugitive, material witness or missing person
- To report a death if SWFAA has a suspicion that the
death may have resulted from criminal conduct
- About criminal conduct that occurred on SWFAA's premises
- In emergency circumstances to report: a crime; the location
of the crime or victims of the crime; or the identity,
description or location of the person who committed the
crime
For Specific Government Functions: SWFAA may release
medical information of military personnel (and foreign military
personnel) in certain situations, and SWFAA may release
the medical information of inmates to correctional facilities
in certain situations. SWFAA may also release medical information
for national security reasons or activities.
For other specific purposes, including:
- To send you treatment reminders
- To send you information about treatment alternatives
or health-related benefits and services
- For fundraising
- For research
- For Organ and Tissue Donation, if you are an organ donor
- To Coroners, Medical Examiners and funeral Directors
If Ohio law is more stringent than HIPAA, SWFAA must comply
with the more stringent provisions of Ohio law.
USE OR DISCLOSURE OF YOUR MEDICAL INFORMATION WITH YOUR
CONSENT
Under HIPAA, SWFAA may use or disclose your medical information
for other purposes not covered by this Notice or applicable
laws only with your written authorization. If you provide
SWFAA with authorization to use or disclose medical information
about you, you may revoke that authorization, in writing,
at any time. If you revoke your authorization, SWFAA will
no longer use or disclose medical information about you
for the reasons covered by your written authorization, unless
you authorized disclosure for a research study your information
is needed to protect the integrity the study.
You understand that SWFAA is unable to take back any disclosures
that have already been made with your authorization, and
that SWFAA is required to retain its records of the care
that SWFAA provides you.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
Right to inspect and copy. You have the right to
inspect and have a copy made of the medical information
contained in your designated record set. A "designated
record set" includes medical and billing records and
any other records SWFAA uses for making decisions about
you. You do not usually have the right to obtain information
compiled in reasonable anticipation of, or for use in, a
civil, criminal or administrative action or proceeding.
You must submit your request to inspect and copy medical
information in writing to the Privacy Officer. If you request
a copy of the information, SWFAA may charge a reasonable,
cost-based fee to cover the costs associated with your request.
SWFAA may deny your request in very limited circumstances.
If you are denied access to your medical information, you
may request that the denial be reviewed. Another licensed
health care professional chosen by SWFAA will review your
request and the denial. The person conducting the review
will not be the person who denied your request. SWFAA will
comply with the outcome of the review.
Right to amend. If you feel that the medical information
in the designated record set which SWFAA maintains about
you is incorrect or incomplete, you may ask SWFAA to amend
the information. You have this right for as long as the
information is kept by or for SWFAA.
You must submit your request to amend medical information
in writing to the Privacy Officer, along with a reason that
supports your request.
Your request for an amendment may be denied for the following
reasons:
- The request was not made in writing
- The request does not include a reason to support the
request
- The information was not created by SWFAA, unless the
person or entity that created the information is no longer
available to make the amendment
- The information is not kept by or for SWFAA
- The information is not part of the information which
you would be permitted to inspect and copy
- The information is accurate and complete
Right to an accounting of Certain Disclosures. You
have the right to request an accounting of certain disclosures
that SWFAA made of your medical information within six years
prior to your request. This does not apply to disclosures
for purposes of treatment, payment or healthcare operations,
as described in this Notice.
You must submit your request for disclosures of medical
information in writing to the Privacy Officer. The request
must include a specific time period which may not be longer
than six years and may not include dates prior to April
14, 2003, and should indicate in what form you want the
list (for example, on paper or electronically). The first
list you request within a 12-month period will be free.
For additional lists, SWFAA may charge a reasonable, cost-based
fee to cover the costs associated with your request. SWFAA
will notify you of the cost involved and you may choose
to withdraw or modify your request at that time before any
costs are incurred.
Right to request Restrictions. You have the right
to request a restriction or limitation on the medical information
SWFAA uses or discloses about you for treatment, payment
or healthcare operations. You also have a right to request
a limit on the medical information SWFAA uses or discloses
about you to someone who is involved in your care or the
payment for your care, like a family member or friend. For
example, you could ask that SWFAA not use or disclose information
about a surgery that you had.
SWFAA is not required to agree to your request. If SWFAA
does agree, SWFAA will comply with your request unless the
information is needed to provide you with emergency treatment.
You must submit your request for restrictions of medical
information in writing to the Privacy Officer. The request
must include:
- What information you want to limit
- Whether you want to limit SWFAA's use, disclosure or
both
- To whom you want the limits to apply, for example, disclosure
to your spouse or clergy
Right to request Confidential communications. You
have the right to request that SWFAA communicate with you
about medical matters in a certain way or at a certain location.
For example, you can ask that SWFAA only contact you at
work or by mail. The policy of SWFAA is to leave messages
at home or work indicating only the name of the person who
called, the name of the practice and the phone number for
you to return the call.
You must submit your request for confidential communications
in writing to the Privacy Officer. Your request must specify
how or where you wish to be contacted. SWFAA will not ask
you the reason for your request. SWFAA will use reasonable
efforts to accommodate all reasonable requests.
Right to a paper copy of this notice. You have the
right to receive a paper copy of this Notice. You may ask
SWFAA to give you a copy of this notice at any time. To
obtain a paper copy of this Notice please contact the Privacy
Officer.
You may obtain a copy of this notice at our website, www.
swfootandankle.com.
CHANGES TO THIS NOTICE
SWFAA reserves the right to change this notice. SWFAA reserves
the right to make the revised or changed Notice effective
for all medical information which SWFAA already has about
you as well as any information SWFAA receives or creates
in the future. The Notice will contain on the first page,
in the top right-hand corner (see the front page of this
Notice), the effective date. SWFAA will post a copy of its
current Notice at SWFAA's location and on its website www.
swfootandankle.com.
COMPLAINTS
If you believe your privacy rights have been violated, you
may file a complaint with SWFAA or with the Secretary of
the Department of Health and Human Services. To file a complaint
with SWFAA, contact the Privacy Officer. All complaints
must be submitted in writing.
You will not be penalized by SWFAA on the grounds that
a complaint was filed.
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