Notice of Privacy Practices For:
Michael W. Higgins, D.O., PA,
DBA Hernando Orthopaedic and Spinal Surgery
(referred to in this document as “the provider”)
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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.
This Notice of Privacy Practices is being provided to you as a requirement
of the Health Insurance Portability and Accountability Act (HIPAA). This
Notice 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 in some
cases. Your "protected health information" means any of your written and
oral health information, including demographic data that can be used to
identify you. This is health information that is created or received by your
health care provider, and that relates to your past, present or future
physical or mental health or condition.
I. Uses and Disclosures of Protected Health Information
The provider may use your protected health information for purposes of
providing treatment, obtaining payment for treatment, and conducting health
care operations. Your protected health information may be used or disclosed
only for these purposes unless the Provider has obtained your authorization
or the use or disclosure is otherwise permitted by the HIPAA Privacy
Regulations or State law. Disclosures of your protected health information
for the purposes described in this Notice may be made in writing, orally, or
by facsimile.
A.
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 for treatment purposes. For example, we may
disclose your protected health information to a pharmacy to fulfill a
prescription, to a laboratory to order a blood test, or to a home health
agency that is providing care in your home. We may also disclose protected
health information to other physicians who may be treating you or consulting
with your physician with respect to your care. In some cases, we may also
disclose your protected health information to an outside treatment provider
for purposes of the treatment activities of the other provider.
B.
Payment. Your protected health information will be used, as needed,
to obtain payment for the services that we provide. This may include certain
communications to your health insurer to get approval for the treatment that
we recommend. For example, if a hospital admission is recommended, we may
need to disclose information to your health insurer to get prior approval
for the hospitalization. We may also disclose protected health information
to your insurance company to determine whether you are eligible for benefits
or whether a particular service is covered under your health plan. In order
to get payment for your services, we may also need to disclose your
protected health information to your insurance company to demonstrate the
medical necessity of the services or, as required by your insurance company,
for utilization review. We may also disclose patient information to another
provider involved in your care for the other provider’s payment activities.
C.
Operations. We may use or disclose your protected health
information, as necessary, for our own health care operations in order to
facilitate the function of the provider and to provide quality care to all
patients. Health care operations include such activities as:
- Quality assessment and improvement activities.
- Employee review activities.
- Training programs including those in which students, trainees, or practitioners in health care learn under supervision.
- Accreditation, certification, licensing or credentialing activities.
- Review and auditing, including compliance reviews, medical reviews, legal services and maintaining compliance programs.
- Business management and general administrative activities.
In certain situations, we may also disclose patient information to another
provider or health plan for their health care operations.
D. Other Uses and Disclosures. As part of treatment, payment and healthcare
operations, we may also use or disclose your protected health information
for the following purposes:
- To remind you of an appointment.
- To inform you of potential treatment alternatives or options.
- To inform you of health-related benefits or services that may be of interest to you.
II. Uses and Disclosures Beyond Treatment, Payment, and Health Care
Operations Permitted Without Authorization or Opportunity to Object
Federal privacy rules allow us to use or disclose your protected health
information without your permission or authorization for a number of reasons
including the following:
A. When Legally Required. We will disclose your protected health information
when we are required to do so by any Federal, State or local law.
B. When There Are Risks to Public Health. We may disclose your protected
health information for the following public activities and purposes:
- To prevent, control, or report disease, injury or disability as permitted by law.
- To report vital events such as birth or death as permitted or required by law.
- To conduct public health surveillance, investigations and interventions as permitted or required by law.
- To collect or report adverse events and product defects, track FDA regulated products, enable product recalls, repairs or replacements to the FDA and to conduct post marketing surveillance.
- To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law.
- To report to an employer information about an individual who is a member of the workforce as legally permitted or required.
C. To Report Abuse, Neglect Or Domestic Violence. We may notify government
authorities if we believe that a patient is the victim of abuse, neglect or
domestic violence. We will make this disclosure only when specifically
required or authorized by law or when the patient agrees to the disclosure.
D. To Conduct Health Oversight Activities. We may disclose your protected
health information to a health oversight agency for activities including
audits; civil, administrative, or criminal investigations, proceedings, or
actions; inspections; licensure or disciplinary actions; or other activities
necessary for appropriate oversight as authorized by law. We will not
disclose your health information if you are the subject of an investigation
and your health information is not directly related to your receipt of
health care or public benefits.
E. In Connection With Judicial And Administrative Proceedings. We may
disclose your protected health information in the course of any judicial or
administrative proceeding in response to an order of a court or
administrative tribunal as expressly authorized by such order or in response
to a subpoena in some circumstances.
F. For Law Enforcement Purposes. We may disclose your protected health
information to a law enforcement official for law enforcement purposes as
follows:
- As required by law for reporting of certain types of wounds or other physical injuries.
- Pursuant to court order, court-ordered warrant, subpoena, summons or similar process.
- For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
- Under certain limited circumstances, when you are the victim of a crime.
- To a law enforcement official if the provider has a suspicion that your death was the result of criminal conduct.
- In an emergency in order to report a crime.
G. To Coroners, Funeral Directors, and for Organ Donation. We may disclose
protected health information to a coroner or medical examiner for
identification purposes, to determine 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 a 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.
H. For Research Purposes. We may use or disclose your protected health
information for research when the use or disclosure for research has been
approved by an institutional review board or privacy board that has reviewed
the research proposal and research protocols to address the privacy of your
protected health information.
I. In the Event of A Serious Threat To Health Or Safety. We may, consistent
with applicable law and ethical standards of conduct, use or disclose your
protected health information if we believe, in good faith, that such use or
disclosure is necessary to prevent or lessen a serious and imminent threat
to your health or safety or to the health and safety of the public.
J. For Specified Government Functions. In certain circumstances, the Federal
regulations authorize the provider to use or disclose your protected health
information to facilitate specified government functions relating to
military and veterans activities, national security and intelligence
activities, protective services for the President and others, medical
suitability determinations, correctional institutions, and law enforcement
custodial situations.
K. For Worker's Compensation. The provider may release your health
information to comply with worker's compensation laws or similar programs.
III. Uses and Disclosures Permitted Without Authorization But With
Opportunity to Object
We may disclose your protected health information to your family member or a
close personal friend if it is directly relevant to the person’s involvement
in your care or payment related to your care. We can also disclose your
information in connection with trying to locate or notify family members or
others involved in your care concerning your location, condition or death.
You may object to these disclosures. If you do not object to these
disclosures or we can infer from the circumstances that you do not object or
we determine, in the exercise of our professional judgment, that it is in
your best interests for us to make disclosure of information that is
directly relevant to the person’s involvement with your care, we may
disclose your protected health information as described.
IV. Uses and Disclosures Which You Authorize
Other than as stated above, we will not disclose your health information
other than with your written authorization. You may revoke your
authorization in writing at any time except to the extent that we have taken
action in reliance upon the authorization.
V. Your Rights
You have the following rights regarding your health information:
A. The right to inspect and copy your protected health information. You may
inspect and obtain a copy of your protected health information 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 provider
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 for use in, a civil, criminal, or administrative action
or proceeding; and protected health information that is subject to a law
that prohibits access to protected health information. Depending on the
circumstances, you may have the right to have a decision to deny access
reviewed.
We may deny your request to inspect or copy your protected health
information if, in our professional judgment, we determine that the access
requested is likely to endanger your life or safety or that of another
person, or that it is likely to cause substantial harm to another person
referenced within the information. You have the right to request a review of
this decision.
To inspect and copy your medical information, you must submit a written
request to the Privacy Officer whose contact information is listed on the
last pages of this Notice. If you request a copy of your information, we may
charge you a fee for the costs of copying, mailing or other costs incurred
by us in complying with your request.
Please contact our Privacy Officer if you have questions about access to
your medical record.
B. The right to request a restriction on uses and disclosures of your
protected health information. You may ask us not to use or disclose certain
parts of your protected health information for the purposes of treatment,
payment or health care operations. You may also request that we not disclose
your health information to family members or friends who may be involved in
your care or for notification purposes as described in this Notice of
Privacy Practices. Your request must state the specific restriction
requested and to whom you want the restriction to apply.
The provider is not required to agree to a restriction that you may request.
We will notify you if we deny your request to a restriction. If the provider
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. Under certain circumstances, we may
terminate our agreement to a restriction. You may request a restriction by
contacting the Privacy Officer.
C. The right to request to receive confidential communications from us by
alternative means or at an alternative location. You have the right to
request that we communicate with you in certain ways. We will accommodate
reasonable requests. We may 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 require you to
provide an explanation for your request. Requests must be made in writing to
our Privacy Officer.
D. The right to have your physician amend your protected health information.
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. Requests for amendment
must be in writing and must be directed to our Privacy Officer. In this
written request, you must also provide a reason to support the requested
amendments.
E. The right to receive an accounting. You have the right to request an
accounting of certain disclosures of your protected health information made
by the provider. This right applies to disclosures for purposes other than
treatment, payment or health care operations as described in this Notice of
Privacy Practices. We are also not required to account for disclosures that
you requested, disclosures that you agreed to by signing an authorization
form, disclosures for a facility directory, to friends or family members
involved in your care, or certain other disclosures we are permitted to make
without your authorization. The request for an accounting must be made in
writing to our Privacy Officer. The request should specify the time period
sought for the accounting. We are not required to provide an accounting for
disclosures that take place prior to January 3, 2005. Accounting requests
may not be made for periods of time in excess of six years. We will provide
the first accounting you request during any 12-month period without charge.
Subsequent accounting requests may be subject to a reasonable cost-based
fee.
F. The right to obtain a paper copy of this notice. Upon request, we will
provide a separate paper copy of this notice even if you have already
received a copy of the notice or have agreed to accept this notice
electronically.
VI. Our Duties
The provider is required by law to maintain the privacy of your health
information and to provide you with this Notice of our duties and privacy
practices. We are required to abide by terms of this Notice as may be
amended from time to time. We reserve the right to change the terms of this
Notice and to make the new Notice provisions effective for all protected
health information that we maintain. If the provider changes its Notice, we
will provide a copy of the revised Notice by sending a copy of the Revised
Notice via regular mail or through in-person contact.
VII. Complaints
You have the right to express complaints to the provider and to the
Secretary of Health and Human Services if you believe that your privacy
rights have been violated. You may complain to the provider by contacting
the provider’s Privacy Officer verbally or in writing, using the contact
information below. We encourage you to express any concerns you may have
regarding the privacy of your information. You will not be retaliated
against in any way for filing a complaint.
VIII. Contact Person
The provider’s contact person for all issues regarding patient privacy and
your rights under the Federal privacy standards is the Privacy Officer.
Information regarding matters covered by this Notice can be requested by
contacting the Privacy Officer. Complaints against the provider can be
mailed to the Privacy Officer by sending it to:
Hernando Orthopaedic & Spinal Surgery
4055 Mariner Blvd.
Spring Hill, FL 34609
ATTN: Privacy Officer
The Privacy Officer can be contacted by telephone at (352) 688-6035
IX. Effective Date
This Notice is effective January 03, 2005.
