Summary of
NOTICE OF PRIVACY PRACTICES
For GRE O&P
This summary briefly describes important information
contained in our Notice of Privacy Practices. We encourage you
to take the time to read the complete Notice, which follows this
summary.
Our 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. Your "protected health
information" means any of your written and oral health information,
including your 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.
This Notice will let you know about
the various ways we use and disclose your medical information, describe
your rights and our obligations with respect to the use or disclosure
of your medical information. We will also ask that you
acknowledge receipt of this Notice the first time you come to or use
any of our facilities, because the law requires us to make a good
faith effort to obtain your acknowledgment.
We are required by law
to:
Make sure that any medical or health information that we have that
identifies you is kept private, and will be used or disclosed only
in accord with our Notice of Privacy Practices and applicable law;
Give
you the complete Notice of our legal duties and our privacy practices;
and
Abide by the terms of the Notice of Privacy Practices that is in
effect from time to time.
NOTICE OF PRIVACY PRACTICES
For GRE O&P
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 Contact who is
Cheryl
Naft 440-285-5785.
OUR COMMITMENT TO PROTECT YOUR HEALTH INFORMATION
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. Your "protected health information"
means any of your written and oral health information, including your
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.
We are strongly committed to protecting your
medical information. We create a medical record about your care
because we need the record to provide you with appropriate treatment
and to comply with various legal requirements. We transmit some
medical information about your care in order to obtain payment for
the services you receive, and we use certain information in our day
to day operations. This Notice will let you know about
the various ways we use and disclose your medical information, describe
your rights and our obligations with respect to the use or disclosure
of your medical information. We will also ask that you
acknowledge receipt of this Notice the first time you come to or use
any of our facilities, because the law requires us to make a good
faith effort to obtain your acknowledgment.
We are required by law
to:
Make sure that any medical or health information that we have that
identifies you is kept private, and will be used or disclosed only
in accord with this Notice of Privacy Practices and applicable law;
Give
you this Notice of our legal duties and our privacy practices; and
Abide
by the terms of the Notice of Privacy Practices that is in effect
from time to time.
1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
A. Uses and Disclosures of Protected Health Information for Treatment,
Payment and Healthcare Operations
Your protected health information
may be used and disclosed by your (Orthotist or Prosthetist), our
office staff and others outside of our office who 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 this
GRE O&P.
Following are examples of the types of uses
and disclosures of your protected health care information that this
GRE O&P is permitted to make. We have provided some
examples of the types of each use or disclosure we may make, but not
every use or disclosure in any of the following categories will be
listed.
For Treatment: We will use and disclose your protected
health information to provide, coordinate, or manage your health care
and any related treatment. 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 the physician that referred you to us. We will also disclose protected
health information to other health care providers who may be treating
you when we have the necessary permission from you to disclose your
protected health information.
For 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. We may also tell your health plan about an orthotic
or prosthetic device you are going to receive to obtain prior approval
or to determine whether your plan will cover the device.
For Healthcare
Operations: We may use or disclose, as needed, your protected
health information in order to support the business activities of
this GRE O&P. These activities include, but are not limited
to, quality assessment activities, employee review activities, legal
services, licensing, and conducting or arranging for other business
activities. We may share your protected health information with
third party “business associates” that perform various activities
(e.g., billing, transcription services) for this GRE O&P. Whenever
an arrangement between our GRE O&P and our 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.
Treatment Alternatives:
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.
Appointment Reminders: We may use or disclose your protected health
information, as necessary, to contact you to remind you of your appointment.
Sign In Sheets: We may use a sign-in sheet at the registration
desk where you will be asked to sign your name. We may also call you
by name in the waiting room when your (Orthotist or Prosthetist) is
ready to see you.
Marketing and Health Related Benefits and Services:
We may also use and disclose your potected health information for
other marketing activities. For example, we may send you information
about products or services that we believe may be beneficial to you.
You may contact our Privacy Contact to request that these materials
not be sent to you.
Sale of the Practice: If we decide
to sell this practice or merge or combine with another practice, we
may share your protected health information with the new owners.
B.
Uses and Disclosures of Protected Health Information Based upon Your
Written Authorization
Other uses and disclosures of your protected
health information will be made only with your written authorization,
unless otherwise permitted or required by law as described below.
You may revoke your authorization, at any time, in writing. You understand that we can not take back any use or disclosure we
may have made under the authorization before we received your written
revocation, and that we are required to maintain a record of the medical
care that has been provided to you. The authorization is a separate
document, and you will have the opportunity to review any authorization
before you sign it. We will not condition your treatment in
any way on whether or not you sign any authorization.
C. Other Permitted
and Required Uses and Disclosures That May Be Made Either With Your
Agreement or the 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 or 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 (Orthotist or Prosthetist) may, using
their professional judgment, 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, orally or in writing, 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 judgment. We may
use or disclose your 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 or general
condition.
D. Other Permitted and Required Uses and Disclosures That
May Be Made Without Your Authorization or Opportunity to Object
We
may use or disclose your protected health information in the following
situations without your authorization or providing you the opportunity
to object.
Required By Law: We may use or disclose your protected
health information to the extent that the use or disclosure is required
by federal, state or local law. The use or disclosure will be made
in compliance with the law and will be limited to the relevant requirements
of the law. You will be notified, as required by law, of any such
uses or disclosures.
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. A disclosure under this
exception would only be made to somebody in a position to help prevent
the threat to public health
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 disclose your protected health information
to a public health 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. We will only make
this disclosure if you agree or when required or authorized by law. In this case, the disclosure will be made consistent with the requirements
of applicable federal and state laws.
Military and Veterans: If you
are a member of the military, we may release protected health information
about you as required by military command authorities.
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 your 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 your protected health information,
so long as applicable legal requirements are met, for law enforcement
purposes. These law enforcement purposes might include (1) legal processes
and otherwise required by law, (2) limited information requests for
identification and location purposes, (3) pertaining to victims of
a 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 GRE O&P’s premises)
and it is likely that a crime has occurred.
Coroners, Funeral Directors,
and Organ Donation: We may disclose your 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 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.
Research: Under certain circumstances, 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.
Workers’ Compensation: We may disclose your protected health information as authorized
to comply with workers’ compensation laws and other similar legally-established
programs that provide benefits for work-related illnesses and injuries.
Inmates: We may use or disclose your protected health information
if you are an inmate of a correctional facility and your (Orthotist
or Prosthetist) 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 and when required by the
Secretary of the Department of Health and Human Services to investigate
or determine our compliance with the requirements of the final rule
on Standards for Privacy of Individually Identifiable Health Information.
2.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
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 your protected health
information contained in your medical and billing records and any
other records that your (Orthotist or Prosthetist) uses for making
decisions about you, for as long as we maintain the protected health
information.
To inspect and copy your medical information, you must
submit a written request to the Privacy Contact listed on the first
and 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.
We may
deny your request in limited situations specified in the law. For example, you may not inspect or copy psychotherapy notes; or information
compiled in reasonable anticipation of, or use in, a civil, criminal,
or administrative action or proceeding, and certain other specified
protected health information defined by law. In some circumstances,
you may have a right to have this decision reviewed. The
person conducting the review will not be the person who initially
denied your request. We will comply with the decision in any
review. Please contact our Privacy Contact if you have 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.
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 this Notice
of Privacy Practices. Your request must state the specific restriction
requested and to whom you want the restriction to apply.
Your (Orthotist
or Prosthetist) is not required to agree to a restriction that you
may request. If the (Orthotist or Prosthetist) believes it is in your
best interest to permit use and disclosure of your protected health
information, your protected health information will not be restricted.
If your (Orthotist or Prosthetist) 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 (Orthotist or Prosthetist). You may request a restriction
by submitting your request in writing to our Privacy Contact.
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 Contact.
You may have the right to have your (Orthotist or Prosthetist) amend
your protected health information. This means you may request an amendment
of your protected health information contained in your medical and
billing records and any other records that your (Orthotist or Prosthetist)
uses for making decisions about you, for as long as we maintain the
protected health information. You must make your request for
amendment in writing to our Privacy Contact, and provide the reason
or reasons that support your request.
We may deny any request that
is not in writing or does not state a reason supporting the request. We may deny your request for an amendment of any information that:
1. Was
not created by us, unless the person that created the information
is no longer available to amend the information;
2. Is not part of the protected health information kept by or for us;
3. Is not part of the information you would be permitted to inspect or
copy; or
4. Is accurate
and complete.
If we deny your request for amendment, we will do so
in writing and explain the basis for the denial. You have the
right to file a written statement of disagreement with us. We may prepare a rebuttal to your statement and will provide you with
a copy of any such rebuttal. Please contact our Privacy Contact
to determine if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures
we have made, if any, of your protected health information. This right
only applies to disclosures for purposes other than treatment, payment
or healthcare operations as described in this Notice of Privacy Practices.
It also excludes disclosures we may have made to you, to family members
or friends involved in your care, or for notification purposes. You
have the right to receive specific information regarding these disclosures
that occurred after April 14, 2003. The right to receive this information
is subject to certain exceptions, restrictions and limitations. You must submit a written request for disclosures in writing to the
Privacy Contact. You must specify a time period, which may not
be longer than six years and cannot include any date before April
14, 2003. You may request a shorter timeframe. Your request
should indicate the form in which you want the list (i.e., on paper,
etc). You have the right to one free request within any 12 month
period, but we may charge you for any additional requests in the same
12 month period. We will notify you about the charges you will
be required to pay, and you are free to withdraw or modify your request
in writing before any charges are incurred.
You have the right to obtain
a paper copy of this notice from us, upon request to our Privacy Contact,
or in person at our office, at any time, 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 contact of your
complaint. We will not retaliate against you in any way for
filing a complaint, either with us or with the Secretary.
You may contact
our Privacy Contact, Cheryl Naft at (440) 285-5785 or cnaft@greop.com for
further information about the complaint process.
4. CHANGES
TO THIS NOTICE
We reserve the right to change the privacy practices
that are described in this Notice of Privacy Practices. We also reserve
the right to apply these changes retroactively to Protected Health
Information received before the change in privacy practices. You may
obtain a revised Notice of Privacy Practices by calling the office
and requesting a revised copy be sent in the mail, asking for one
at the time of your next appointment, or accessing our website
This
notice was published and becomes effective on March 13, 2003.