Chesapeake Orthopaedic and Sports Medicine Center HIPAA Notice

Our Commitment Regarding Health Information
We understand that health information about you and your health care is personal. We are committed to protecting health information about you. This notice applies to all of the records of your care generated by this health care practice, whether made by your personal physician or others working in this practice. This notice will tell you about the ways in which we may use and disclose health information about you and your rights to your health information are also described.

Understanding Your “Medical Record”
A record is made each time you visit a physician, hospital, or other health care provider. Your symptoms, examination and test results, diagnoses, treatment, and a plan for future care are recorded. This information is most often referred to as your “Medical Record”, and serves as a basis for planning your care and treatment. It also serves as a means of communication among any and all other health care professionals who may contribute to your care. Understanding what information is retained in your medical record and how that information may be used will help you to ensure its accuracy, and enable you to relate to who, what, when, where, and why others may be allowed access to your health information. Your medical record is the physical property of the health care practitioner of the facility that compiled it but the content is about you, and therefore belongs to you. This effort is being made to assist you in making informed decisions before authorizing the disclosure of you health information to others.

We are required by law to:

• Maintain the privacy of your health information
• Provide you with a notice of our legal commitment and privacy practices with respect to the information we collect and maintain about you;
• Abide by the terms of this notice and to notify you if we are unable to grant requested restrictions or reasonable desires to communicate your health information by alternative means or to alternative locations.

How We May Use & Disclose Health Information About You
The following categories describe different ways that we use and disclose health information. For each category of use or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. All of the ways we are permitted to use and disclose information will fall within one of the categories.

Treatment - We may use health information about you to provide you with medical treatment or services. We may disclose health information about you to physicians, nurses, technicians, medical students or other personnel involved in taking care of you. They may work at our office, at the hospital, or at another physicians’ s office, lab, pharmacy, or other health care provider to whom we may refer you for consultations, to have prescriptions filled, or for other treatment purposes. For example, a physician treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the physician may need to tell the hospital’s food service if you have diabetes so that we can arrange for appropriate meals. We may also disclose health information about you to transport companies, community agencies and family members.

Payment - We may use and disclose health information about you so that the treatment and services you receive from us may be billed to and payment collected from you, an insurance carrier, or a third party payer. For example, we may need to give your health insurance information about your office visit in order for your health insurance to pay us or reimburse you for the visit. We may also tell your health insurance about a surgery that you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

Health Care Operations - We may use and disclose health information about you for operations of our medical practice. These uses and disclosures are necessary to assess the care you received and the outcome of your case compared to others like it. Your information may be reviewed for risk management or quality improvement in our efforts to continually improve the quality and effectiveness of the care and services we provide. We may remove information that identifies you from this set of health information so others may use it to study health delivery without learning the names of our patients.

Appointment Reminders - We may use and disclose health information to contact you as a reminder that you have an appointment. Please let us know if you do not wish to have us contact you concerning your appointment, or if you wish to have us use a different telephone number or address to contact you for this purpose.

As Required By Law - We will disclose health information about you when required to do so by federal, state, or local law.

Military Personnel - If you are a member of the armed forces, we may release health information about you to military authorities as authorized or required by law. We also may release information about foreign military personnel to the appropriate military authority as authorized or required by law.

Research - All research projects must be approved through a special process to protect patient safety, welfare and confidentiality. Your health information may be important to further research efforts and the development of new knowledge. We may use and disclose health information about our patients for research purposes under specific rules determined by the confidentiality provisions of federal and state law. We will always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or who will be involved in your care.

To Avert a Serious Threat to Health or Safety - We may use and disclose health information about you when necessary to prevent or lessen a serious and imminent threat to your health and safety or the health and safety of the public or another person. Any disclosure would be to help stop or reduce the threat.

Public Health Risks - We may disclose health information about you for public health activities. These activities generally include the following:

• To prevent or control disease, injury or disability;
• To report births and deaths;
• To report child abuse or neglect;
• To report reactions to medications or problems with products;
• 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: or
• To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Lawsuits and Disputes - We may disclose health information to courts, attorneys and court employees when we get a court order, subpoena, discovery request, warrant, summons or other lawful instructions from those courts or public bodies and in the course of certain other lawful, judicial or administrative proceedings.

Law Enforcement - We may release health information if asked to do so by law enforcement, and as authorized by law. We may disclose health information in response to a court order, subpoena, warrant, summons or similar process to identify or locate a suspect, fugitive, material witness, or missing person. About criminal conduct at our facility or in emergency circumstances to report a crime; the location of the crime or victim(s); or the identity, description, or location of the person who committed the crime.

Coroners, Health Examiners and Funeral Directors - We may release health information to a coroner or health examiner. This may be necessary, for example, to identity a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities - We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the U.S. President and Others - We may disclose health information about you as authorized or required by law. We may release health information about you for intelligence, counterintelligence, and other national security activities.

Your Rights Regarding Health Information About You
Your health information is the property of Chesapeake Orthopaedic & Sports Medicine Center. You have the following rights regarding health information we maintain about you:

• Right to Inspect and Copy - You have the right to inspect and to obtain a copy of your health information with certain exceptions (psychotherapy notes, information collected for certain legal proceedings, and health information restricted by law). You must submit your request in writing. We may charge you a reasonable fee for copying your records. We may deny your request in certain very limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed. Another licensed health care professional chosen by our practice, but who did not participate in the original decision to deny access, will review your request and the denial. We will comply with the outcome of the review.

• Right to Amend - If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information or add an addendum. You have the right to request an amendment or addendum for as long as the information is kept by or for Chesapeake Orthopaedic & Sports Medicine Center. To request an amendment or addendum, your request must be made in writing. If we accept your request, we will tell you we agree and we will amend your records. We cannot take our what is in the record. We add the supplemental information. With your help, we will notify others who have the incorrect or incomplete health information. We may deny your request for an amendment or addendum if it is not in writing or does not include a reason to support the request. If we deny your request, we will give you a written explanation of why we did not make the amendment and explain your rights. We may deny your request if you ask us to amend health information that:
  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.
  • Is not part of the health information kept by or for our practice.
  • 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 a list of the disclosures of your health information we have made, except for: uses and disclosures for treatment, payment, and health care operations, as previously described, disclosures to you, disclosure to persons involved in your care, disclosure for national security or intelligence purpose, disclosure to correctional institutions or law enforcement official, and disclosures that occurred prior to April 14, 2003. You must state the time period for which you want to receive the account, which may not be longer that six years. The first list of disclosures you request in a 12-month period will be free. We will mail you a list of disclosures in paper form within 30 days of your request or notify you if we are unable to supply the list within the time period and by what date we can supply the list. This date will not exceed a total of 60 days from the date of your request. For the request of additional lists in that period, we will assess a fee of $25.00.

Right to Request Restrictions - You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information to a family member about a surgery that you had. You must submit a written request in which you tell us what information you want to omit and to whom you want the limits to apply. We are not required to agree to your request for restrictions if is not feasible for us to ensure our compliance or believe it will negatively impact the care we may provide you. If we do agree, our agreement must be in writing, and we will comply with your request unless the information is needed to provide you emergency treatment or we are required by law to disclose it. We are allowed to end the restriction if we tell you. If we end the restriction, it will only effect health information that was created or received after we notify you.

Right to Request Confidential Communications - You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For example, you may ask that we only contact you at home or by mail to a post office box. To request confidential communications, you must make your request in writing. You will need to give us details about how to contact you, including a valid alternative address. You will also need to give us information as to how billing will be handled. We will honor reasonable requests. However, if we are unable to contact you using the requested ways or locations, we may contact you using any information we have available.

Right to a Paper Copy of the Notice - You have a right to obtain a paper copy of this notice at any time. Copies of this notice will be available throughout Chesapeake Orthopaedic & Sports Medicine Center.

Rights Of Your Medical Provider

Changes to the Notice - We reserved the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facility. The paper copy of the notice will contain on the first page, in the top right-hand corner, the effective date. In addition, at any time you may request a copy of the notice currently in effect.

Our Right to Check Your Identity - For your protection, we may check your identity whenever you have questions about your treatment or billing activities. We will check your identity whenever we get a request to look at, copy or amend your records, or to obtain a list of disclosures of your health information. Forms for each of these requests will be available.

Other Uses of Health Information - We will release health information for other uses and disclosures not covered by this notice or the laws that apply to us only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time.

Revoking Your Permission - If you revoke permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. Please be aware that we are not able to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

If you believe that your privacy rights have not been followed as directed by federal regulations and state law or as explained in the notice, you may file a written complaint with us. Please send the complaint to the Administrator of Chesapeake Orthopaedic & Sports Medicine Center at the address provided below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint.

If you have any question or would like further information about Chesapeake Orthopaedic’s HIPAA notice, please contact:

Administrator
Chesapeake Orthopaedic & Sports Medicine Center
200 Hospital Drive Suite #306
Glen Burnie, MD 21061
Phone: 410-768-5555

Chesapeake Orthopaedic & Sports Medicine Center HIPAA notice is effective November 1, 2003