Notice of Privacy Practices
Alpena Orthopaedic Associates, PLLC
This Notice describes how Protected Health Information (PHI) about you may be used and disclosed and how you can get access to this information. Please read it carefully. We may change the terms of our Notice at any time. Upon your request we will provide you with a revised Notice.
We understand that the privacy of your personal information is important to you. As your physician, we believe your right to privacy is a fundamental part of your treatment; as such, we want you to understand our privacy practices and procedures. Should you have any questions regarding these policies please do not hesitate to ask our privacy official, who can be reached at (989) 356-9333 during office hours.
We collect personal information about you and your family as part of our registration process, during the course of your care, and from other health care entities you utilize such as hospitals, laboratories, other physicians, imaging facilities and your insurance company. This personal information includes items such as your name, address, phone number, birth date, social security number, employer, health history, insurance policy and coverage information and any information you provide via our website. During the course of your treatment we will collect health information regarding your diagnosis, treatment plans, progress and any test results or films.
How Your Information is Used
You will be asked to sign a one-time acknowledgement form that indicates your receipt of the Notice of Privacy Practices brochure. This form will also ask for your general consent for Alpena Orthopaedic Associates, PLLC (hereafter referred to as AOA) to use and disclose your personal health information for purposes of treatment, payment or routine healthcare operations. This means that we may provide your information to other physicians or facilities (examples: nursing homes, hospitals, home health care agencies, laboratories, pharmacies, etc.) involved in your treatment as well as to your insurance company or a collection agency to obtain payment.
AOA does not sell patient information to marketing or pharmaceutical companies. We may use your 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 use your information to send you a newsletter about our practice and services that we offer. Please contact our Privacy Official in writing 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
Others Involved in Your Healthcare: You will be asked to complete and sign a questionnaire stating family members or representatives to whom AOA can release information regarding your condition and diagnosis. If you have not had the opportunity to complete this form or are unable to agree or object to such a disclosure, then your provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your healthcare will be disclosed. This questionnaire will also ask other pertinent questions regarding correspondence, telephone calls and messages.
Emergencies: We may use or disclose your information in an emergency treatment situation. If this happens, AOA will try to obtain your consent as soon as reasonably practicable after the delivery of treatment.
Communication Barriers: We may use and disclose your information if AOA has attempted to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgment that you intend to consent under the circumstances.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
When required by law: You will be notified, as required by law, of any such uses or disclosures. We may also disclose your information so long as applicable legal requirements are met, for law enforcement purposes.
Public Health: The disclosure will be made for the purpose of controlling disease, injury or disability as permitted by law.
Communicable Diseases: We may disclose your 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 your information to a health oversight agency for activities authorized by law, such as audits, investigations & inspections.
Abuse or Neglect: We may disclose your information to a public health authority that is authorized by law to receive reports of child abuse or neglect or domestic violence as required by law.
Food & Drug Administration: We may disclose your information to a person or company required by the FDA to report adverse events, product defects or problems, to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceeding: We may disclose information in the course of any judicial or administrative proceedings, in response to an order of a court or administrative tribunal, in response to a subpoena, discovery request or other lawful process.
Coroners, Funeral Directors, and Organ Donation: For identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law and for funeral directors to carry out their duties as authorized by law.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your 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 or as necessary for law enforcement to apprehend an individual.
Military Activity and National Security: We may use or disclose information of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military command authorities, for the determination by the Department of Veterans Affairs of your eligibility for benefits or to authorized federal officials for conducting national security and intelligence activities.
Workers’ Compensation: Your information may be disclosed as authorized to comply with workers’ compensation laws. Your information may be shared with the workers’ compensation carrier, rehabilitation nurses and nurse case managers employed by your employer or the comp carrier. We may disclose your information to third party administrators hired by your employer.
Inmates: We may disclose your information if you are an inmate of a correctional facility and your physician created or received your 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 45 CFR 164.500.
Your Rights
You have the right to inspect and obtain a copy of your protected health information contained in a designated record set as long as we maintain the protected health information. There will be a reasonable fee for the cost of copying (including supplies and labor) and postage, if you request that the copy be mailed to you. All requests must be submitted in writing to our Medical Records Department. 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.
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 or the purposes of treatment, payment or healthcare operations. Your request must be made in writing to our Medical Records Department and must state the specific restriction requested and to whom you want the restriction to apply. Your provider is not required to agree to a restriction that you may request. If the provider believes it is in your best interest to permit use and disclosure of your protected health information, your information will not be restricted.
You have the right to request to receive confidential communications (not including billing statements) from us by alternative means or at an alternative location. We will accommodate reasonable requests. You must make this request in writing to our Medical Records Department. We will not ask you the reason for the request.
You have the right to amend your protected health information. To request an amendment, your request must be in writing and submitted to our Privacy Official. You will be asked to complete a “Request to Amend Protected Health Information” form. This form will become a permanent part of your designated record set. 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.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information other than for purposes of treatment, payment and healthcare operations made after April 14, 2003. It also excludes disclosures we may have made to you, to family members or friends you permitted on the patient questionnaire or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations. To request this accounting of disclosures, you must submit your request in writing to the Privacy Official. Your request must state a time period, which may not be longer than six years. The first list you request within a 12-month period will be free. There will be a fee for additional lists.
You have the right to obtain a paper copy of this Notice from us. Upon your request, we will provide you with a copy at any time.
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 Official of your complaint. All complaints must be submitted in writing. We will not retaliate against you for filing a complaint.
This Notice was published and becomes effective on March 14, 2003.
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