Center for Musculoskeletal Care
181 Waukegan Road, Suite 103
Northfield, IL. 60093
Privacy Officer: Barbara Mokrzycka-Pys
Effective Date: April 1, 2016
Notice of Privacy Practices as required by the Health Insurance Portability and Accountability Act.
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 Officer (847.999.0074).
This office understands the importance of privacy and will do the most possible to protect the confidentiality of protected health information. This practice is required by law to maintain the privacy of that information, and to abide by the terms of this Notice. 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. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. You may request a revised version by accessing our website, or calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.
HOW THE PRACTICE MAY USE AND DISCLOSE YOUR
PROTECTED HEALTH INFORMATION
The Practice, in accordance with this Notice and without asking for your express consent or authorization, may use and disclose your protected health information for the purposes of:
Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the types of uses and disclosures that may be made by our office.
Treatment: We will use and disclosure 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 another provider. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your care diagnosis or treatment to your physician.
Payment: Your protected health information will be used and disclosed, as needed to obtain payment for your health care services provided by us or by another provider. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommended 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. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
Health Care Operations: We may use or disclose, as needed, your protected health information to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. Or we may use and disclose your protected information to get your health plan to authorize services or referrals. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs and business planning and management. We may also share your protected health information with our “business associates,” such as our billing service, that perform administrative services for us. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have written contract terms that will protect the privacy of your protected health information. We may also share your information with other health care providers, health care clearinghouses or health plans that have a relationship with you, when they request this information to help them with their quality assessment and improvement activities, their patient-safety activities, their population-based efforts to improve health or reduce health costs, their protocol development, case management or care-coordination activities, their review of competence, qualifications and performance of health professionals, their training programs, their accreditation, certification or licensing activities, or their care fraud and abuse detection and compliance efforts. We may also share medical information about you with the other health care providers, health care clearinghouses and health plans that participate with us in “organized health care arrangement” (OHCAs) for any of the OHCAs’ health care operations. OHCAs include hospitals, physician organizations, health plans, and other entities, which collectively provide health care services. A listing of the OHCAs we participate in is available from the Privacy Official.
Appointment Reminders: We may use and disclose your protected health information to remind you by the telephone, text, email or mail about appointments you have with us, or to follow up on a missed or cancelled appointments.
Required By Law: We may use or disclose your protected health information to the extent that law requires the use or disclosure. 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, if required by law, of any such uses or disclosures.
Public Health: We may disclose your protected health information for public health activities and purpose to a public health authority that is permitted by law to collect or receive the information. For example, a disclosure may be made for the purpose of preventing or controlling disease, injury or disability.
Communicable Diseases: We may disclose your protected health text 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 disclosure 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. In this case the disclosure will be made consistent with the requirements of applicable federal and state law.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration for the purpose of quality, safety, or effectiveness of FDA-regulated products or activities including, to report adverse events, product defects or problems, biologic product deviation, to track products; to enable product recalls; to make repairs or replacement, or to conduct post marketing surveillance, as required.
Legal Proceedings: We may disclose protected heath 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), or in certain conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of 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 our practice, and (6) medical emergency (not on our practice’s premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose 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: We may disclose your protected health information to research when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information has approved their research.
Criminal Activity: Consistent with applicable federal and state law, 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 the 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.
Breach Notification: In case of a breach of unsecured protected health information, we will notify you as required by law. We may use e-mail or other methods as appropriate. In some circumstances our business associate may provide the notification.
Change of Ownership: In the event this practice is sold or merged with another practice, your protected health information will become the property of the new owner. However you will maintain the right to request transfer of copies to another physician.
Inmates: We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.
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 this authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your protected health information for the reason covered by your written authorization. Please understand that we are unable to take back any disclosures already made with your authorization.
Other Permitted and Required Uses and Disclosures That Require Providing You the Opportunity to Agree or 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 physician may, using professional judgment, determine whether the disclosure is in your best interest.
Facility Directories: Unless you object, we will use and disclose in our facility directory your name, the location at which you are receiving care, your general condition (such as fair or stable), and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name. Your religious affiliation will be only given to a member of a clergy, such as a priest or rabbi.
Others Involved in Your Health Care or Payment for your Care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, 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 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, general condition or death. Finally, we may disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Right to Revoke Authorization: You have a right to revoke any Authorization or consent you have given to us, at any time. To request a revocation, you must submit a written request to the Privacy Officer.
Right to Inspect and Copy: Patients have the right to inspect and copy of their medical records. This includes medical and billing records but does not include psychotherapy notes, information complied for use in a civil, criminal, or administrative action or proceeding, and protected health information to which access is prohibited by law. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, patient may have a right to have this decision reviewed. We will comply with the outcome of the review. We are required to fulfill copy requests within 30 days. We reserve the right to charge a fee for the costs of copying.
Right to Request Restrictions: Patients have the right to request a restriction or limitation on medical information we use or disclose for treatment, payment or health care operations, or to someone who is involved in the patient care or the payment for that care. Due to certain required payment and treatment operations, as well as legally required releases (e.g. subpoenas) not all requests can be fulfilled. If we do agree, we will comply with the request unless the information is needed to provide emergency treatment. To request restriction, the request must be submitted in writing to our Privacy Officer. The request must list what protected health information to limit and to whom you want the restriction to apply.
Your physician is not required to agree to a restriction that you may request. If your physician does agree to the requested restriction, we may not use or disclose your medical 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 physician.
Right to Receive Confidential Communications: Patients 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. However, the request must specify how or where the patient should be contacted. Please make this request in writing to our Privacy Officer. We reserve the right to deny a request if it imposes an unreasonable burden on the practice.
Right to Amend: If patients feel that medical information we have about them is incorrect or incomplete, they may ask us to amend the information. The request to amend must be made in writing and submitted to our Privacy Officer. In addition, a reason that supports the request to amend must be provided. We may deny the request if it is not in writing or does not include a reason to support the request. In addition, we may deny the request if the information was not created by us, is not part of medical information kept at this practice, or if we deem the amendment to be inaccurate or incomplete. If we deny the request for amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to the statement and will provide a copy of such rebuttal.
Right to an Accounting of Disclosures: You have the right to request an accounting of disclosures. This is a list of certain disclosures we have made regarding your private health records. This right applies to disclosures for purposes other than treatment, payment, or health care operations as described in the Notice of Privacy Practices. It excludes disclosures we may have made to you if you authorized us to make the disclosure, for the facility directory, to family members or friends involved in your care, or for notification purposes, for national security or intelligence, to law enforcement or correctional facilities, as part of a limited data set disclosure. The request must state the time period for which the disclosures should be accounted. This time period can be no longer than six years, and may not include dates before April 14, 2013. The first list requested within a 12-month period will be free. For additional lists, we reserve the right to charge patients for the cost of providing the list.
We do not participate in any marketing ventures that involve selling patient information to any third parties.
Right to a Paper Copy of this Notice: You have the right to obtain a paper copy of this Notice of Privacy Practices, from us, upon request, even if you have agreed to accept this notice electronically.
You may contact our Privacy Officer if you have any other questions about privacy practices.
Right to File a Complaint: If patients believe that their privacy rights have been violated, they may file a complaint with us by notifying our Privacy Officer or with the Secretary of Health and Human Services. All complaints must be submitted in writing. The complaint form may be found at www.hhs.gov/ocr/privacy/hipaa/complaints/hipcomplaint.pdf. We will not retaliate against you for filing a complaint.
Changes to this Notice of Privacy Practices: We reserve the right to change this Notice of Privacy Practices at anytime, and make the revised Notice effective for all health information that we had at the time, and any information we create or receive in the future. A revised Notice may be requested, in writing, from our Practice’s Privacy Officer.