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PATIENT PRIVACY NOTICE Effective Date: April 14, 2003 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 office at telephone number
(405) 748-6600, or come by our office at 10914 Hefner Pointe Drive,
Suite 200, Oklahoma City, Oklahoma 73120, during our business hours. WHO
WILL FOLLOW THIS NOTICE: This notice describes our
office's practices and that of: Any health care professional authorized
to enter information into your file or record.
All employees, staff and other personnel. OUR
PLEDGE REGARDING MEDICAL INFORMATION: We understand that medical
information about you and your health is personal.
We are committed to protecting medical information about you.
We create a record of the care and services you receive in our
practice. We need this
record to provide you with quality care and to comply with certain legal
requirements. This notice
applies to all of the records of your care. This notice will tell you
about the ways in which we may use and disclose medical information
about you. It also
describes your rights and certain obligations we have regarding the use
and disclosure of medical information. We are required by law to: $
make sure that medical information that identifies you is kept
private; $
give you this notice of our legal duties and privacy practices
with respect to protected medical information about you;
and $
follow the terms of the notice that is currently in effect. HOW
WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION. The following categories
describe different ways that we use and disclose protected medical
information. For each
category of uses or disclosures we will explain what we mean.
Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose
information will fall within one of the categories. For
Treatment:
We may use protected medical information about you to provide you
with medical treatment or services.
We may disclose protected medical information about you to
doctors, nurses, technicians, medical students, pharmacists, or other
personnel who are involved in taking care of you.
Different departments of our practice also may share medical
information about you in order to coordinate the different things you
need, such as prescriptions, lab work and x-rays.
We also may disclose protected medical information about you to
people outside the practice who may be involved in your medical care,
such as family members or others we use to provide services that are
part of your care. For
Payment:
We may use and disclose protected medical information about you
so that the treatment and services you receive may be billed to and
payment may be collected from you, an insurance company or a third
party. For example, we may
need to give your health plan information about treatment you received
so your health plan will pay us or reimburse you.
We may also tell your health plan about a treatment you are going
to receive to obtain prior approval or to determine whether your plan
will cover the treatment. We also may use and disclose your information
to obtain payment from third parties that may be responsible for such
costs, such as family members. And we may use your information to bill
you directly for services and items. Appointment
Reminders: We
may use and disclose protected medical information to contact you as a
reminder that you have an appointment for treatment or medical care. Treatment
Alternatives: We may use and disclose protected medical
information to tell you about or recommend possible treatment options or
alternatives that may be of interest to you. Health-Related
Benefits and Services: We
may use and disclose protected medical information to tell you about
health-related benefits or services that may be of interest to you. Individuals
Involved in Your Care or Payment for Your Care:
We may release protected medical information about you to a
friend or family member who is involved in your medical care.
We may also give information to someone who helps pay for your
care. We may also tell your
family or friends your condition. In addition, we may disclose protected medical information
about you to an entity assisting in a disaster relief effort so that
your family can be notified about your condition, status and location. Research:
Under certain circumstances, we may use and disclose protected
medical information about you for research purposes.
For example, a research project may involve comparing the health
and recovery of all patients who received one medication to those who
received another, for the same condition.
All research projects, however, are subject to a special approval
process. This process
evaluates a proposed research project and its use of medical
information, trying to balance the research needs with patients' need
for privacy of their medical information.
Before we use or disclose medical information for research, the
project will have been approved through this research approval process,
but we may, however, disclose medical information about you to people
preparing to conduct a research project, for example, to help them look
for patients with specific medical needs.
We will almost 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 will be involved in your care in our
practice. As
Required by Law: We
will disclose protected medical information about you when required to
do so by federal, state or local law. To
Avert a Serious Threat to Health or Safety:
We may use and disclose protected medical information about you
when necessary to prevent a serious threat to your health and safety or
the health and safety of the public or another person.
Any disclosure, however, would only be to someone able to help
prevent the threat. SPECIAL
SITUATIONS. Organ
and Tissue Donation: If
you are an organ donor, we may release protected medical information to
organizations that handle organ procurement or organ, eye or tissue
transplantation or to an organ donation bank, as necessary to facilitate
organ or tissue donation and transplantation. Military
and Veterans: If
you are a member of the armed forces, we may release protected medical
information about you as required by military command authorities.
We may also release protected medical information to a foreign
military authority, if you are in their service. Workers'
Compensation: We
may release protected medical information about you for workers'
compensation or similar programs. These
programs provide benefits for work-related injuries or illness.
Release of such information is controlled by state and/or federal
law. Public
Health Risks: We
may disclose protected medical 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 a known or suspected crime; $
to report child abuse or neglect; $
to report vulnerable adult abuse; $
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; $
to notify the appropriate government authority if we believe a
patient has been the victim of domestic violence.
We will only make this disclosure if you agree or when required
or authorized by law. Health
Oversight Activities: We
may disclose protected medical information to a health oversight agency
for activities authorized by law. These
oversight activities include, for example, audits, investigations,
inspections, and licensure. These
activities are necessary for the government to monitor the health care
system, government programs, and compliance with civil rights laws. Lawsuits
and Disputes: If
you are involved in a lawsuit or a dispute, we may disclose protected
medical information about you in response to a subpoena, discovery
request, or other lawful process by someone else involved in the
dispute, but only if efforts have been made to tell you about the
request or to obtain an order protecting the information requested. Law
Enforcement: We
may release protected medical information if asked to do so by a law
enforcement official: $
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 the victim of a crime if, under certain limited
circumstances, we are unable to obtain the person's agreement; $
about a death we believe maybe the result of criminal conduct; $
about criminal conduct involving our practice; and $
in emergency circumstances to report a crime; the location of the
crime or victims; or the identity, description or location of the person
who committed the crime. Medical
Examiners and Funeral Directors:
We may release protected medical information to a medical
examiner. This may be
necessary, for example, to identify a deceased person or determine the
cause of death. We may also
release protected medical information about patients to funeral
directors as necessary to carry out their duties. National
Security and Intelligence Activities:
We may release protected medical information about you to
authorized federal officials for intelligence, counterintelligence, and
other national security activities authorized by law. Protective
Services for the President and Others:
We may disclose protected information about you to authorized
federal officials so they may provide protection to the President, other
authorized persons or foreign heads of state or conduct special
investigations. Inmates:
If you are an inmate of a
correctional institution or under the custody of a law enforcement
official, we may release protected medical information about you to the
correctional institution or law enforcement official.
This release would be necessary (1) for this practice to provide
you with health care; (2) to protect your health and safety or the
health and safety of others; or (3) for the safety and security of the
correctional institution. YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU. You have the following rights
regarding protected medical information we maintain about you: Right
to Inspect and Copy: You
have the right to inspect and copy medical information that may be used
to make decisions about your care.
This includes medical and billing records, but does not include
psychotherapy notes. To inspect and/or copy your
medical information, you must submit your request to our office. If you request
a copy of the information, we may charge a fee for the costs of copying,
mailing or other supplies associated with your request.
(By statute in Oklahoma we may charge you $1.00 for the first
page and 50¢ for each subsequent page for copies, plus our postage
costs. If your record contains any item that requires a photographic
process to copy, such as an x-ray or photograph, we may charge you up to
$5.00 per image.) 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.
You have the right to request an amendment for as long as the
information is kept by our practice. To request an amendment, your
request must be made in writing and submitted to our office.
In addition, you must provide a reason that supports your
amendment request. We may deny your request for
an amendment if it is not in writing or does not include a reason to
support the request. In
addition, we may deny your request if you ask us to amend 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 medical information kept by our practice; $
is not part of the information which you would be permitted to
inspect and copy; or $
in our judgment is accurate and complete as it appears or as it
was at the time it was originally captured and recorded. Right
to an Accounting of Disclosures:
You have the right to request an "accounting of
disclosures." This is
a list of the disclosures we have made of your medical information. To request this list or
accounting of disclosures, you must submit your request in writing to our office. Your
request must state a time period which may not be longer than six years
and may not include dates before April 14, 2003.
Your request should indicate in what form you want the list (for
example, on paper or electronically, ie. on disk or by e-mail).
The first list you request within each 12-month period will be
free. For additional lists,
we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to
withdraw or modify your request at that time, before any costs are
incurred. Right
to Request Restrictions: You have the right to request a restriction or
limitation on the protected medical information we use or disclose about
you for treatment, payment or health care operations.
However, we must receive your restrictions in writing before we
have made such disclosures. Also, if you restrict our right to use your
protected medical information for treatment, payment or health
operations, we reserve the right to immediately withdraw our services
from you and terminate the physician-patient relationship. You also have the right to
request a limit on the protected medical 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 about a surgery to your family. We are not required to agree
to your request. If we do
agree, we will comply with your request unless the information is needed
to provide you emergency treatment. To request restrictions, you
must make your request in writing to our office.
In your request restrictions, you must tell us (1) what
information you want to limit; (2)
whether you want to limit our use, disclosure or both;
and (3) to whom you
want the limits to apply, for example, disclosures to your spouse. Right
to Request Confidential Communications:
You have the right to request that we communicate with you about
medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work, or
at home, or by mail, or by phone, or by E-mail. To request confidential
communications, you must make your request in writing to our office. We
will not ask you the reason for your request.
We will accommodate all reasonable requests.
Your request must specify how or where you wish to be contacted. Right
to a Copy of This Notice: You
have the right to a copy of this notice.
You may ask us to give you a copy of this notice at any time. (You may obtain a copy of this
notice at our website, www.okhands.com.) CHANGES
TO THIS NOTICE. We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for protected medical 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 office. The notice will contain on the first page, the effective date. In addition, each time you are in our office for treatment or health care services, we will offer you a copy of the current notice in effect. COMPLAINTS. If you believe your privacy
rights have been violated, you may file a complaint with our office or
with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact our "New Patient
Coordinator", at (405) 748-6600.
All complaints must be submitted in writing. Our office address
is located HERE. You will not be
penalized for filing a complaint. To
file a complaint with the Secretary of the Department of Health and
Human Services, contact the:
Office of Civil Rights, Region VI
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, Texas 75202
Voice
phone (214) 767-4056
FAX
(214) 767-0432
TDD
(214) 767-8940
For all complaints filed by e-mail send to: OCRComplaint@hhs.gov. OTHER
USES OF MEDICAL INFORMATION. Other uses and disclosures of
protected medical information not covered by this notice or the laws
that apply to us will be made only with your written permission. If you provide us permission to use or disclose protected
medical information about you, you may revoke that permission, in
writing, at any time. If
you revoke your permission, we will no longer use or disclose protected
medical information about you for the reasons covered by your written
authorization. You
understand that we are unable 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. |
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Hand Surgery Center