handsurg.com :: Hand Surgery Specialists, Inc.

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.

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 that we have regarding the use and disclosure of your medical information.

Hand Surgery Specialists, Inc. entities which are covered by regulations pursuant to the Health Insurance Portability and Accountability Act of 1996 (‘HIPAA’) are required by law to maintain the privacy of your health information, give you notice of our privacy practices with respect to your medical information, and follow the terms of this Notice. This Notice applies to all of the records of your care generated and maintained by Hand Surgery Specialists, Inc.’s affiliated entities. While you are a patient with a Hand Surgery Specialists, Inc. facility, you may also receive health care services from other health care providers who are not employees or agents of Hand Surgery Specialists, Inc. but who will follow the terms of this Notice with respect to the privacy of your health information. Accordingly, this Notice also applies to the records of your care generated by the following physician practices while you are being treated by Hand Surgery Specialists, Inc.: Mary S. Stern Hand Surgery Foundation (collectively Hand Surgery Specialists, Inc. and Mary S. Stern Hand Surgery Foundation will be referred to as ‘Hand Surgery Specialists’). Hand Surgery Specialists will share your medical information, as necessary, in order to carry out your treatment, obtain payment for the services provided to you or operate their health care facilities.

Uses and Disclosures about You
Hand Surgery Specialists, may use your protected health information for purposes of providing treatment, obtaining payment for treatment, and conducting health care operations. Your protected health information may be used or 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 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 the physician’s practice.

The following are examples of the types of uses and disclosures of your protected health care information that we are permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

Treatment
Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment
Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

Health care operations
Your health information may be used as necessary to support the day-to-day activities and management of Hand Surgery Specialists. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

In addition, we may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment or account information or, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or Opportunity to Object

We may use and disclose your protected health information in the following instances if we inform you in advance of such use or disclosure and if you have the opportunity to agree, object or restrict the use or disclosure.

Facility Directories
We may use your protected health information to create and distribute a facility directory, so long as we notify you in advance of this use and you do not object to such use.

Others Involved in Your Health 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. In addition, 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.

If you are unable to agree or object to such a disclosure, we may disclose limited information, as necessary, if we determine that it is in your best interest based on our professional judgment.

Disaster Relief Purposes
We may use or 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.

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 consent or authorization. These situations include:

Required By Law
We may use or disclose your protected health information to the extent that the use or disclosure is required by 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 Activities
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.

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 Activities
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. In this case, the disclosure will be made consistent with the requirements of applicable federal and state law.

Legal Proceedings
We may disclose protected health information in the course of any judicial or administrative proceeding in response to the following: 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 purpose.

Law Enforcement Purposes
We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. For example. we may disclose protected health information pursuant to legal process or as otherwise required by law in compliance with and as limited by a court order or a subpoena issued by a court or a judicial officer.

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 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.

Prevention of a Serious Threat to Health or Safety
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.

Specialized Government Functions
When the appropriate conditions apply, we may use or disclose protected health information in order to assist agencies of individuals involved in specialized government functions. For example, we may disclose protected health information of individuals who are armed forces personnel for activities deemed necessary by appropriate military command authorities to assure the proper execution of a military mission if the appropriate military authority has published the requisite notice as required by law.

Workers’ Compensation
Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally-established programs.

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 Section 164.500 et. seq.

Other uses and disclosures which require your authorization.

Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.

Individual Rights
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A ‘designated record set’ contains medical and billing records and any other records that your physician and the practice use for making health care decisions about you.

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 health care 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 physician is not required to agree to a restriction that you may request. If the physician 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 physician 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 physician. You may request a restriction by submitting your request in writing to our Privacy Officer.

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 submit this request in writing to our Privacy Officer.

You may have the right to have your physician amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. 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. Please contact our Privacy Officer 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 applies to disclosures for purposes other than treatment, payment, or health care operations as described in the Notice of Privacy Practices. However, this right does not apply to all disclosures and it is subject to certain other exceptions, restrictions and limitations. For example, it excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding disclosures subject to an accounting that occurred after April 14, 2003.

You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

Hand Surgery Specialists’ Duties
We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice.

Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.

Requests to Inspect Protected Health Information
As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Front Desk Receptionist or the Medical Record Department of Hand Surgery Specialists.

Complaints
If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns to:

Medical Record Department
Hand Surgery Specialists
Attn: Privacy Officer
10700 Montgomery Road, Suite 150
Cincinnati, OH 45242
513 961-4263

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the same address.

You will not be penalized or otherwise retaliated against for filing a complaint.

Contact Person
The name and address of the person you can contact for further information concerning our privacy practices is:

Medical Record Department
Hand Surgery Specialists
Attn: Privacy Officer
10700 Montgomery Road, Suite 150
Cincinnati, OH 45242
513 961-HAND (4263)

Effective Date: This Notice is effective on or after April 14, 2003.