Notice of
Privacy Practices
ROBERT A. GOLDSTONE, MD
PA
Notice of Privacy Practices
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 Contact who is:
Dr.
Robert A. Goldstone
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 by accessing
our website:
http://orthodoc.aaos.org/RobertGoldstone
and following
the “Privacy
Statement” link, by calling the office and requesting that a revised copy be sent
to you in the mail or by asking for one at the time of your next appointment.
1. Uses
and Disclosures of Protected Health Information
Uses and
Disclosures of Protected Health Information Based Upon Your Written Consent
You will be
asked by your physician to sign a consent form. Once you have consented to use
and disclosure of your protected health information for treatment, payment and
health care operations by signing the consent form, your physician will use or
disclose your protected health information as described in this Section 1. 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 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.
Following are
examples of the types of uses and disclosures of your protected health care
information that the physician’s office is permitted to make once you have
signed our consent form. These examples are not meant to be exhaustive, but to
describe the types of uses and disclosures that may be made by our office once
you have provided consent.
Treatment: We will use and
disclose 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 a third party that has already obtained
your permission to have access to your protected health information. 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 when we have the
necessary permission from you to disclose your protected health information.
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 health care diagnosis or treatment to your physician.
Payment: Your protected health
information will be used, as needed, to obtain payment for your health care
services. This may include certain activities that your health insurance plan
may undertake before it approves or pays for the health care services we
recommend 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.
Healthcare
Operations: We may use or disclose, as-needed, your protected health
information in order to support the business activities of your physician’s
practice. These activities include, but are not limited to, quality assessment
activities, employee review activities, training of medical students, licensing,
marketing and fundraising activities, and conducting or arranging for other
business activities.
For example, we
may disclose your protected health information to medical school students that
see patients at our office. In addition, we may use a sign-in sheet at the
registration desk where you will be asked to sign your name and indicate your
physician. We may also call you by name in the waiting room when your physician
is ready to see you. We may use or disclose your protected health information,
as necessary, to contact you to remind you of your appointment.
We will share
your protected health information with third party “business associates” that
perform various activities (e.g., billing, transcription services) for the
practice. Whenever an arrangement between our office and a business associate
involves the use or disclosure of your protected health information, we will
have a written contract that contains terms that will protect the privacy of
your protected health information.
We may use or
disclose your protected health 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 also use and disclose your
protected health information for other marketing activities. For example, your
name and address may be used to send you a newsletter about our practice and
the services we offer. We may also send you information about products or
services that we believe may be beneficial to you. You may contact our Privacy
Contact to request that these materials not be sent to you.
We may use or
disclose your demographic information and the dates that you received treatment
from your physician, as necessary, in order to contact you for fundraising
activities supported by our office. If you do not want to receive these
materials, please contact our Privacy Contact and request that these
fundraising materials not be sent 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, at any time, in writing,
except to the extent that your physician or the physician’s practice has taken
an action in reliance on the use or disclosure indicated in the authorization.
Other
Permitted and Required Uses and Disclosures That May Be Made With Your Consent,
Authorization or Opportunity to 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 judgement, determine whether the disclosure
is in your best interest. In this case, only the protected health information
that is relevant to your health care will be disclosed.
Others
Involved in Your Healthcare: 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 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.
Emergencies: We may use or disclose
your protected health information in an emergency treatment situation. If this
happens, your physician shall try to obtain your consent as soon as reasonably
practicable after the delivery of treatment. If your physician or another
physician in the practice is required by law to treat you and the physician has
attempted to obtain your consent but is unable to obtain your consent, he or
she may still use or disclose your protected health information to treat you.
Communication
Barriers: We may use and disclose your protected health information if your
physician or another physician in the practice attempts 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
to use or disclosure under the circumstances.
Other
Permitted and Required Uses and Disclosures That May Be Made Without Your
Consent, 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: 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. We may also disclose
your protected health information, if directed by the public health authority,
to a foreign government agency that is collaborating with the public health
authority.
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: 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 laws.
Food and
Drug Administration: We may disclose your protected health information to a
person or company required by the Food and Drug Administration to report
adverse events, product defects or problems, biologic product deviations, track
products; to enable product recalls; to make repairs or replacements, or to
conduct post marketing surveillance, as required.
Legal
Proceedings: We may disclose protected health 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), in certain conditions in response to a subpoena, discovery request
or other lawful process. Information,
reports and records obtained and/or reviewed and/or created during the course
of an Independent Medical Examination (IME) that you have submitted to upon
advice of your attorney, may be released to the concerned parties, including,
but not limited to, attorneys and carriers involved in the litigation.
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 a 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 the practice, and (6) medical emergency (not on the 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 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.
Criminal
Activity: 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.
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 that 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: Your protected health information may be disclosed by us as
authorized to comply with workers’ compensation laws and other similar
legally-established programs.
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.
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.
2. Your
Rights
Following is a
statement of your rights with respect to your protected health information and
a brief description of how you may exercise these 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 uses for
making decisions about you. In some
cases, the physician might decide that it is not in your physical or
psychological best interest to review all or part of a record, and that portion
or record will not be made available to you pending a review of that decision.
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. In some circumstances, you may have a right to have this decision
reviewed. Please contact our Privacy Contact if you have questions about access
to your medical record.
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 healthcare 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 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 writing a letter to this office, which, in the
case of an IME, will be reviewed by attorneys for both plaintiff and defense
before a final decision is made.
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 make this request
in writing to our Privacy Contact.
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 Contact 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 healthcare operations as described in
this Notice of Privacy Practices. 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 these disclosures that occurred after April 14, 2003. You
may request a shorter timeframe. The right to receive this information is
subject to certain exceptions, restrictions and limitations.
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.
3.
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 contact of your complaint. We will not retaliate
against you for filing a complaint.
You may contact
our Privacy Contact, Robert A. Goldstone MD at (201) 444-1166, for further
information about the complaint process.
This notice was
published and becomes effective on April 14, 2003.
© 2001 American Medical
Association
All Rights Reserved