Front Range Orthopaedics
Notice of Privacy Practices for Protected Health Information 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!
Front Range Orthopaedics (the “Office”) is permitted by federal
privacy laws to make uses and disclosures of your health information for purposes
of treatment, payment, and health care operations. Protected health information
(PHI) is the information we create and obtain in providing our services to you.
Such information may include documenting your symptoms, examination, and test
results, diagnoses, treatment, and applying for future care or treatment.
It also includes billing documents for those services.
Examples of Uses of Your Health Information
for Treatment Purposes are:
• A nurse obtains treatment information about you
and records it in a health record.
• During the course of your treatment, the physician determines he/she
will need to consult with another specialist in the area. He/she will
share the information with such specialist and obtain his/her input.
• Our staff may call you to remind you with appointment reminders, or
with information you may need to facilitate your care, and we may leave messages
at numbers you provide to us.
Example of Use of Your Health Information for Payment
Purposes:
We submit requests for payment to your health insurance company, should you
have one. The health insurance company (or other business associate helping
us obtain payment) requests information from us regarding medical care given.
We will provide information to them about you and the care given.
Example of Use of Your Information for Health
Care Operations:
We obtain services from our insurers or other business associates such as quality
assessment, quality improvement, outcome evaluation, protocol and clinical guideline
development, training programs, credentialing, medical review, legal services,
and insurance. We will share information about you with such insurers
or other business associates as necessary to obtain these services.
Your Health Information Rights
The health and billing records we maintain are the physical property of the
office. The information in it, however, belongs to you. You have
a right to:
• Request a restriction on certain uses and disclosures
of your health information by delivering the request to our office -- we are
not required to grant approval of the request, but we will comply with any
approval we do grant;
• Obtain a paper copy of the current Notice of Privacy Practices for
Protected Health Information ("Notice") by making a request at our
office;
• Request that you be allowed to obtain and inspect a copy of your health
record and billing record – you may exercise this right by delivering
the request to our office. The office may charge you the cost of copying
these records;
• Appeal a denial of access to your protected health information, except
in certain circumstances;
• Request that your health care record be amended to correct incomplete
or incorrect information by delivering a request to our office. 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 health information kept by or for the office;
• Is not part of the information that you would be permitted to inspect
and copy; or,
• Is accurate and complete.
If your request is denied, you will be informed
of the reason for the denial and will have an opportunity to submit a statement
of disagreement to be maintained with your records;
• Request that communication of your health information
be made by alternative means or at an alternative location by delivering the
request in writing to our office;
• Obtain an accounting of disclosures of your health information as
required to be maintained by law by delivering a request to our office.
This accounting will not include disclosures prior to April 14, 2003, and
will not go in arrears beyond 6 years. An accounting will not include
uses and disclosures of information for treatment, payment, or operations;
disclosures or uses made to you or made at your request; uses or disclosures
made pursuant to an authorization signed by you; uses or disclosures made
to family members or friends relevant to that person's involvement in your
care or in payment for such care; or, uses or disclosures to notify family
or others responsible for your care of your location, condition, or your death.
• Revoke authorizations that you made previously to use or disclose
information by delivering a written revocation to our office, except to the
extent information or action has already been taken.
If you want to exercise any of the above rights, please
ask our reception desk staff, or contact Ms. Kathy Abeyta, Business Office Supervisor,
via phone at 719-473-3332, or in person or via mail at Front Range Orthopaedics,
175 S. Union Blvd., #200, Colorado Springs, CO 80910. She will inform
you of the steps that need to be taken to exercise your rights.
Our Responsibilities
The office is required to:
• Maintain the privacy of your health information
as required by law;
• Provide you with a notice as to our duties and privacy practices as
to the information we collect and maintain about you;
• Abide by the terms of this Notice;
• Notify you if we cannot accommodate a requested restriction or request;
and,
• Accommodate your reasonable requests regarding methods to communicate
health information with you.
We reserve the right to amend, change, or eliminate provisions
in our privacy practices and access practices and to enact new provisions regarding
the protected health information we maintain without your approval or without
notifying you. If our information practices change, we will amend our
Notice. You are entitled to receive a revised copy of the Notice by calling
and requesting a copy of our "Notice" or by visiting our office and
picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to report
a problem regarding the handling of your information, you may contact Ms. Kathy
Abeyta, Business Office Supervisor, via phone at 719-473-3332, or in person
or via mail at Front Range Orthopaedics, 175 S. Union Blvd., #200, Colorado
Springs, CO 80910.
Additionally, if you believe your privacy rights have been violated, you may
file a written complaint at our office by delivering the written complaint to
Mr. Richard West, Practice Administrator, in person or via mail at Front Range
Orthopaedics, 175 S. Union Blvd., #200, Colorado Springs, CO 80910. You
may also file a complaint with the Secretary of Health and Human Services.
• We cannot, and will not, require you to waive
the right to file a complaint with the Secretary of Health and Human Services
(HHS) as a condition of receiving treatment from the office.
• We cannot, and will not, retaliate against you for filing a complaint
with the Secretary of Health and Human Services.
Other Disclosures and Uses
Organized Health Care Arrangement (OHCA)
• The law recognizes that certain, more structured,
joint arrangements exist between organizations and providers that greatly benefit
patient care. Such a relationship exists between our office and Memorial
Hospital (MH). The Hospital provides x-ray services to you in, or adjacent
to, our office. We routinely share information about you to facilitate
treatment, payment and health care operations. Such an Agreement also
exists with MH to allow our physicians to be members of its medical staff.
Similarly, but not always as formally, a relationship exists between our office
and the other hospitals and surgery centers in town.
Communication with Family
• Using our best judgment, we may disclose to a family member, other relative,
close personal friend, or any other person you identify, health information
relevant to that person's involvement in your care or in payment for such care
if you do not object, or in an emergency.
Notification
• Unless you object, we may use or disclose your protected health information
to notify, or assist in notifying, a family member, personal representative,
or other person responsible for your care, about your location, and about your
general condition, or your death.
Research
• We may disclose 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.
Disaster Relief
• We may use and disclose your protected health information to assist
in disaster relief efforts.
Food and Drug Administration (FDA)
• We may disclose to the FDA your protected health information relating
to adverse events with respect to food, supplements, products and product defects,
or post-marketing surveillance information to enable product recalls, repairs,
or replacements.
Workers Compensation
• If you are seeking compensation through Workers Compensation, we may
disclose your protected health information to the extent necessary to comply
with laws relating to Workers Compensation.
Public Health
• As authorized by law, we may disclose your protected health information
to public health or legal authorities charged with preventing or controlling
disease, injury, or disability; to report reactions to medications or problems
with products; to notify people of recalls; to notify a person who may have
been exposed to a disease or who is at risk for contracting or spreading a disease
or condition.
Abuse & Neglect
• We may disclose your protected health information to public authorities
as allowed by law to report abuse or neglect.
Employers
• We may release health information about you to your employer if we provide
health care services to you at the request of your employer, and the health
care services are provided either to conduct an evaluation relating to medical
surveillance of the workplace or to evaluate whether you have a work-related
illness or injury.
Correctional Institutions
• If you are an inmate of a correctional institution, we may disclose
to the institution or its agents the protected health information necessary
for your health and the health and safety of other individuals.
Law Enforcement
• We may disclose your protected health information for law enforcement
purposes as required by law, such as when required by a court order, or in cases
involving felony prosecution, or to the extent an individual is in the custody
of law enforcement.
Health Oversight
• Federal law allows us to release your protected health information to
appropriate health oversight agencies or for health oversight activities.
Judicial/Administrative Proceedings
• We may disclose your protected health information in the course of any
judicial or administrative proceeding as allowed or required by law, with your
authorization, or as directed by a proper court order.
Serious Threat
• To avert a serious threat to health or safety, we may disclose your
protected health information consistent with applicable law to prevent or lessen
a serious, imminent threat to the health or safety of a person or the public.
For Specialized Governmental Functions
• We may disclose your protected health information for specialized government
functions as authorized by law such as to Armed Forces personnel, for national
security purposes, or to public assistance program personnel.
Coroners, Medical Examiners, and Funeral Directors
• We may release health information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person or determine
the cause of death. We may also release health information about patients
to funeral directors as necessary for them to carry out their duties.
Other Uses
• Other uses and disclosures, besides those identified in this Notice,
will be made only as otherwise required by law or with your written authorization
and you may revoke the authorization as previously provided in this Notice under
"Your Health Information Rights."
Website
• Absent technical difficulties, we maintain a website that provides information
about Front Range Orthopaedics and this Notice.