ORTHOPAEDICS INDIANAPOLIS, P.C. and INDIANA ORTHOPAEDIC HOSPITAL, LLC (ORTHOINDY)
Clinic and Surgery Facilities
Notice of Privacy Practices
Original Effective Date: April 14, 2003
Updated Effective Date: May 1, 2010
THIS PRIVACY 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 privacy notice ("Notice") is provided to you on behalf of Orthopaedics Indianapolis and The Indiana Orthopaedic Hospital (collectively referred to herein as "we" or "our"). If you have any questions about this Notice, please contact our Privacy Contact, Angela Szalkowski (zowl-kow-ski) at 8450 Northwest Boulevard, Indianapolis, Indiana 46278, (317) 802-2000.
This Notice describes how we may use and disclose your protected health, personal and financial information ("PHI") 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 to control your PHI. PHI 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, or payment for your health care services.
We are required by law to maintain the privacy of your PHI, to provide you with this Notice, and to maintain and comply with the terms of this Notice.
This Notice describes our practices, and those of our employees, staff, students, trainees, and other health care professionals authorized to provide services or care on our behalf. This Notice applies to all sites of OrthoIndy, our hospital and surgery facilities and any other location where we may provide health care service.
All of the above entities, sites, and locations are to abide by the terms of this Notice and to maintain the privacy of your PHI. We may change the terms of this Notice at any time. The new Notice will be effective for all PHI that we maintain after that time. Upon your request, we will provide you with any revised Notice. Please call the office ((317) 802-2000) and request that a revised copy of the Notice be sent to you in the mail, ask for one at your next appointment, or you may access the revised Notice at our website at http://www.OrthoIndy.com.
Acknowledgment of Notice Being Provided:
You have been asked to sign an acknowledgment that you have been provided with this Notice. This Notice explains how we use and disclose your PHI.
1. Uses and Disclosures for Treatment, Payment, and Health Care Operations.
Following are examples of the common ways we use and disclosure your PHI. These are just examples and do not describe every use and disclosure that may be made.
We use and disclose your PHI to provide, coordinate, or manage your health care and any related services. For example, we communicate your PHI to the hospital where you are admitted, or we may disclose your PHI, as necessary, to a home health agency that provides care to you. We will also disclose PHI to other physicians who may be treating you and to other providers such as laboratories that process your lab tests.
(i) Your PHI will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan requires before it approves or pays for the health care services we recommend for you such as, making a decision about coverage for insurance benefits; reviewing services provided to you for medical necessity; and utilization review activities such as obtaining approval for a hospital stay by sending your PHI to your health plan to obtain approval for the hospital admission.
(ii) Your financial PHI, including for example, your credit card account information may be collected, used and disclosed for the purpose of processing your online registration and bill payments. Access to your financial PHI is limited; we utilize state of the art encryption technologies to protect the security of your financial PHI. For more information about our online privacy and security practices, please click here.
We may use or disclose, as needed, your PHI in order to support the business activities of the practice, hospital or other organizations that are involved in your health care. These activities include, but are not limited to quality assessment activities, employee review activities, training of students, licensing, and conducting or arranging for other business activities.
For example, we may disclose your PHI to students that see patients at our facilities. 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 PHI, as necessary, to contact you to remind you of your appointment.
We will share your PHI with third party "business associates" or other providers that perform various activities (e.g., billing, transcription services, etc.) for us. Whenever an arrangement between us and a business associate involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy of your PHI.
We may use or disclose your PHI, 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 send you information about products or services that we believe may be beneficial to you. For example, your name and address may be used to send you a newsletter about the services we offer. You may contact our Privacy Contact to request that these materials not be sent to you.
Other Uses and Disclosures That May Be Made With Your Authorization or Opportunity to Object:
We may use and disclose your PHI in the following instances when you have the opportunity to agree or object. If you are not present or able to agree or object to the use or disclosure of the PHI, then your physician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.
Unless you object, we will use and disclose in any one of our OrthoIndy surgery facility directory(s) your name, the location at which you are receiving care, your condition (in general terms), and your religious affiliation. All of this information, except religious affiliation will be disclosed to people that ask for you by name. Members of the clergy will be told of your religious affiliation.
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 PHI 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 PHI 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 PHI 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.
We may use or disclose your PHI in an emergency treatment situation. If this happens, your physician shall try to obtain your acknowledgment of this Notice as soon as reasonably practical after the delivery of treatment.
We may use and disclose your PHI if your physician or another physician in the practice attempts to obtain an authorization from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgment, that you intend to authorize the use or disclosure under the circumstances.
Other Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object:
We may use or disclose your PHI in the following situations without your authorization. These situations include:
As required by Law: We may use and disclose your PHI as required by federal, state, or local law. Said disclosure(s) shall comply with the law and is limited to the requirements of the law.
Public Health Activities: We may use and disclose your PHI to public health authorities or other authorized persons to carry out certain activities related to public health, including the following activities:
1. To prevent or control disease, injury, or disability,
2. To report disease, injury, birth, or death,
3. To report domestic violence or child abuse or neglect,
4. To report reactions to medications or problems with products or devices regulated by the federal Food and Drug Administration (FDA) or other activities related to quality, safety, or effectiveness of FDA-regulated products or activities,
5. To locate and notify persons of recalls of products they may be using,
6. To notify a person who may have been exposed to a communicable disease in order to control who may be at risk of contracting or spreading the disease, or
7. To report to your employer, under limited circumstances, information related primarily to workplace injuries or illness, or workplace medical surveillance.
Health Oversight Activities: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information includes government agencies that oversee the health care system, government benefit programs, other government benefit programs, other government regulatory programs and civil rights laws.
Legal Proceedings: We may disclose your PHI in the course of any judicial or administrative proceeding, in response to an order of the court and in certain conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes. For example,
1. legal processes as 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 OrthoIndy, and
6. medical emergency (not on OrthoIndy's premises) and is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose your PHI 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 PHI to a funeral director, as authorized by law, in order to permit the funeral director(s) to carry out their duties. We may disclose such information in reasonable anticipation of death. PHI may be used and disclosed for cadaver organ, eye or tissue donation purposes.
Research: We may disclose your PHI to researchers when their research has been approved by an Institutional Review Board or Privacy Committee that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your PHI, 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 PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
Specialized Government Functions: Under certain circumstances we may disclose your PHI for certain military and veteran activities, including determination of eligibility for veterans for veterans benefits and where deemed necessary by military command authorities for national security and intelligence activities, to help provide protective services for the President and others, for the health or safety of inmates and others at correctional institutions or other law enforcement custodial situations for the general safety and health related to corrections facilities.
Workers' Compensation: Your PHI may be disclosed by us as authorized to comply with worker's compensation laws and other similar legally established programs which may include your employer.
Uses and Disclosures of PHI Based Upon Your Written Authorization:
Other uses and disclosures of your PHI will be made only with your written authorization. You may revoke this authorization at any time in writing except to the extent that we have already taken action in reliance on your authorization.
1. Your Rights.
Following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.
You have the right to inspect and have a copy of your PHI. This means you may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A "designated record set" contains medical and billing records that we use for making decisions about you. If the records are electronic, you may obtain an electronic copy.
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 PHI that is subject to law that prohibits access to PHI. 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 PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI 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. We are not required to agree to a restriction that you may request. If we believe it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted.
If we do agree to the requested restriction, we will document your request in your health record. We may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restrictions you wish to request with your physician. Your physician may request this restriction be made in writing. You should mail your written request to the Privacy Contact, Angela Szalkowski, OrthoIndy, 8450 Northwest Blvd., Indianapolis, Indiana 46278.
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 have the right to request we amend your PHI. This means you may request an amendment of the PHI 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 or if you have questions about amending your medical record.
You have the right to receive an accounting of disclosures. You have the right to request an accounting of certain disclosures that we have made of PHI about you. This is a list of disclosures made by us during a specified period of up to six (6) years other than disclosures made: for treatment, payment, and health care operations; for use in or related to a facility directory; to family members or friends involved in your care; to you directly; pursuant to an authorization from you or your personal representative, or for certain notification purposes (including national security, intelligence, correctional, and law enforcement purposes) and disclosures made before April 14, 2003. If you wish to make such a request, please contact our Privacy Contact. The first list that you request in a twelve (12) month period will be free, but we may charge you for our reasonable costs of providing additional lists in the same twelve (12) month period. We will tell you about these costs, and you may choose to cancel your request at any time before costs are incurred.
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.
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, Angela Szalkowski at (317) 802-2000 or at 8450 Northwest Boulevard, Indianapolis, Indiana 46278 for further information about the complaint process.
E-Mail Policy and Opt-Out
You can opt-out of use of this Web site or unsubscribe from receiving emails from us by sending your request to our Privacy Contact, Angela Szalkowski at 8450 Northwest Boulevard, Indianapolis, Indiana 46278, (317) 802-2000 or firstname.lastname@example.org with the subject line "unsubscribe" or by following the instructions on any e-mails that you receive from OrthoIndy.