NOTICE OF PRIVACY PRACTICES

This Privacy Notice is being provided to you as a requirement of a federal law, the Health Insurance Portability and Accountability Act (HIPAA). This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) for treatment, payment or health care operations and for other purposes that are permitted or required by law.  This notice is not meant to be a substitute for the applicable law, nor should it be taken as a complete statement of the law. It also describes your rights to access and control your PHI.  We are required by Federal law to give you this Notice and to maintain the privacy of your health information. Please review it carefully. Upon review of our Notice of Privacy Practices, you will be asked to sign an Acknowledgement of Receipt.

How we may use and disclose your protected health information
Once you have reviewed our Notice and signed the Acknowledgement, we may use your PHI for treatment, payment and health care operations. We may use or disclose your PHI in an emergency treatment situation. If this happens, we will try to obtain your signature on the Acknowledgement as soon as reasonably possible after the delivery of treatment. The following examples show the types of uses and disclosures of your PHI that our office is permitted to make.

Treatment:Your PHI may be used and disclosed by our office and others outside of our office that may be involved in your medical care. We will use and disclose your protected health information to other physicians to provide, coordinate, or manage your health care.

Others Involved in Your Healthcare: Unless you object, we may disclose your PHI to your family member, a relative, a close friend or any other person you select, to the extent necessary to help with you care for the services we have provided. We will also use our professional judgment and common practice to make reasonable decisions in your best interest in allowing a person to pick up medical supplies, x-rays, prescriptions or other similar forms of health information.

Payment:Your PHI may be used and disclosed to pay your health care bills. Your protected health information will be used to obtain payment for services we provide to you. This may include certain activities that your insurance plan may undertake before it approves or pays for the services we recommend.

Healthcare Operations: We may use or disclose your PHI in order to support the business activities of our practice. Healthcare operations include quality assessment activities, employee review activities, licensing or credentialing activities, conducting training and conducting auditing or review activities. For example, we may send you reminder postcards or telephone you to remind you of an appointment. We may also send you a newsletter about our practice and the services we offer. You may contact our Administrator to request that these materials not be sent to you.

Business Associates: We will share you PHI with third party business associates that perform various activities for our practice. For example, we may disclose pertinent medical information to physical therapists or to obtain medical equipment for the purpose of designing a regime that is specific to you, safe for you, and within your medical parameters.

Required by law:We may use or disclose your PHI when we are required to do so by state or federal law, including with the Department of Health and Human Services if it wants to determine our compliance with federal privacy law.

Public Health Purposes:  We may disclose your PHI to (a) a public health authority that is authorized by law to collect information for the purpose of preventing or controlling disease, injury, or disability, including, but not limited to, the reporting of disease, injury, vital events such as birth or death, and the conduct of public health surveillance, public health investigations, and public health interventions; or, at the direction of a public health authority, to an official of a foreign government agency that is acting in collaboration with a public health authority, (b) a public health authority or other appropriate government authority authorized by law to receive reports of abuse, neglect, or domestic violence, (c) to a person subject to the jurisdiction of the Food and Drug Administration (FDA) with respect to a FDA-regulated product or activity for which that person has responsibility, for the purpose of activities related to the quality, safety or effectiveness of such FDA- regulated product or activity such as the collection or reporting of adverse events, product defects or problems, the tracking of FDA- regulated products, to enable product recalls, repairs, or replacement, or to conduct post marketing surveillance, (d) in relation to a public health investigation into whether a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition so long as the investigating health authority is authorized by law to notify such person as necessary in the conduct of a public health intervention or investigation or (e) preventing or reducing a serious threat to anyone’s health or safety.

Military personnel and national security:We may disclose the PHI of Armed Forces personnel when requested by command military authorities. We may disclose to authorized federal officials PHI required for lawful intelligence, counterintelligence and other national security activities.

Worker’s Compensation & Health Oversight Activities:We may disclose your PHI to comply with worker’s compensation laws and to health oversight agencies when conducting investigations or inspections as authorized by law.

Support of Medical Research:  We may disclose your PHI to researchers conducting medical research that has been approved and the researcher has obtained the necessary authorizations.

Required uses and disclosures:Under the law, we must make disclosures of your PHI to you and when required, to the Department of Health and Human Services when determining our compliance.

Event of Death:  In the event of your death, consistent with applicable law, we may disclose your PHI to coroners, medical examiners, or funeral directors.

Release of Information to Family/Friends:  Our practice may release your PHI to a friend or family member that is involved in your care, or who assists taking care of you.

Health Oversight Activities: Our practice may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

Respond to Organ and Tissue Donation Requests:  We can share health information about you with organ procurement organizations.

Work with Medical Examiner or Funeral Director:  We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Lawsuits and Similar Proceedings: Our practice may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI in response to a discovery request, subpoena or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

Law Enforcement: We may release PHI if asked to do so by a law enforcement official:  Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement;  Concerning a death we believe has resulted from criminal conduct; Regarding criminal conduct at our offices; In response to a warrant, summons, court order, subpoena or similar legal process; To identify/locate a suspect, material witness, fugitive or missing person; In an emergency, to report a crime (including the location of victim(s) of the crime, or the description, identify or location of the perpetrator).

You have the following rights
Inspect and copy your protected health information.You have the right to look at or get copies of your health information.  You may request that we provide copies in an electronic or paper copy. We will use the format you request unless we cannot practically do so. You must make the request in writing to obtain access to your health information. You may obtain access by sending a letter to our Administrator listed at the end of this notice.  We will provide a copy or summary of your health information, usually within 30 days or your request.  We may charge a reasonable, cost-based fee.

Request a restriction of your protected health information.You have the right to request that we place additional restrictions on our use or disclosure of your health information. However, be advised that we are not required to agree to these additional restrictions if it does not comply with applicable law or other government directives.  If you pay for a service or health care item out-of-pocket in full, you can request that we not share that information for the purpose of payment or our operations with your health care insurer.  We will comply with your request unless a law requires us to share that information.

Request an amendment of your health information:You have the right to request that we amend or correct your health information. Your request must be in writing and must explain why the information should be amended or corrected. We may, however, deny your request and you will be provided with an explanation of the reason for denial in writing within 60 days.

Receive an accounting of disclosures we have made of your health information.You have the right to an accounting of disclosures of your health information. This accounting will be for purposes other than treatment, payment or healthcare operations, or disclosures we may have made to you, to your family members or friends involved in your care. The right to receive this information is subject to some exceptions.

Request to receive confidential communications from us by alternative means or at an alternative location.You have the right to request that we communicate with you in certain ways. We will accommodate reasonable requests. We will not require you to provide an explanation for your request. Requests must be made in writing to our Administrator.

Obtain a List of Those with Whom We’ve Shared Information:  You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, with whom we shared and why.  We will include all disclosures except for those about treatment, payment, health care operations, and certain other disclosures (such as any you asked us to make).  We can provide one accounting per year but will charge a reasonable, cost-based fee if you should request another one within twelve months.

Obtain a Copy of this Privacy Notice:  You can request a paper copy of this notice at any time, even if you agreed to receive the notice electronically.

Choose Someone to Act For You:  If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.  We will require a copy of the document of medical power of attorney and it will remain in your records.  We will make sure the person has this authority and can act on your behalf prior to taking any action.

Make a complaint about our privacy practices:  If you are concerned that we have violated your privacy rights, you may file a complaint with our Administrator using the contact information listed at the bottom of this page. You may also file a written complaint with the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W.  Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/  We will not retaliate against you for making a complaint or change the way we treat you.

You have choices regarding the manner we use and share your information
For certain health information, you can direct us your choices about what information we share and how to share it.

The right and choice in these circumstances:  Share information with your family, close friends, or others involved in your care, in a disaster relief situation or include your information in a hospital directory.  If you are unable to tell us your preference, we may share your information if we believe it is in your best interest.  We may also share your information when needed to lessen a serious and imminent threat to health or safety.

Unless you give us permission, your information is never shared in these circumstances:  Marketing purposes, sale of your information, or providing psychotherapy notes.

In the case of fundraising:  We may contact you for fundraising efforts, but you may request not to contact you again for this matter.

Our responsibilities
The facility is required by law to maintain the privacy and security of your protected health information and to provide you with this Privacy Notice of our duties and privacy practices. We are required to abide by terms of this Notice and to make the new Notice provisions effective for all future protected health information that we maintain. We will promptly inform you if a breach occurs that may have compromised the privacy or security of your information.  We will not use or share your information other than as described here, unless you tell us otherwise in writing.  You may change your mind at any time.  You will need to let us know in writing if you change your mind.  For more information: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Contact Person
The facility’s contact person for all issues regarding patient privacy and your rights under the federal privacy standards is the Administrator. Information regarding matters covered by this Notice can be requested by contacting the Administrator. If you feel that your privacy rights have been violated by this facility you may submit a complaint to our Administrator by sending it to:

ATTN: Administrator, 4110 North Scottsdale Road, Suite #315, Scottsdale, AZ  85251

Changes to Terms of Notice
We can change the terms of this Notice, and the changes will apply to all information we have about you.  The new Notice will be available upon request, in our office, and on our web site.  This Notice of Privacy Practices applies to the following organizations:  PJC Orthopedics®, Personalized Joint Care®, Concierge Sportscare®, Concierge Orthopedics℠, Concierge Orthocare℠, and Tamasa Medical PLLC.

Effective Date
This revised notice is effective January 23, 2013.