NOTICE OF PRIVACY PRACTICES

Spine Institute, P.S.C.

EFFECTIVE DATE OF PRIVACY NOTICE: 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.

If you have any questions about this notice, please contact: Brenda Stewart, Privacy Officer/Contact Person, Spine Institute, P.S.C., 210 East Gray Street, Suite 900, Louisville, KY 4020

Our Philosophy on Patient Privacy

We recognize the importance of patient privacy. As such, it is our policy to treat all medical information as personal and confidential; we are committed to protecting your privacy rights. We will create a record of the care and services you receive at our Practice. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this Practice.

Uses and Disclosures of Medical Information

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will try to explain what we mean and give examples. Not every possible use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

A. Uses and Disclosures for Patient Treatment, Payment,
Health Care Operations, and Administrative Matters

The law permits us to use/disclose your medical information or protected health information ("PHI") for treatment, payment, and/or health care operations.

(i) For Treatment - We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, and other staff here at the Practice who are involved in taking care of you at the Practice. We may also disclose medical information about you to people outside our office who may be involved in your medical care. For example, we may disclose medical information to a referring physician who will be involved in treating you after you leave our office. In most cases, before treating you, we will obtain a written acknowledgement from you that you have received a copy of this Notice of Privacy Practices and have had a chance to review it.
(ii) For Payment - We may use or disclose medical information about you to your insurance company, a governmental payer, or other responsible third party for the purpose of receiving payment for the medical treatment you have received. For example, we may tell your health plan about a medical treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
(iii) For Health Care Operations - We may use and disclose medical information about you for purposes of health care operations. These uses and disclosures are necessary to ensure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.
(iv) For Certain Administrative Matters - We may also use and disclose medical information about you to:
  • Contact you as a reminder that you have an appointment for treatment at the Practice;
  • Tell you about or recommend possible treatment options or alternatives that may be of interest to you; and
  • Tell you about health-related benefits or services that may be of interest to you.
(v) Exceptions - Kentucky law gives certain types of medical information more stringent confidentiality protection. Ordinarily, because of the nature of our Practice, we do not have occasion to access, use, or disclose such information. If we do use such information, however, our practice is as follows:
HIV/AIDS ­ For purposes other than diagnosis or medical treatment, we must obtain your specific authorization before we disclose information about HIV/AIDS status or test results. Thus, for example, we must obtain specific authorization from you before releasing any such information about you for payment or health care operations purposes, but we do not have to do so for treatment purposes. We will not disclose, either voluntarily or under compulsion, information about HIV/AIDS status or test results to anyone other than those you specifically authorize, health care personnel who have a legitimate need to know in order to provide for their or your protection and welfare, and appropriate public health entities.

B. Other Uses and Disclosures of Medical Information
for which Patient Authorization is Not Necessary

In limited instances, we may use and disclose medical information without your Authorization in the following situations:

(i) Uses and Disclosures to Family and Friends - We may disclose to your family member or close personal friend involved with your medical care medical information about you that is directly relevant to your family member or friend’s involvement with your care or with the payment related to your care. In most instances, before we disclose any medical information about you to your family members or your friends, we will inform you of the disclosure and give you an opportunity to agree or object to the disclosure.
(ii) Uses and Disclosures for Disaster Relief Purposes - For the limited circumstances of disaster relief efforts, we may disclose medical information about you to your close family or friends or to a public or private disaster relief entity for purposes of notifying your family and friends of your condition and location. If you are available and competent, prior to the disclosure we will give you an opportunity to agree or object to the disclosure to the extent that providing you with prior notice and an opportunity to restrict or object to the disclosure will not interfere with our ability to respond to the emergency situation.
(iii) Uses and Disclosures Required by Law - We may use or disclose medical information to the extent that such use or disclosure is required by federal, state, or local law and the use or disclosure complies with and is limited to the relevant requirements of such law;
(iv) Uses and Disclosures for Public Health Activities - We may use or disclose medical information about you for public health activities to:
  • A public health authority that is authorized by law to collect or receive information for the purposes of preventing or controlling disease, injury, or disability;
  • A public health authority or other appropriate government entity authorized by law to receive reports of child abuse or neglect
  • An FDA agent or official to report reactions to medication or problems with products;
  • 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; or
  • To an employer, to evaluate whether the individual has a work-related illness.
(v) Disclosures about Victims of Abuse, Neglect, or Domestic Violence - We may disclose medical information about you to a government authority, including a social service or protective agency, if we reasonably believe a patient to be a victim of abuse, neglect, or domestic violence.
(vi) Uses and Disclosures for Health Oversight Activities - We may disclose or use medical information to a health oversight agency for oversight activities authorized by law, including audit;, civil; administrative; or criminal investigations; inspections; or licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
(vii) Disclosures for Judicial and Administrative Proceedings - If you are involved in a legal dispute, we may disclose medical information about you in the course of any judicial or administrative proceeding with a valid court order or appropriate subpoena or discovery request. We will make all reasonable efforts to tell you about this request before making this disclosure.
(viii) Disclosures for Law Enforcement Purposes - We may disclose medical information if asked to do so by a law enforcement official:
  • In response to a court order, subpoena, warrant, summons, or similar process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • About the victim of a crime, if, under certain limited circumstances, we are unable to obtain the person’s agreement
  • About a death we believe may be the result of criminal conduct;
  • About criminal conduct here at the Practice; and
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.
(ix) Uses and Disclosures to Coroners, Medical Examiners, and Funeral Directors - We may release medical information to a coroner or medical examiner for the purpose of identifying a deceased person, determining the cause of death, or other duties as authorized by law. We may also release medical information to funeral directors, as necessary, to carry out their duties.
(x) Uses and Disclosures for Organ, Eye, or Tissue Donation Purposes - We may use or disclose medical information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue for the purpose of facilitating organ, eye, or tissue donation and transplantation.
(xi) Uses and Disclosures for Research Purposes - We may use or disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, specifically trying to balance the research needs with patients’ needs for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process or your Authorization for the use or disclosure will have been obtained.
(xii) Uses and Disclosures to Avert a Serious Threat to Health or Safety - We may use or disclose medical information about you if we reasonably believe, in good faith, that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person.
(xiii) Uses and Disclosures for Specialized Government Functions - We may use or disclose medical information of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military command authorities. We may use or disclose medical information to authorized federal officials for national security and intelligence purposes and for protection of the President of the United States or other heads of state. In some circumstances, we may use or disclose medical information about an inmate or individual that the correctional institution has lawful custody of.
(xiv) Uses and Disclosures for Workers’ Compensation - We may disclose medical information as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs. These programs provide benefits for work-related injuries.

Other Uses and Disclosures

Use and disclosure of medical information for purposes not listed above in parts A and B will only be made with your written Authorization. You may revoke this Authorization at any time by providing us with written notice of such revocation. Your revocation shall become effective immediately upon our receipt of such notice, except to the extent that we have already relied upon your previous Authorization.

Patient Rights Regarding Private Medical Information

Each patient has the following rights with respect to protected, private health or medical information:

A. Right to Request Restrictions

You have the right to request that we restrict the uses or disclosures of your medical information to carry out treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care, like a family member or friend. For example, you could ask that we not disclose or use information about a certain medical treatment you received. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to Brenda Stewart, Privacy Officer, Spine Institute, P.S.C., 210 East Gray Street, Suite 900, Louisville, KY 40202. In your request, you must tell us:
  • What information you want to limit;
  • Whether you want to limit our use, disclosure, or both; and
  • To whom you want the limits to apply, for example, disclosures to your spouse.

B. Right to Receive Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work. To request confidential communications, you must make your request in writing to Brenda Stewart, Privacy Officer, Spine Institute, P.S.C., 210 East Gray Street, Suite 900, Louisville, KY 40202. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

C. Right to Inspect and Copy Protected Health Information

You have the right to inspect and copy medical information that may be used to make decisions about your care. If you agree in advance, we may provide you with a summary or explanation of your medical information.

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Brenda Stewart, Privacy Officer, Spine Institute, P.S.C., 210 East Gray Street, Suite 900, Louisville, KY 40202. If you request a copy of the information, we may charge a reasonable fee for the costs of preparing a summary or explanation of your medical information or for the costs of copying, mailing, or other supplies associated with your request (with the exception that we shall charge no fee for the first copy of a patient’s medical records).
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to certain medical information, in many instances you may request that the denial be reviewed.

D. Right to Amend Protected Health Information

You have the right to request an amendment of your medical information if you feel the information is incomplete or incorrect for as long as the information is maintained by the Practice. To request an amendment, your request must be made in writing and submitted to Brenda Stewart, Privacy Officer, Spine Institute, P.S.C., 210 East Gray Street, Suite 900, Louisville, KY 40202. If for some reason the Practice, in compliance with state and federal law, rejects your amendment, we shall permit you to submit to us a written statement of disagreement to be kept with your medical information. The Practice may reasonably limit the length of such statement of disagreement.

E. Right to Receive an Accounting of Disclosures of Protected Health Information

You have the right to receive an accounting of disclosures of your medical information in the six years prior to the date on which the accounting is requested, except for disclosures made:

  • To carry out treatment, payment and health care operations;
  • To the Patients themselves (or the Patients’ legal representative);
  • To persons involved in the individual’s care;
  • For national security or intelligence purposes;
  • To correctional institutions or law enforcement officials;
  • Pursuant to your valid Authorization; or
  • That occurred prior to the compliance date for the Practice.

To request this list or accounting of disclosures, you must submit your request in writing to Brenda Stewart, Privacy Officer, Spine Institute, P.S.C., 210 East Gray Street, Suite 900, Louisville, KY 40202. You have the right to one accounting of disclosures of your medical information in a twelve-month period free of charge. We may charge a reasonable fee for the costs associated with your request for any additional accountings within the same twelve-month period. You may modify or withdraw your additional accounting requests in order to reduce or avoid the fee.

F. Right to Receive a Paper Copy of Notice from the Practice

You have the right, even if you have previously agreed to receive this notice electronically, to obtain a paper copy of this notice upon request from the Practice. You may ask us to give you a copy of this notice at any time.

Practice Duties Regarding Private Health Information

A. We are required by law to maintain the privacy of protected health information. In other words, we must make sure that medical information that identifies you is kept private.

B. We are required by law to give you this notice of our legal duties and privacy practices with respect to medical information about you.

C. We are required to abide by the terms of the privacy notice that is currently in effect.

D. We reserve the right to change the terms of this notice policy at any time. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the office waiting area. In addition, each time you visit our office for treatment, we will make a copy of the current notice in effect available to you upon your request.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with this Practice or with the Secretary of the Department of Health and Human Services.
To file a compliant with the Practice, contact Brenda Stewart, Privacy Officer, Spine Institute, P.S.C., 210 East Gray Street, Suite 900, Louisville, KY 40202, or at 502-992-0488. All complaints must be submitted in writing.

To file a complaint with the Secretary of the Department of Health and Human Services, contact Medical Privacy, Complaint Division, Office of Civil Rights, United States Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201; Voice Hotline Number (800) 368-1019; Internet Address www.hhs.gov/ocr.

You will not be penalized in any way for filing a complaint.