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HIPAA NOTICE OF PRIVACY PRACTICES
Commonwealth Hand Therapy, LLC

Effective Date: October 3, 2016
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 the Practice Administrator at (859) 447-8600.

WHO WILL FOLLOW THIS NOTICE:

Commonwealth Hand Therapy, LLC

330 Waller Avenue, Suite 275
Lexington Kentucky 40504

This notice describes our privacy practices. All these entities, sites, and locations follow the terms of this notice. In addition, these entities, sites, and locations may share health information with each other for treatment, payment or health care operations purposes described in this notice.

OUR PLEDGE REGARDING HEALTH INFORMATION

We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by this health care practice, whether made by your personal therapist or others working in this office. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information.

We are required by law to:
          • Make sure that health information that identifies you is kept private
          • Give you this notice of your legal duties and privacy practices related with respect to health information

            about you
          • Follow the terms of the notice currently in effect

HOW WE MAY USE OR DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that we may use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every 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.

For Treatment

We may use health information about you to provide you with health care treatment or services. We may disclose health information about you to doctors, nurses, technicians, health students, or other personnel that are involved in taking care of you. They may work at our offices, at the hospital if you are hospitalized, or at another doctor’s office, lab, pharmacy, or other health care provider to whom we may refer you for consultation for other treatment purposes. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctors may need to tell the dietitian at the hospital if you

have diabetes so that they can arrange for the appropriate meals. We may also disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

For Payment

We may use and disclose health information about you so that the treatment and services you receive from us may be billed to and payment collected from you, an insurance company, or a third party. For example, we may need to file your health plan information about your office visit so your health plan will pay us or reimburse you for the visit. We may also tell you health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

For Health Care Operations

We may use and disclose health information about you for operations of our health care practice. These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, whether certain new treatments are effective, or to compare how we are doing with others and to see where we can make improvements. We may remove information that identifies you from this set of health information so that others may use it to study health care delivery without learning who our specific patients are.

As Required by Law

We will disclose health information about you when required to do so by federal, state, or local law.

To Avert Serious Threat to Health or Safety

We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of another person. Any disclosure, however, would only be to someone able to help prevent the threat.

Military and Veterans

If you are a member of the Armed Forces or separated/discharged from military service, we may release health information about you as required by military command authorities or the Department of Veterans Affairs as may be applicable. We may also release health information about foreign military personnel to the appropriate foreign military authorities.

Workers’ Compensation

We may release health information about you for works’ compensation or similar programs. These programs provide benefit for work-related injuries or illness.

Public Health Risks

We may disclose health information about your for public health activities. These activities generally include the following:

          1. To prevent or control disease, injury, or disability
          2. To report births and deaths
          3. To report child abuse or neglect
          4. To report reactions to medication or problems with products

          5. To notify people of recalls of products they may be using
          6. To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a

             disease or condition
          7. To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect,

              or domestic violence. We will only make this disclosure if you agree or when required by law.

Health Oversight Activities

We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

 

Lawsuits and Disputes

If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery

request, or other lawful process by someone else involved in a dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement

We may release health information if asked to do so by a law enforcement official:

  • In reporting certain injuries, as required by law, gunshot wounds, burns, injuries to perpetrators of crime

  • In response to a court order, subpoena, warrant, summons or similar process

  • To identify or locate a suspect, fugitive, material witness or missing person

    Name & Address
    Date of Birth or Place of Birth
    Social Security Number
    Blood Type or RH factor
    Type of Injury, Date & Time of Treatment and/or Death, if applicable, and
    A Description of Distinguishable Characteristics.

  • About the victim of a crime, if the victim agrees to disclosure under certain limited circumstances, we are unable to obtain the persons agreement

  • About a death we believe may be the result of criminal conduct

  • About criminal conduct at our facility

  • In emergency circumstances to report a crime; the location of the crime or victims, or the identity,

    description, or location of the persona who committed the crime.

 

Coroners, Health Examiners, and Funeral Directors

We may release health information to coroners or heath examiners. 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 to carry out their duties.

National Security and Intelligence Activities

We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others

We may disclose health information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign head of state or to conduct special investigations.

 

Inmates

If you are an inmate of a correctional institute or under the custody of a law enforcement official, we may release health information about you to the correctional institution or the law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Your Rights Regarding Health Information About You

You have the following rights regarding health information we maintain about you.

 

Right to Inspect and Copy

You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records.
To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to the Practice Administrator. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies and services associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by our practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right to Amend

If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information. To request an amendment, your request must be made in writing to the Practice Administrator, and must be contained on one page of paper legibly handwritten or typed in at least 10-point font size. In addition, you must provide a reason that supports your request for an amendment. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, 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 our practice

  • Is not part of the information which you would be permitted to inspect and copy

  • Is accurate and complete

Any amendment we make to your health information will be disclosed to those with whom we disclose information as previously specified.

 

Right to an Accounting of Disclosures

You have the right to request a list of accounting for any disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and health care operations, as previously described. To request a list of disclosures, you must submit your request in writing to the Practice Administrator. Your request must state a time period, which may not be longer than six years and may not include dates before 10/03/2016.

The first list you request within a 12-month period will be free. For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at the time before any costs are incurred. We will mail you a list of disclosures in paper form within 30 days of your request, or notify you if we are unable to supply the list within that time period and by what date we can supply the list; but this date will not exceed a total of 60 days from the date you made your request.

Right to Request Restrictions

You have the right to request a restriction or limitation on the health information we use or disclose to you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is not involved in your care or the payment of your care, such as a family member or friend. For example, you could ask that we restrict a specified nurse from use of your information, or that we do not disclose information to your spouse about a surgery you had. We are not required to agree to your request for restriction if it is not feasible for us to ensure our compliance or believe it will negatively impact the care we may provide you. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request a restriction, you must make your request in writing to the Practice Manger. In your request, you must tell us what information you want to limit and to whom you wan the limits to apply; for example, use of any information by a specified nurse, or disclosure of specified surgery to your spouse.

Right to Request Confidential Communications

You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail to a post office box. To request confidential communications you must make your request in writing to the Practice Administrator. We will not ask you for the reason for your request. We will accommodate all reasonable requests. Your request must specify how and where you wish to be contacted.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health 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 our facility. The notice will contain on the first page, the effective date. In addition, each time you register for treatment or health care services; we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe these privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact the Practice Administrator. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this notice of the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will not longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the health care are that we provided you.

ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE

We will request that you sign a separate form or notice acknowledging you have received a copy of this notice. If you choose, or are not able to sign, a staff member will sign their name and date. This acknowledgement will be filed with your records.