Summary of

NOTICE OF PRIVACY PRACTICES

For DOUGLASS CPO, INC

 

This summary briefly describes important information contained in our Notice of Privacy Practices.  We encourage you to take the time to read the complete Notice, which is attached to this summary.

 

Our Notice of Privacy Practices describes how we may use and disclose your protected health information 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 control your protected health information.  Your “protected health information” means any of your written and oral health information, including your demographic data that can be used to identify you.  This is health information that is created or received by your health care provider, ant that related to your past, present, or future physical or mental health or condition. 

This Notice will let you know about the various ways we use and disclose your medical information, describe your rights and our obligations with respect to the use or disclosure of your medical information.  We will also ask that you acknowledge receipt of this Notice the first time you come to or use any of our facilities, because the law requires us to make a good faith effort to obtain your acknowledgment.

We are required by law to:

  • Make sure that any medical or health information that we have that identifies you is kept private, and will be used or disclosed only in accord with our Notice of Privacy Practices and applicable law;
  • Give you the complete Notice of our legal duties and our privacy practice; and
  • Abide by the terms of the Notice of Privacy Practices that is in effect from time to time.

 

NOTICE OF PRIVACY PRACTICES

FOR DOUGLASS CPO, INC

 

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: our Privacy Contact who is the Office Manager at (206) 363-7790.

OUR COMMITMENT TO PROTECT YOUR HEALTH INFORMATION

This Notice of Privacy Practices describes how we may use and disclose your protected health information 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 control your protected health information.  Your “protected health information” means any of your written and oral health information, including your demographic data that can be used to identify you.  This is health information that is created or received by your health care provider, and that relates to your past, present or future physical or mental health or condition.

We are strongly committed to protecting your medical information.  We create a medical record about your care because we need the record to provide you with appropriate treatment and to comply with various legal requirements.  We transmit some medical information about your care in order to obtain payment for the services you receive, and we use certain information in our day to day operations.  This notice will let you know about the various ways we use and or disclose your medical information, describe your rights and our obligations with respect to the use or disclosure of your medical information.  We will also ask that you acknowledge receipt of this Notice the first time you come to or use any of our facilities, because the law requires us to make a good faith effort to obtain your acknowledgement. 

We are required by law to:

  • Make sure that any medical or health information that we have that identifies you is kept private, and will be used or disclosed only in accord with this Notice of Privacy Practices and applicable law;
  • Give you this Notice of our legal duties and our privacy practices; and
  • Abide by the terms of the Notice of Privacy Practices that is in effect from time to time.

1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

A. Uses and Disclosures of Protected Health Information for Treatment, Payment and Healthcare Operations

Your protected health information may be used and disclosed by your (Orthotist or Prosthetist), our office staff and other outside of our office who are involved in your care and treatment for the purpose of providing health care services to you.  Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of this DOUGLASS CPO, INC.

Following are examples of the types of uses and disclosures of your protected health care information that this DOUGLASS CPO, INC is permitted to make.  We have provided some examples of the types of each use or disclosure we may make, but not every use or disclosure in any of the following categories will be listed.

For Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related treatment.  This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information.  For example, we would disclose your protected health information, as necessary, to the physician that referred you to us.  We will also disclose protected health information to other health care providers who may be treating you when we have the necessary permission from you to disclose your protected health information.

For Payment: Your protected health information will be used, as needed, to obtain payment for your health care services.  This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to your for medical necessity, and undertaking utilization review activities.  We may also tell your health plan about an orthotic or prosthetic device you are going to receive to obtain prior approval or to determine whether your plan will cover the device.

For Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of this DOUGLASS CPO, INC.  These activities include, but are not limited to, quality assessment activities, employee review activities, legal services, licensing, and conducting or arranging for other business activities.  We may share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for this DOUGLASS CPO, INC.  Whenever an arrangement between our DOUGLASS CPO, INC. and our business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

Treatment Alternatives: We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Appointment Reminders: We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

Sign In Sheets: We may use a sign-in sheet at the registration desk where you will be asked to sign your name.  We may also call you by name in the waiting room when your (Orthotist or Prosthetist) is ready to see you.

Marketing and Health Related Benefits and Services: We may also use and disclose your protected health information for other marketing activities. For example, we may send you information about products or services that we believe may be beneficial to you.  You may contact our Privacy Contact to request that these materials not be sent to you.

Sale of the Practice: If we decide to sell this practice or merge or combine with another practice, we may share your protected health information with the new owners.

B.  Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below.  You may revoke your authorization, at any time, in writing.  You understand that we can not take back any use or disclosure we may have made under the authorization before we received your written revocation, and that we are required to maintain a record of the medical care that has been provided to you.  The authorization is a separate document, and you will have the opportunity to review any authorization before you sign it.  We will cont condition your treatment in any way on whether or not you sign any authorization.

C. Other Permitted and Required Uses and Disclosures That May BE Made Either With Your Agreement or the Opportunity to Object

We may use or disclose your protected health information in the following instances.  You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information.  If you are not present or able to agree or object to the use or disclosure of the protected health information, then your (Orthotist or Prosthetist) may, using their professional judgment, determine whether the disclosure is in your best interest.  In this case, only the protected health information that is relevant to your health care will be disclosed.

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, orally or in writing, your protected health information 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 it is in your best interest based on our professional judgment. We may use or disclose your protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location or general condition.

D. Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object

We may use or disclose your protected health information in the following situations without your authorization or providing you the opportunity to object.

Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by federal, state or local law.  The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.  You will be notified, as required by law, of any such uses or disclosures.

Public Health: We may use or disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information.  The disclosure will be made for the purpose of controlling disease, injury or disability.  A disclosure under this exception would only be made to somebody in a position to prevent the threat to public health.

Communicable Diseases: We may use or disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

Health Oversight: We may use or disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.