PF-1000        Notice of Privacy Practices

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.

Uses and Disclosures

Treatment. Your health information may be used by staff members or dis­closed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For exam­ple, results of laboratory tests and procedures will be available in your medi­cal record to all health professionals who may provide treatment or who may be consulted by staff members.

 

Payment. Your health information may be used and disclosed to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For exam­ple, your health plan may request and receive information on dates of ser­vice, the services provided, and the medical condition being treated.

 

Health care operations. Your health information may be used and disclosed as necessary to support the health care operations of Milwaukee Spinal Specialists, S.C..  Health care operations include:

 

v            Health care quality assessment and improvement activities;

v            Reviewing and evaluating health care provider performance, qualifications and competence, health care training programs, health care provider accreditation, certification, licensing and credentialing activities;

v            Conducting or arranging for medical reviews, audits, and legal services, including fraud and abuse detection and prevention; and

v            Business planning, development, management, and general  administration, including customer service.

 

With your written permission, we may disclose your health information to a health plan or another health care provider who is subject to federal privacy protection laws, as long as the provider or plan has or had a relationship with you and the health information is for that provider’s or plan’s health care quality assessment and improvement activities, competence and qualification evaluation and review activities, or fraud and abuse detection and prevention.

 

Public Health and Benefit Activities.  We may use and disclose your health information, without your permission, when required by law, and when authorized by law for the following kinds of public health and interest activities:

 

v            For public health, including to report disease and vital statistics, child abuse, and adult abuse or neglect;

v            To avert a serious and imminent threat to health or safety;

v            For health care oversight, such as activities of state licensing and peer   review authorities, and fraud prevention enforcement agencies;

v           For research;

v           In response to court and certain administrative orders and other lawful process;

v           To law enforcement officials with regard to crime victims, crimes on our premises, crime reporting in emergencies, and identifying or locating suspects or other persons;

v           To coroners and medical examiners;

v           To the military, to federal officials for lawful intelligence, counterintelligence, and national security activities, and to correctional institutions and law enfocement regarding persons in lawful custody; and

v           As authorized by state worker’s compensation laws.

 

You may be able to opt out of use or disclosure of your health information for

(a) research purposes or (b) pursuant to a written request from a government agency, unless the disclosure is required by law.

 

We may not disclose certain confidential health information or mental health treatment records for some of these purposes without your written permission, unless required by law.

 

Family Members and Others Involved in Your Care.  With your written permission, we may disclose your confidential medical information, HIV test results, or mental health treatment records to a family member, friend, or any other person you involve in your health care or payment for your health care.  We will disclose only the information that is relevant to the person’s involvement.

 

Other uses and disclosures require your authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a writ­ten revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.

 

Additional Uses of Information

Appointment reminders. Your health information may be used by our staff to send you appointment reminders.

 

Information about treatments. Your health information may be used to send you information that you may find interesting on the treatment and management of your medical condition.. We may also send you infor­mation describing other health-related products and services that we believe may interest you.

 

Individual Rights

You have certain rights under the federal privacy standards. These include:

 

v             the right to request restrictions on the use and disclosure of your protected health information

v             the right to receive confidential communications concerning your medical condition and treatment

v             the right to inspect and copy your protected health information

v             the right to amend or submit corrections to your protected health information

v             the right to receive an accounting of how and to whom your protected health information has been disclosed

v             the right to receive a printed copy of this notice

 

Milwaukee Spinal Specialists, S.C.’s Duties

We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices.

 

We also are required to abide by the privacy policies and practices that are outlined in this notice.

 

Right to Revise Privacy Practices

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all pro­tected health information we maintain.

 

Requests to Inspect Protected Health Information

You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Receptionist or the Privacy Officer. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.

 

Complaints

If you would like to submit a comment or complaint about our privacy prac­tices, you can do so by sending a letter outlining your concerns to:

 

Privacy Officer

Milwaukee Spinal Specialists, S.C.

2015 E Newport Ave, Suite 805

Milwaukee, WI 53211

 

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your con­cern to the same address.

 

You will not be penalized or otherwise retaliated against for filing a com­plaint.

 

Contact Person

The name and address of the person you can contact for further information concerning our privacy practices is:

 

Privacy Officer

Milwaukee Spinal Specialists, S.C.

2015 E Newport Ave, Suite 805

Milwaukee, WI  53211

(414) 961-2225

 

Effective Date

This Notice is effective on or after April 14, 2003.