The Orthopedic Center

THE ORTHOPEDIC CENTER

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

If you have any questions about this notice, please contact Debbie Laber, our Imaging Technician at 410-820-8226, extension 123.

OUR COMMITMENT TO YOUR PRIVACY

The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 contains provisions that give you greater access to your health information - your medical record, your billing and insurance records, and any other information our practice might collect from you to provide healthcare services to you or to receive payment for the healthcare services rendered. In essence, HIPAA provides you with greater control over how your health information is used and disclosed.

HIPAA also outlines the responsibilities that healthcare providers and insurance plans have to keep your health information confidential. For example, HIPAA requires we provide you with this Notice and that we follow its expressed terms and the commitments.
We are committed to maintaining the privacy of your health information within the standards of sound medical practice. In conducting our business, we will create records regarding you and the treatment and services we provide to you.

These records are our property. However, as required by law, we will:

• Maintain the confidentiality of your health information.
• Provide you with this Notice of our legal duties and privacy practices concerning your health information.
• Follow the terms of our Notice of Privacy Practices in effect at the time.

In addition, unless specifically provided for by state or federal law, we may not use or disclose your health information without your written authorization. You may revoke your authorization at any time.

CHANGES TO THIS NOTICE

The terms of this Notice apply to all records containing your health information that are created or retained by us. We reserve the right to revise, change, or amend our Notice of Privacy Practices. Any revision or amendment to this Notice will be effective for all of the information that we already have about you, as well as any of your health information that we may receive, create, or maintain in the future. Our practice will post a copy of our current Notice in our offices in a prominent location, and you may request a copy of our most current Notice during any visit to our practice.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

The following categories describe the different ways in which HIPAA allows The Orthopedic Center to use and disclose your health information without your authorization. We have not provided an exhaustive list of every type of use or disclosure we are permitted to make. The different ways we are permitted to use and disclose your health information do fall within one of the following categories.

Treatment
Our practice will use and disclose your health information as necessary for you to receive treatment. For example, we may conduct diagnostic tests and use the results to help us reach a diagnosis, to provide further treatment to you, or to assist other in your treatment. Additionally, we may disclose your health information to others outside our practice that may assist in your care, such as other physicians, caregivers, or members of our family.

Payment
Our organization will use and disclose your health information in order to bill and collect payment for the services and items you receive from us. For example, we may contact your health insurer to confirm you are eligible for benefits and for what range of benefits. We may be asked by your insurer to provide specific details about the treatment you received so your insurer can determine whether the costs of your treatment are reimbursable. We also may use and disclose your health information to obtain payment from third parties that may be responsible for such costs, such as members of your family. Also, we may use your information to bill you directly for the services we provide during your treatment.

Health Care Operations
The Orthopedic Center will use and disclose your health information, kept outside of your medical record, within our practice to help ensure that you receive quality care and that we run efficiently and in compliance with state and federal laws. Similarly, we may use such health information to conduct cost-management and planning activities to identify new services needed in the community. We may use and disclose your information to certification agencies to help us evaluate the quality of care we provide, as limited below. Whenever we use or disclose your health information for these purposes, we will, to the extent possible, delete any information that could be used to identify you such as your name, your address and telephone number and your social security number.

Appointment Reminders
Our practice will use and disclose your health information to remind you that you have an appointment by mail and by telephone.

Alternative Treatments/Health-Related Benefits and Services
Our practice will use and disclose your health information to inform you of treatment alternative and/or health-related benefits and services that may be of interest to you.

Business Associates
Individuals and entities not employed by our practice but who perform certain functions for us or provide services on our behalf occasionally require the use of health information in our possession or require the disclosure of health information from us. However, we have contracts with all of our business associates, and these contracts prohibit them from using or disclosing the health information for reasons other than those specified in the contracts and from redisclosure of identifying information. Such business associates include our legal counsel, but, only for the purposes of his representation of us. Signing the consent authorizes disclosure to our business associates, other than our legal counsel, subject to these restrictions. Your health information might be used by, stored at, or disclosed to a business associate to function on our behalf.

Disclosures to Those Involved in Your Healthcare
Unless you object or instruct us otherwise, we may disclose your health information to a family member, relative, close friend or any other person that you identify who has involvement in your care or with payment related to your care who accompanies you when you receive treatment. We will, however, disclose only that health information that is directly related to the person's involvement. If you are unable to agree or object to a disclosure, we will use our professional judgment to determine whether to disclose such health information to immediate family members or to any other individual with whom you have a close personal relationship.

OTHER PERMITTED USES AND DISCLOSURES

As Required By Law
The Orthopedic Center will use or disclose health information about you to a government agency when required to do so by applicable state or federal law. For example, a physician is required to report individuals who receive treatment for gunshot wounds to the State. If you receive treatment for a gunshot wound, we will provide your health information to the appropriate State agency.

For Public Health Activities
Our organization may disclose your health information for educational or research purposes subject to, and in accordance with, an institutional oversight board. For example, we will disclose your health information to report reactions to drugs, problems with products or devices, or to notify you if a device you have has been recalled. Such disclosures shall only occur if the persons given access to the health information signs an acknowledgment agreeing not to redisclose any of your identifying information.

Victims of Abuse or Neglect
We will disclose your health information to the appropriate government authority if we believe you are a victim of abuse or neglect. Such disclosure is restricted to information which, in our opinion, will contribute to the assessment of risk, development of a service plan, implementation of a safety plan or the investigation of a case of abuse or neglect. If such disclosure is made, you will be informed unless your physician thinks informing you would place you at risk of serious harm or is otherwise not in your best interest. For example, The Orthopedic Center must notify Adult Protective Services if an elderly person appears to have been a victim of neglect.

For Health Oversight Activities
Our practice may receive a subpoena from a health oversight agency requiring disclosure of your health information, with which we must comply. Such disclosure may only relate to an investigation regarding the licensure, certification or discipline of a health professional or the improper practice of a health professional without your authorization.

For Lawsuits and Similar Proceedings
Our practice will use and disclose your health information in response to a court or administrative order or subpoena, which appears, on its face, to be lawfully issued. Except in the case of criminal investigations, that health information will not be released unless the order or subpoena contains a good faith certification of service of the order or subpoena upon you (or your attorney) unless: 1) you have waived such service; or 2) the court waives service as permitted by law. Furthermore, your health information will not be disclosed before you can object to the disclosure with sufficient information regarding the case or proceeding at issue. Disclosure of health information in criminal matters does not require service, but does require that the agency have written procedures to protect the confidentiality of records.

To Law Enforcement
We will release your health information to law enforcement upon receipt of a subpoena, warrant or court order but only if the information sought is sought solely for the investigating and prosecuting of criminal activity and the agencies have written procedures to protect the confidentiality of records. Unless the process is issued by a court or a grand jury, we will only honor the request if the request is specific and limited in scope and only with information that does not disclose your identity, unless de-identified information cannot reasonably be used.

To Coroners, Medical Examiners, and Funeral Directors
Our practice may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the case of death. We may also release health information about patients of a hospital to funeral directors as necessary to carry out their duties.

For Organ and Tissue Donation Purposes
We may disclose your health information to organizations legally authorized to handle organ and tissue procurement, banking, or transplantation. For example, we might provide your health information to an organ donation center if the information were needed to include you on a list of individuals awaiting an organ for transplant, or if you are listed as an organ donor.

To Avert a Serious Threat to Health or Safety
Our practice may use and disclose your health information when necessary to provide for the emergency health care needs of a patient. Under these circumstances, we will only make disclosures to a person or organization able to help provide for those needs.

For Specialized Government Functions
Our practice may disclose your health information if you are a member of U.S. or foreign military forces (including veterans) and if required to do so by the appropriate military command authorities, and as otherwise required by federal law.

Furthermore, our practice may disclose your health information if you are involuntarily committed under State law, or ordered by a court to detention: 1) in a correctional institution; or 2) by law enforcement officials. We would have to be satisfied that disclosure of the information is necessary for your proper care and treatment.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION

Under HIPAA, you have several specific rights regarding the health information we maintain about you. Some of these rights require you to contact The Orthopedic Center in writing in order to exercise them. If you are required to contact The Orthopedic Center in writing, please submit your written request to:

Debbie Laber , Imaging Technician
The Orthopedic Center
510 Idlewild Avenue, Suite 200
Easton, Maryland 21601

Right to Request Restrictions
You have the right to ask that we limit how we use and disclose your health information. Additionally, you have the right to request that we limit any disclosures we make of your health information to only those individuals who are involved in your care or for payment for your care.

We are not required to agree to your request; although we will accommodate reasonable requests. Further, if we do agree to your request, we are bound by our agreement with you except when otherwise required by law, in case of an emergency, or when the information we need to use or disclose is necessary to treat you.

Requests for restrictions must be submitted in writing to Debbie Laber at the above listed address.

Your request must describe in a clear and concise fashion: (1) the information you wish restricted; (2) whether you are requesting to limit our practice's use, disclosure or both; and (3) to whom or how you want the limits to apply.

Right to Receive Confidential Communications

You have the right to request the manner in which, and where we should communicate with you regarding your health information. For instance, you may direct us to contact you by mail rather than by telephone, or at work rather than at your home. You also have the right to ask us to send your health information to you at a location other than the one we have on file for you. For example, you might want us to send your health information to a post office box instead of your home address.

In order to receive a confidential communication or to have communications sent to a different location, you must submit your request in writing to Debbie Laber, at the above listed address.

Your request must specify the requested method of contact and/or the location, as appropriate. You are not required to give a reason for your request. The Orthopedic Center will accommodate all reasonable requests.

Right to Inspect and Copy
You have the right to inspect and obtain a copy of the health information about you that we use and/or store, including your medical records and insurance and billing records in "designated record sets" defined by our practice. If you want to inspect or obtain a copy of your health information, you must submit your request in writing to Debbie Laber at the address provided on the last page of this Notice.

Our practice charges a fee that covers the costs we incur to make the copies, send or mail the health information to you, and any labor and supplies required. We will inform you of the estimated cost associated with your request before we make copies for you in case you want to withdraw or limit your request.

In only a few, limited circumstances, The Orthopedic Center will deny a patient's request. If we deny you access to or a copy of your health information, you may request a review of the denial which will be performed by a healthcare provider chosen by us who was not involved in the initial decision.

Right to Request Amendments
You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for The Orthopedic Center. Your request for amendment(s) must be made in writing and submitted to Debbie Laber at the address provided on the last page of this Notice.

In your request, you must specify the reason(s) you believe your information is incorrect or incomplete. Failure to submit your request in writing and/or failing to include the proper documentation will result in a denial. In addition, your request will be denied if you ask us to amend information that is:

• accurate and complete;
• not part of the health information kept by or for The Orthopedic Center;
• not part of the health information which you would be permitted to inspect and copy; or
• not created by The Orthopedic Center, unless the individual or entity that created the information is not available to amend the information and The Orthopedic Center has all the information required to evaluate and respond to your request.

Right to Receive an Accounting of Disclosures
You have the right to request an accounting of disclosures of your health information that have been made by The Orthopedic Center. The accounting of disclosures will not include: (1) disclosures that are made in the course of providing treatment to you; (2) disclosures that are made for purposes of obtaining payment for the services rendered to you; (3) disclosures that are made for purposes of operating our practice; and (4) any disclosures you previously authorized The Orthopedic Center to make.

In order to obtain an accounting of disclosures, you must submit your request in writing to Debbie Laber at the address provided on the last page of this Notice.

You request must include a specific period of time that may not be longer than six (6) years prior to the date of the request, and the specific period of time may not include dates prior to April 14, 2003.

The first accounting of disclosures you request in a twelve (12) month period will be provided free of charge. There will be a charge for any additional accountings of disclosures requested within the same (12) month period. The Orthopedic Center will notify you of the costs associated with any additional requests made by you. That way, you may withdraw or limit your request prior to incurring any costs.

Right to a Paper Copy of This Notice
You are entitled to receive a paper copy of this Notice of Privacy Practices the first time you come to The Orthopedic Center for treatment. However, you may ask for and we will provide you with a copy of this Notice at any time. Please direct your requests for a copy of this Notice to Debbie Laber at the address provide at the end of this Notice.

Right to File a Complaint
If you believe The Orthopedic Center has misused or improperly disclosed your health information, you may file a complaint with our practice by contacting Debbie Laber, our Imaging Technician at (410) 820-8226 extension 123.

Alternatively, you may file a complaint with the Secretary of the Department of Health and Human Services.

All complaints must be submitted in writing, either to Debbie Laber, Imaging Technician at the previous listed address or to the Department of Health and Human Services.

You will not be penalized for filing a complaint.

Right to Provide an Authorization for Other Uses and Disclosures
Our practice will obtain your written authorization for uses and disclosures that are not identified by this Notice or that are not permitted by law. You may revoke any authorization you provide to us regarding the use and disclosure of your health information at any time in writing. After you revoke your authorization, we will no longer use or disclose your health information for the reasons described in the authorization. Of course, we are unable to take back any disclosures that we have already made with your permission.

CONTACT
If you have any questions about how The Orthopedic Center will use or disclose your health information, or if you require further information about this Notice of Privacy Practices, please contact:

Debbie Laber, Imaging Technician
The Orthopedic Center
510 Idlewild Avenue, Suite 200
Easton, Maryland 21601
(410) 820-8226, extension 123