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.
We understand
the importance of privacy and
are committed to maintaining
the confidentiality of your medical
information. We make a record
of the medical care we provide
and may receive such records
from others. We use these records
to provide or enable other health
care providers to provide quality
medical care, to obtain payment
for services provided, and for
administrative and operational
purposes. The medical record is
the property of this facility.
If you have any questions about
this notice, please contact our
privacy officer for SCOTT SABOLICH
PROSTHETICS & RESEARCH at 405
841-6800 or toll free at 877-226-5424.
HOW THIS CENTER
MAY USE OR DISCLOSE
YOUR MEDICAL INFORMATION
For treatment. We
use medical information about you
to provide your care. We disclose
medical information to our employees
and others who are involved in providing
the care you need. For example, we
may share your medical information
with physicians or other healthcare
providers who will provide services
which we do not provide. We may share
your medical information with prosthetic
and orthotic manufacturers who need
it make your device. We may also
disclose medical information to members
of your family or others who can
help you. To assist with the education
and encouragement of other patients,
we may share information about your
case with others patients, however
you will only be individually identified
if you agree to such disclosure.
For payment. We
use and disclose medical information
about you to obtain payment for the
services you receive. For example,
a bill may be sent to you and/or
to a third-party payor, such as an
insurance company or health plan.
For health care operations. We
may use and disclose medical information
about you to operate this facility.
For example, we may use and disclose
this information to review and improve
the quality of care we provide or
the competence and qualifications
of our professional staff. We may
use and disclose medical information
about you to get your health plan
to authorize services or referrals.
We may also share your medical information
with our business associates, such
as a billing service, that perform
administrative services for us. We
have a written contract with each
business associate that contains
terms requiring them to protect the
confidentiality of your medical information.
If you call for a facility staff
member, we may announce your name
on our paging system.
Appointment reminders. We
may use and disclose medical information
to contact and remind you about appointments.
If time allows, we will mail a postcard
reminder. Otherwise, we may phone
your home. If you are not at home,
we may leave this information on
your answering machine or in a message
left with the person answering the
phone.
Sign-in sheet. We
may use and disclose medical information
about you by having you sign in when
you arrive at our office. We may
also call out your name when we are
ready to see you.
Notification and communication
with family. We may
disclose your medical information
to notify or assist in notifying
a family member, your personal
representative, or another person
responsible for your care about
your location or your general
condition. In the event of a
disaster, we may disclose information
to a relief organization so that
they may coordinate these notification
efforts. We may also disclose
information to someone who is
involved with your care. If you
are able and available to agree
or object, we will give you the
opportunity to object prior to
making these disclosures, although
we may disclose medical information
in a disaster even over your
objection if we believe it is
necessary to respond to the emergency
circumstances. If you are unable
and unavailable to agree or object,
our health professionals will
use their best judgment in communication
with your family and others.
Required by law. We
may use and disclose medical information
about you as required by law. For
example, we may disclose information
in the course of certain events or
for the following purposes:
To report information related to
victims of abuse, neglect or domestic
violence;
To assist law enforcement officials
in their law enforcement duties;
To respond to judicial and administrative
proceedings or, in the course of
judicial proceedings, if you have
waived your rights to confidentiality
under Oklahoma law; and,
To help health oversight agencies
during the course of audits, investigations,
inspections, licensure, and other
proceedings, subject to the limitations,
imposed by federal and Oklahoma law.
Lawsuits and disputes. If
you are involved in a lawsuit or
a dispute, we may disclose medical
information about you in response
to a court or administrative order.
If the lawsuit is a medical negligence
action, your medical information
may be disclosed without a court
order or subpoena. We may also disclose
medical information about you in
response to a subpoena, discovery
request, or other lawsuit process
by someone else involved in the dispute,
but only if efforts have been made
to tell you about the request or
to obtain an order protecting the
information requested.
Public health and safety. Your
medical information may be used or
disclosed for public health activities
such as assisting public health authorities
or other legal authorities prevent
or control disease, injury, or disability,
or for other health oversight activities.
Your medical information may be disclosed
to appropriate persons in order to
prevent or lessen a serious and imminent
threat to the health and safety of
a particular person or the general
public.
Specialized government function. We
may disclose your medical information
for military or national security
purposes or to correctional institutions
or law enforcement officers that
have you in their lawful custody.
Workers’ compensation. Your
medical information may be used or
disclosed as necessary in order to
comply with laws and regulations
related to workers’ compensation.
Change of ownership. In
the event that this facility is sold
or merged with another organization,
your medical information will become
the property of the new owner, although
you will maintain the right to request
that copies of your medical information
be transferred to another facility.
Marketing. We may
contact you to give you information
about products or services related
to your treatment, case management
or care coordination, or to direct
or recommend other treatments or
health-related benefits and services
that may be of interest to you. We
may also encourage you to purchase
a product or service when we see
you. We will not use or disclose
your medical information for marketing
purposes without your written authorization.
Research. We may
use your health information for research
purposes when an institutional review
board or privacy board has reviewed
the research proposal and established
protocols to ensure the privacy of
your health information and has approved
the research.
By Oklahoma
law we are required to notify you … that
your medical information used or
disclosed as described in this Notice of
Privacy Practices may include
records which may indicate the presence
of a communicable or venereal disease
which may include, but are not limited
to, diseases such as hepatitis, syphilis,
gonorrhea, and the human immunodeficiency
virus, also known as Acquired Immune
Deficiency Syndrome (AIDS).
WHEN THIS CENTER
MAY NOT USE
OR DISCLOSE YOUR MEDICAL INFORMATION
Except as described in this Notice
of Privacy Practices, this facility
will not use or disclose medical
information which identifies you
without your written authorization.
If you do authorize this facility
to use or disclose your medical information
for another purpose, you may revoke
your authorization in writing at
any time.
YOUR MEDICAL INFORMATION
RIGHTS
You have the right:
- To a paper copy of this Notice
of Privacy Practices.
- To request restriction on certain
uses and disclosures of your medical
information by written request
specifying what information you
want to limit and what limitations
on our use or disclosure of that
information you wish to have imposed.
We reserve the right to accept
or reject your request and will
notify you of our decision.
- To request that you receive medical
information in a specific way or
at a specific location. For example,
you may ask that we send information
to your work address. We will comply
with all reasonable requests submitted.
- To obtain
access to or a copy of your medical
information, with limited exceptions.
A reasonable fee may be charged
for making copies. Under current
Oklahoma law, fees of 25¢ per
page and $5.00 per film are allowed.
We may also charge for postage
if the copies are to be mailed.
If we deny your request for access
or copies, you will be informed
of your right to appeal our decision.
- To request
that we amend your medical information
that you believe is incorrect
or incomplete. Your request to
amend must be in writing and
include the reasons you believe
the information is inaccurate or
incomplete. We are not required
to change your medical information
and will provide you with information
about this facility’s denial
and how you can disagree with the
denial. You also have the right
to request that we add to your
record a statement of up to two
hundred and fifty (250) words concerning
any statement or item you believe
to be incomplete or incorrect.
- To receive an accounting of disclosures
made of your medical information
by this facility unless the disclosures
were for purposes of treatment,
payment, health care operations,
certain government function, or
pursuant to your written authorization.
You have the right to revoke your
authorization to use or disclose
medical information except to the
extent that this use or disclosure
has already occurred.
IF YOU WOULD LIKE TO HAVE A
MORE DETAILED EXPLANATION OF THESE
RIGHTS, OR IF YOU WOULD LIKE TO
EXERCISE ONE OR MORE OF THESE RIGHTS,
CONTACT OUR PRIVACY OFFICER LISTED
AT THE BEGINNING OF THIS NOTICE
OF PRIVACY PRACTICES.
OBLIGATIONS OF
THIS FACILITY
We are required to maintain the
privacy of your confidential medical
information, provide you with this
notice of our legal duties and privacy
practices with respect to your medical
information, abide by the terms of
this notice, notify you if we are
unable to agree with a requested
restriction on how your information
is used or disclosed, accommodate
reasonable requests you make to communicate
medical information by alternative
means or alternative locations, and
obtain your written authorization
to use or disclose your medical information
for reasons other than those listed
above and permitted under law. We
reserve the right to change or amend
this Notice of Privacy Practices at
any time in the future. After an
amendment is made, the revised Notice
of Privacy Practices will apply
to all medical information that we
maintain. A copy of any Revised Notice
of Privacy Practices will be
made available to you at each appointment.
COMPLAINTS
Complaints about this Notice
of Privacy Practices or how
this facility handles your medical
information should be directed
to:
PRIVACY
OFFICER
Scott
Sabolich Prosthetics & Research
10201
N Broadway Extension
Oklahoma
City, OK 73114
405
841-6800
toll
free 877 226-5424
If you are not satisfied with the
manner in which the facility handles
a complaint, you may submit a formal
complaint to:
The
Department of Health and Human Services
Office
of Civil Rights
Herbert
H Humphrey Building, Room 509 F
200
Independence Avenue, SW
Washington,
DC 20201
You will not be penalized for filing
a complaint.
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