| 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 Linda Wells,
Compliance Officer or John Ficociello, President.
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
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 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 Orthotic, Prosthetic or HME
Practitioner, our office staff and others outside of our
office who are involved in your care and treatment for the
purpose of providing health care services to you.
Following are examples of the types of uses and
disclosures of your protected health care information that
this facility 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 you for
medical necessity, and undertaking utilization review
activities. We may also tell your health plan about an
orthotic/prosthetic/HME 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 facility. 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 facility. Whenever an arrangement between
our facility 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.
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 not
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 and 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/Prosthetist/HME Practitioner and Billing)
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 that 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 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 help prevent the threat to
public health
Communicable Diseases: We may 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 disclose protected health
information to a health oversight agency for activities
authorized by law, such as audits, investigations, and
inspections. Oversight agencies seeking this information
include government agencies that oversee the health care
system, government benefit programs, other government
regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected
health information to a public health authority that is
authorized by law to receive reports of child abuse or
neglect. In addition, we may disclose your protected health
information if we believe that you have been a victim of
abuse, neglect or domestic violence to the governmental
entity or agency authorized to receive such information. We
will only make this disclosure if you agree or when required
or authorized by law. In this case, the disclosure will be
made consistent with the requirements of applicable federal
and state laws.
Military and Veterans: If you are a member of the
military, we may release protected health information about
you as required by military command authorities.
Food and Drug Administration: We may disclose your
protected health information to a person or company required
by the Food and Drug Administration to report adverse
events, product defects or problems, biologic product
deviations, track products; to enable product recalls; to
make repairs or replacements, or to conduct post marketing
surveillance, as required.
Legal Proceedings: We may disclose your protected
health information in the course of any judicial or
administrative proceeding, in response to an order of a
court or administrative tribunal (to the extent such
disclosure is expressly authorized), in certain conditions
in response to a subpoena, discovery request or other lawful
process.
Law Enforcement: We may also disclose your
protected health information, so long as applicable legal
requirements are met, for law enforcement purposes. These
law enforcement purposes might include (1) legal processes
and otherwise required by law, (2) limited information
requests for identification and location purposes, (3)
pertaining to victims of a crime, (4) suspicion that death
has occurred as a result of criminal conduct, (5) in the
event that a crime occurs on the premises of the practice,
and (6) medical emergency (not on the facility’s premises)
and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation:
We may disclose your protected health information to a
coroner or medical examiner for identification purposes,
determining cause of death or for the coroner or medical
examiner to perform other duties authorized by law. We may
also disclose protected health information to a funeral
director, as authorized by law, in order to permit the
funeral director to carry out their duties. We may disclose
such information in reasonable anticipation of death.
Protected health information may be used and disclosed for
cadaveric organ, eye or tissue donation purposes.
Research: Under certain circumstances, we may
disclose your protected health information to researchers
when their research has been approved by an institutional
review board that has reviewed the research proposal and
established protocols to ensure the privacy of your
protected health information.
Criminal Activity: Consistent with applicable
federal and state laws, we may disclose your protected
health information, if we believe that the use or disclosure
is necessary to prevent or lessen a serious and imminent
threat to the health or safety of a person or the public. We
may also disclose protected health information if it is
necessary for law enforcement authorities to identify or
apprehend an individual.
Military Activity and National Security: When the
appropriate conditions apply, we may use or disclose
protected health information of individuals who are Armed
Forces personnel (1) for activities deemed necessary by
appropriate military command authorities; (2) for the
purpose of a determination by the Department of Veterans
Affairs of your eligibility for benefits, or (3) to foreign
military authority if you are a member of that foreign
military services. We may also disclose your protected
health information to authorized federal officials for
conducting national security and intelligence activities,
including for the provision of protective services to the
President or others legally authorized.
Workers’ Compensation: We may disclose your
protected health information as authorized to comply with
workers’ compensation laws and other similar
legally-established programs that provide benefits for
work-related illnesses and injuries.
Inmates: We may use or disclose your protected
health information if you are an inmate of a correctional
facility and your Orthotic, Prosthetic or HME
Practitioner created or received your protected health
information in the course of providing care to you.
Required Uses and Disclosures: Under the law, we
must make disclosures to you and when required by the
Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the
requirements of the final rule on Standards for Privacy of
Individually Identifiable Health Information.
2. YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
Following is a statement of your rights with respect to
your protected health information and a brief description of
how you may exercise these rights.
You have the right to inspect and copy your protected
health information.
This means you may inspect and obtain a copy of your
protected health information contained in your medical and
billing records and any other records that your
Orthotist/Prosthetist/HME Practitioner uses for making
decisions about you, for as long as we maintain the
protected health information.
To inspect and copy your medical information, you must
submit a written request to the Privacy Contact listed on
the first and last pages of this Notice. If you request a
copy of your information, we may charge you a fee for the
costs of copying, mailing or other costs incurred by us in
complying with your request.
We may deny your request in limited situations specified
in the law. For example, you may not inspect or copy
psychotherapy notes; or information compiled in reasonable
anticipation of, or use in, a civil, criminal, or
administrative action or proceeding, and certain other
specified protected health information defined by law. In
some circumstances, you may have a right to have this
decision reviewed. The person conducting the review will not
be the person who initially denied your request. We will
comply with the decision in any review. Please contact our
Privacy Contact if you have questions about access to your
medical record.
You have the right to request a restriction of your
protected health information. This means you may ask us
not to use or disclose any part of your protected health
information for the purposes of treatment, payment or
healthcare operations. You may also request that any part of
your protected health information not be disclosed to family
members or friends who may be involved in your care or for
notification purposes as described in this Notice of Privacy
Practices. Your request must state the specific restriction
requested and to whom you want the restriction to apply.
Yankee Medical is not required to agree to a
restriction that you may request. If Yankee Medical
believes it is in your best interest to permit use and
disclosure of your protected health information, your
protected health information will not be restricted. If we
agree to the requested restriction, we may not use or
disclose your protected health information in violation of
that restriction unless it is needed to provide emergency
treatment. With this in mind, please discuss any restriction
you wish to request with your Orthotist, Prosthetist or
HME Practitioner. You may request a restriction by
submitting the request in writing to the Compliance Officer.
You have the right to request to receive confidential
communications from us by alternative means or at an
alternative location. We will accommodate reasonable
requests. We may also condition this accommodation by asking
you for information as to how payment will be handled or
specification of an alternative address or other method of
contact. We will not request an explanation from you as to
the basis for the request. Please make this request in
writing to our Compliance Officer.
You may have the right to have Yankee Medical amend
your protected health information. This means you may
request an amendment of your protected health information
contained in your medical and billing records and any other
records that Yankee Medical uses for making decisions about
you, for as long as we maintain the protected health
information. You must make your request for amendment in
writing to our Compliance Officer, and provide the reason or
reasons that support your request.
We may deny any request that is not in writing or does
not state a reason supporting the request. We may deny your
request for an amendment of any information that:
1. Was not created by us, unless the person that created
the information is no longer available to amend the
information;
2. Is not part of the protected health information kept by
or for us;
3. Is not part of the information you would be permitted to
inspect or copy; or
4. Is accurate and complete.
If we deny your request for amendment, we will do so in
writing and explain the basis for the denial. You have the
right to file a written statement of disagreement with us.
We may prepare a rebuttal to your statement and will provide
you with a copy of any such rebuttal. Please contact our
Privacy Contact to determine if you have questions about
amending your medical record.
You have the right to receive an accounting of certain
disclosures we have made, if any, of your protected health
information. This right only applies to disclosures for
purposes other than treatment, payment or healthcare
operations as described in this Notice of Privacy Practices.
It also excludes disclosures we may have made to you, to
family members or friends involved in your care, or for
notification purposes. You have the right to receive
specific information regarding these disclosures that
occurred after April 14, 2003. The right to receive this
information is subject to certain exceptions, restrictions
and limitations. You must submit a written request for
disclosures in writing to the Privacy Contact. You must
specify a time period, which may not be longer than six
years and cannot include any date before April 14, 2003. You
may request a shorter timeframe. Your request should
indicate the form in which you want the list (i.e., on
paper, etc). You have the right to one free request within
any 12 month period, but we may charge you for any
additional requests in the same 12 month period. We will
notify you about the charges you will be required to pay,
and you are free to withdraw or modify your request in
writing before any charges are incurred.
You have the right to obtain a paper copy of this
notice from us, upon request to our Privacy Contact, or
in person at our office, at any time, even if you have
agreed to accept this notice electronically. You may obtain
a copy of this notice at our website
www.yankeemedical.com.
3. COMPLAINTS
You may complain to us or to the Secretary of Health and
Human Services if you believe your privacy rights have been
violated by us. You may file a complaint with us by
notifying our privacy contact of your complaint. We will not
retaliate against you in any way for filing a complaint,
either with us or with the Secretary.
You may contact our Compliance Officer, Linda Wells at
(802) 863-4591 ext 1032 or email us
the compliant. You may also contact John Ficociello,
President at (802) 863-4591 ext 1030
for further information about the complaint process.
4. CHANGES TO THIS NOTICE
We reserve the right to change the privacy practices that
are described in this Notice of Privacy Practices. We also
reserve the right to apply these changes retroactively to
Protected Health Information received before the change in
privacy practices. You may obtain a revised Notice of
Privacy Practices by calling the office and requesting a
revised copy be sent in the mail, asking for one at the time
of your next appointment, or accessing our website
This notice was published and becomes effective on
April 14, 2003
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