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Privacy
Notice
Orthopaedic
Associates of Aspen and Glenwood
Notice of Privacy Practices
This Notice Describes How Medical Information
About You May Be Used And Disclosed And How You Can Ger 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 processionals who may provide
treatment or who may be consulted by staff members.
Payment: Your health information may be used 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 and 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 as necessary
to support the day-to-day activities and management of Orthopaedic
Associates of Aspen and Glenwood, P.C. For example, information on
the services you received may be used to support budgeting and financial
reporting, and activities to evaluate and promote quality.
Law enforcement: Your health information may be disclosed
to law enforcement agencies to support government audits and inspections,
to facilitate law-enforcement investigations, and to comply with government
mandated reporting.
Public health reporting: Your health information
may be disclosed to public health agencies as required by law. For
example, we are required to report certain communicable diseases to
the state’s public health department.
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 will 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.
Fundraising. Unless you request us not to, we will
use your name and address to support our fund-raising efforts. If
you do not want to participate in fund-raising efforts, please check
off the following box and sign in the appropriate place on the Acknowledgement
form.
Please do not use my information for fundraising purposes.
Individual Rights
You have certain rights under the federal privacy standards. These
include:
• The right to request restrictions on the use and disclosure
of your protected health information
• The right to receive confidential communications concerning
your medical condition and treatment
• The right to inspect and copy your protected health information
The right to request an amendment or submit corrections to your protected
health information
• The right to receive an accounting of how and to whom your
protected health information has been disclosed
• The right to receive a printed copy of this notice
Orthopaedic Associates of Aspen and Glenwood, P.C 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 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.
Request 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 Office Manager or our Privacy Officer. Your request
will be reviewed and will generally be approved unless there are legal
or medial 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
Orthopaedic Associates of Aspen and Glenwood, P.C.
1450 E Valley Road, suite 201
Basalt, CO 81621
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
Orthopaedic Associates of Aspen and Glenwood, P.C.
1450 E Valley Road, Suite 201
Basalt, CO81621
970-927-8611
Effective Date
This Notice is effective on or after April 14, 2003.
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