NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT PATIENTS MAY BE USED AND DISCLOSED AND HOW THEY CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY
The terms of this Notice of Privacy Practices apply to Northeastern Ohio Foot & Ankle Surgical Associates, Inc.
We are required by law to maintain the privacy of our patients' personal health information and to provide patients with notice of our legal duties and privacy practices with respect to their personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices, as necessary, and to make the new Notice effective for all personal health information maintained by us. A copy of any revised notices can be obtained at the Information Desk at Northeastern Ohio Foot & Ankle Surgical Associates, Inc or viewed on our website, www.neofasa.com. A copy may also be obtained by mailing a request to the Privacy Officer, NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278.
USES AND DISCLOSURES OF PERSONAL HEALTH INFORMATION
Authorization: Except as outlined below, we will not use or disclose personal health information for any purpose unless we have a signed form authorizing the use or disclosure. Patients have the right to revoke their authorization in writing unless we have taken any action in reliance on the authorization.
Uses and Disclosures for Treatment: We will make uses and disclosures of personal health information as necessary for treatment. For instance, doctors, nurses and other professionals involved in a patient’s care will use information in the medical record and information that is provided about symptoms and reactions to plan a course of treatment that may include procedures, medications, tests, etc. We may also release personal health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment. For instance, if, after a patient leaves our office and is going to receive home health care, we may release their personal health information to that home health care agency so that a plan of care can be prepared.
Uses and Disclosures for Payment: We will make uses and disclosures of personal health information, as necessary, for the payment purposes of those health professionals and facilities that have provided treatment or services. For instance, we may forward information regarding medical procedures and treatment to an insurance company to arrange payment for the services provided or we may use this information to prepare a bill to send to the person responsible for your payment.
Uses and Disclosures for Health Care Operations: We will use and disclose personal health information, as necessary, and as permitted by law, for health care operations, which include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose personal health information for purposes of improving the clinical treatment and care of our patients. We may also disclose personal health information to another health care facility, health care professional, or health plan for such things as quality assurance and case management, but only if that facility, professional, or plan also has or had a relationship with a patient.
Family and Friends Involved In Patient Care: With approval, we may from time to time disclose personal health information to designated family, friends, and others who are involved in the care or in payment of a patient in order to facilitate their involvement in caring for or paying for a patient’s care. If unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in the best interest, we may share limited personal health information with such individuals without approval. We may also disclose limited personal health information to a public or private entity that is authorized to assist in disaster relief efforts in order for them to locate a family member or other persons that may be involved in the care of a patient.
Business Associates: Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain pieces of personal health information to one or more of these outside persons or organizations that assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
Fundraising: We may contact you to donate to a fundraising effort for or on our behalf. You have the right to "opt-out" of receiving fundraising materials/communications and may do so by sending your name and address to: Privacy Officer, NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278, together with a statement that you do not wish to receive fundraising materials or communications from us.
Appointments and Services: We may contact patients to provide appointment reminders or test results. They have the right to request, and we will accommodate reasonable requests, to receive communications regarding personal health information from us by alternative means or at alternative locations. For instance, if a patient does not wish to have appointment reminders left on voice mail or sent to a particular address, we will accommodate reasonable requests. Requests for such confidential communication should be sent in writing and mailed to: Privacy Officer, NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278.
Health Products and Services: We may from time to time use personal health information to communicate with patients about health products and services necessary for their treatment, to advise them of new products and services we offer, and to provide general health and wellness information.
Research: In limited circumstances, we may use and disclose personal health information for research purposes. For example, a research organization may wish to compare outcomes of all patients that received a particular drug and will need to review a series of medical records. In all cases where specific authorization has not been obtained, privacy will be protected by strict confidentiality.
Other Uses and Disclosures:. We are permitted or required by law to make certain other uses and disclosures of personal health information without consent or authorization.
We may release personal health information for any purpose required by law.
We may release personal health information for public health activities, such as required reporting of disease, injury, birth and death, and for required public health investigations.
We may release personal health information, as required by law, if we suspect child abuse or neglect; we may also release personal health information as required by law if we believe a patient is a victim of abuse, neglect, or domestic violence.
We may release personal health information to the Food and Drug Administration, if necessary, to report adverse events, product defects, or to participate in product recalls.
We may release personal health information to an employer when we have provided health care to you at the request of your employer. In most cases the patient will receive notice that information has been disclosed to the employer.
We may release personal health information, if required by law, to a government oversight agency conducting audits, investigations, or civil or criminal proceedings.
We may release personal health information, if required to do so by a court or administrative ordered subpoena or discovery request. In most cases notice will be sent of such release.
We may release personal health information to law enforcement officials, as required by law, to report wounds and injuries and crimes.
We may release personal health information to coroners and/or funeral directors consistent with law.
We may release personal health information, if necessary, to arrange an organ or tissue donation or a transplant.
We may release personal health information if someone is a member of the military as required by armed forces services. We may also release personal health information, if necessary, for national security or intelligence activities.
We may release personal health information to workers' compensation agencies, if necessary, for workers' compensation benefit determination.
Ohio Law requires that we obtain a consent in many instances before disclosing the performance or results of an HIV test or diagnosis of AIDS or an AIDS-related condition; before disclosing information about drug or alcohol treatment received in a drug or alcohol treatment program; before disclosing information about mental health services received; and before disclosing certain information to the State Long-Term Care Ombudsman. For full information on when such consents may be necessary, please contact the Privacy Officer, NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278.
RIGHTS THAT PATIENTS HAVE
Access to Personal Health Information: Patients have the right to copy and/or inspect much of the personal health information that we retain on their behalf. All requests for access must be made in writing and signed by the patient or their representative. We will charge a fee set by Ohio law per page if a copy of the information is requested. We will also charge for postage if a mailed copy is requested and will charge for preparing a summary of the requested information if requested. An Access Request Form may be obtained from the Privacy Officer, NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278,
Amendments to Personal Health Information: Patients have the right to request, in writing, that personal health information that we maintain about them be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by the patient or their representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. An Amendment Request Form may be obtained from the Privacy Officer, NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278,
Accounting for Disclosures of Personal Health Information: Patients have the right to receive an accounting of certain disclosures made by us of their personal health information after April 14, 2003. Requests must be in writing and signed by the patient or their representative. Accounting Request Forms are available from the Medical Records Department at NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278,. The first accounting in any 12-month period is free; a fee will be charged as set forth by Ohio law for each subsequent accounting request within the same 12-month period.
Restrictions on Use and Disclosure of Personal Health Information: Patients have the right to request restrictions on certain uses and disclosures of personal health information for treatment, payment, or health care operations. A Restriction Request Form can be obtained from the Medical Records Department at NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278,. We are not required to agree to a restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, notification will be made of such termination. Patients also have the right to terminate, in writing or orally, any agreed-to restriction by sending such termination notice to: Privacy Officer, NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278,
Complaints: If a patient believes their privacy rights have been violated, a complaint can be filed with the Privacy Officer, NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278, A complaint may also be filed with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of their rights. There will be no retaliation for filing a complaint.
Acknowledgment of Receipt of Notice. Patients will be asked to sign a form acknowledging that they received this Notice of Privacy Practices.
FOR FURTHER INFORMATION
If anyone has questions or needs further assistance regarding this Notice, please contact the Privacy Officer, NEOFASA, Inc. 116 East Ave. Suite 4, Tallmadge, Ohio 44278. Patients retain the right to obtain a paper copy of this Notice of Privacy Practices, even if a copy has been requested by e-mail or other electronic means.
EFFECTIVE DATE
This Notice of Privacy Practices is effective April 14, 2003
