JOINT 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.
Orthopaedic Hospital of Wisconsin (“we”, “us” or “our”, as indicated) takes the privacy of your health information seriously. We are required by law to maintain that privacy and to provide you with this Joint Notice of Privacy Practices. This Notice is provided to tell you about our duties and practices with respect to your information. We are required to abide by the terms of this Notice that is currently in effect. This Notice applies to members of our Medical Staff, all staff and other personnel located at Orthopaedic Hospital of Wisconsin, health care professionals authorized to enter information into or consult your medical record, and any member of a volunteer group we allow to help you.
HOW WE MAY USE AND DISCLOSURE YOUR HEALTH INFORMATION
The following is a summary of the circumstances under which and purposes for which your health information may be used and disclosed:
To Provide Treatment. We may use your health information to provide care to you and disclose your health information to others who provide care to you. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. We also may disclose your health care information to individuals not affiliated with us but who are involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.
To Obtain Payment. We may include your health information in invoices to collect payment from third parties for the care you may receive from us. For example, we may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or us. We also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for health care and the services that will be provided to you.
To Conduct Health Care Operations. We may use and disclose health information for our own operations in order to facilitate our functions and as necessary to provide quality care to all of our patients. Health care operations include activities such as:
- Quality assessment and improvement activities.
- Activities designed to improve health or reduce health care costs.
- Protocol development, case management and care coordination.
- Contacting health care providers and patients with information about treatment alternatives and other related functions that do not include treatment.
- Professional review and performance evaluation.
- Training programs including those in which students, trainees or practitioners in health care learn under supervision.
- Training of non-health care professionals.
- Accreditation, certification, licensing or credentialing activities.
- Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
- Business planning and development including cost management and planning related analyses and formulary development.
- Our business management and general administrative activities.
For example, we may use your health information to evaluate our staff performance, combine your health information with our other patients in evaluating how to more effectively serve all of our patients, disclose your health information to our staff and contracted personnel for training purposes, use your health information to contact you as a reminder regarding a visit to you, or contact you or your family as part of community information mailings (unless you tell us you do not want to be contacted). For Facility Directory. We may disclose certain information about you including your name, your general health status, and where you are located in a facility directory while you are in the facility. We may disclose this information to people who ask for you by name. If you do not want us to include your information in the directory, you must notify our Privacy Official at 414-961-6803.
For Appointment Reminders. We may use and disclose your health information to contact you as a reminder that you have an appointment for treatment or medical care with us.
For Treatment Alternatives. We may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
When Legally Required. We will disclose your health information when we are required to do so by any Federal, State or local law.
When There Are Risks to Public Health. We may disclose your health information for the following public activities and purposes:
- To prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of public health surveillance, investigations and interventions.
- To report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
- To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
- To an employer about an individual who is a member of the workforce as legally required.
- To Report Abuse, Neglect Or Domestic Violence. We are allowed to notify government authorities if we believe a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
To Conduct Health Oversight Activities. We may disclose your health information to a health oversight agency for activities including: audits; civil, administrative or criminal investigations; inspections; licensure or disciplinary action. We, however, may not disclose your health information if you are the subject of an investigation and the investigation does not arise out of and is not directly related to your receipt of health care or public benefits.
In Connection With Judicial And Administrative Proceedings. As permitted or required by State law, we may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when we make reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes. As permitted or required by State law, we may disclose your health information to a law enforcement official for certain law enforcement purposes, including, under certain limited circumstances, if you are a victim of a crime or in order to report a crime.
To Coroners And Medical Examiners. We may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
To Funeral Directors. We may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, we may disclose your health information prior to, and in reasonable anticipation of, your death.
For Organ, Eye Or Tissue Donation. We may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.
For Research Purposes. We may, under very select circumstances, use your health information for research. Before we disclose any of your health information for such research purposes, the project will be subject to an extensive approval process.
In the Event of A Serious Threat To Health Or Safety. We may, consistent with applicable law and ethical standards of conduct, disclose your health information if we, in good faith, believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Specified Government Functions. In certain circumstances, Federal regulations authorize us to use or disclose your health information to facilitate specified government functions relating to the military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations and inmates and law enforcement custody.
For Worker’s Compensation. We may release your health information for worker’s compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than is stated above, we will not disclose your health information other than with your written authorization. If you or your representative authorize us to use or disclose your health information, you may revoke that authorization in writing at any time.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that we maintain:
Right to Request Restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on our disclosure of your health information to someone who is involved in your care or the payment of your care. However, we are not required to agree to your request. If you wish to make a request for restrictions, please contact our Privacy Official at 414-961-6803.
Right to Receive Confidential Communications. You have the right to request that we communicate with you in a certain way. For example, you may ask that we only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, please contact our Privacy Official at 414-961-6803. We will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
Right to Inspect and Copy Your Health Information. You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing your health information may be made to our Privacy Official at 414-961-6803. If you request a copy of your health information, we may charge a reasonable fee for copying and assembling costs associated with your request.
Right to Amend Your Health Information. You or your representative have the right to request that we amend your records, if you believe your health information records are incorrect or incomplete. That request may be made as long as we maintain the information. A request for an amendment of records must be made in writing to our Privacy Official, Orthopaedic Hospital of Wisconsin, 575 W. River Woods Parkway, Glendale, WI 53212. We may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if we did not create your health information, if the records you are requesting are not part of our records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, in our opinion, the records containing your health information are accurate and complete.
Right to an Accounting. You or your representative have the right to request an accounting of disclosures of your health information which we made for certain purposes, which may include disclosures authorized by law and disclosures made for research. The request for an accounting must be made in writing to our Privacy Official, Orthopaedic Hospital of Wisconsin, 575 W. River Woods Parkway, Glendale, WI 53212. The request should specify the time period for the accounting starting on April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
Right to a Paper Copy of this Notice. You or your representative have a right to a separate paper copy of this Notice at any time even if you or your representative have received this Notice previously. To obtain a separate paper copy, please contact our Privacy Official at 414-961-6803. A patient or a patient’s representative may also obtain a copy of the current version of our Notice at our Web site, www.ohow.org.
OUR DUTIES AS PROVIDER
We are required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of our duties and privacy practices. We are required to abide by the terms of this Notice as may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that we maintain. If we make a material change to this Notice, we will provide a copy of the revised Notice to you or your appointed representative. You or your representative have the right to complain to us and to the Secretary of Health and Human Services if you or your representative believe that your privacy rights have been violated. Any complaints to us should be made in writing to our Privacy Official, Orthopaedic Hospital of Wisconsin, 575 W. River Woods Parkway, Glendale, WI 53212. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
We have designated the Privacy Official as our contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at Orthopaedic Hospital of Wisconsin, 575 W. River Woods Parkway, Glendale, WI 53212.
This Notice is effective April 14, 2003.
If you have any questions regarding this notice, please contact our Privacy Official, Orthopaedic Hospital of Wisconsin, 575 W. River Woods Parkway, Glendale, WI 53212 or call 414-961-6803.