Notice of Privacy Practices

Vann-Virginia Center for Orthopaedics, Inc.

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 CALVERT KYRUS.

We understand that medical information about you and your health is personal. We are committed to protecting the medical information we have about you.

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. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condi­tion and related health care services.

We ore required by law to: make sure that medical information that identifies you is kept private; give you this notice of our legal duties and privacy practices with respect to medical information about you; and abide by the terms of this Notice of Privacy Practices. We may change the terms or our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. We will also visibly post a copy of our current No1ice of Privacy Practices in our facilities. Additionally a copy of our current Notice of Privacy Practices is available on our website at www.atlanticortho.com/hipaa-privacy-statement.

1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION.

Uses and Disclosures for Treatment, Payment and Healthcare Operations.

We will use or disclose your protected health information as described in this Section 1. Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care ser­vices to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of our practice. However, and as described below, we are obligated to honor your request to restrict the disclosure of your protected health Information to any health plan that pertains solely to a healthcare item or service for which you, or someone on your behalf, has paid us in full.

Below are some examples of the types of uses and disclosures of your protected health care information that we are permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office.

Treatment: We will use and disclose your protected health information to provide, coordinate and manage your health care and any related service. This includes the coordina1ion or management of your health care with a third party involved in your medical care. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g. a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your phy­sician.

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. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission. However, you may restrict disclosures of your protected health information that pertain solely to a healthcare item or service for which you, or someone on your behalf, has paid us in full.

Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the busi­ness activities of our practice. These activities include, but are not limited to, quality assessment activities, employee review activities and training of medical students, professional licensing, and conducting or arranging for other business activities. For example, we may disclose the protected health information to medical school students that see patients at our office. In addi­tion, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physi­cian. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.

We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice. Whenever an arrangement between our office and a business associate in­volves the use or disclosure of your protectcd information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

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.

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. Specifically, other uses and disclosures of protected health information not covered by this Notice of Privacy Practices or the laws that apply to us, including uses or disclosures for most marketing purposes (except as described below) and any sale of your protected health information, except for sales of your protected health information related to your treatment or as otherwise permitted by any applicable law or regulation, will be made only with your written authorization. You may revoke this authorization at any time in writing, except to the extent that your physician or we have taken an action in reliance on the use or disclosure indicated in the authorization.

Others Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or Opportunity to Object.

We may use and disclose your protected health information in the following instance. 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 protcoted health information, then your physician may, using 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, 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 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, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If your physician or another physician in the practice is required by law to treat you and the physician has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your protected health information to treat you.

Other Permitted and Required Uses and Disclosure 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 consent or authorization. These situations include:

Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by 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. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collabo­rating with the public health authority.

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. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

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 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 protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes 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, (S) in the event that a crime occurs on the premises of the practice, and (6) medical emergency (not on the Practice’s premises) and it is likely that a crime has occurred.

Coroners, Funeral Directors and Organ Donation: We may disclose 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 use or disclose your protected health information for re­search purposes. Before we make such disclosures, the research will have been approved through an approval process that evaluates the need of the research project with your needs for privacy of your protected health information. Enrollment in most or these research projects can only occur after you have been informed about the study, had an opportunity to ask questions, and have indicated your willingness to participate in the study by signing a consent form. Other studies may be performed using your protected health infor­mation without requiring your consent. These studies will not affect your treatment or welfare, and your protected health information will continue to be protected. For example, a research study may involve com­paring the health and recovery of all patients who received one type of procedure to those who received another for the same condition.

Serious Threats to Health or Safety: 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 disclove 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: Your protected health information may be disclosed by us as authorized to com­ply with workers’ compensation laws and other similar legally established programs.

Inmates: We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care for you.

2. YOUR RIGHTS.

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 protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that your physician and the practice uses for making decisions about you. We will honor all requests for us to provide you with elec­tronic access to your protected health information if such access can be reasonably provided by us.

Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health infor­mation that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions about access to your medical record. Another licensed healthcare profes­sional chosen by us will review your request and any denial. The individual conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

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.

Your physician is not required to agree to a restriction that you may request. If your physician 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 your physician does 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 physi­cian. You may request a restriction by designating that restriction in writing. Nevertheless, we are required to agree to your request for a restriction of a disclosure of your protected health information to a health plan
if the protected health information pertains solely to a healthcare item or service for which you, or someone
on your behalf, has paid us in full.

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 Privacy Contact.

You have the right to request an amendment to your protected health information: You may have the right to have your physician amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain
this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and 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 1f you have questions about amending your medical record.

You have the right to an accounting of disclosures: You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacv Prac­tices. It excludes disclosures we may have made to you, for a facility director, to family members or friends involved in your care, or for notification purposes. You hove the right to receive specific information regarding these disclosures that occurred up to six years prior to your request. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.

3. COMPLAINTS.

If you believe that your privacy rights have been violated, you can file a complaint with us and with the Secretary of the United Slates Department of Health and Human Services. To file a written complaint with us, please contact Privacy Contact, Calvert Kyrus, at (757) 321-3302 for further information about the complaint process, or send your complaint to the Privacy Contact in care of:

Vann-Virginia Center for Orthopaedics, Inc.
Attn: Privacy Contact
TRC Center, Suite 124
230 Clearfield Avenue
Virginia Beach, Virginia 23462-1832

This notice is published and becomes effective September 23, 2013.

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