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 Alice Rodgers, RHIA.
 

This Notice of Privacy Practices describes how we may use and disclose medical information that is used to carry out treatment, payment or health care operations and other purposes permitted or required by law. Medical information about you is now referred to as "protected health information" (PHI) and includes information that may identify you and that relates to your past, present, or future physical or mental health and related health care services. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.

Federal law requires that TULSA NEUROSPINE obtain an individual's dated and written acknowledged receipt of our Notice of Privacy Practices.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

You will be asked to sign a consent form when you become a patient in our office. This consent form authorizes us to disclose your protected health information for Treatment, Payment, and Health Care Operations. By signing the consent form, our physicians, office staff and others outside of our office who are involved in your care, payment of bills, and support of the physician's office are authorized to use and disclose your protected health information. This Notice of Privacy Practices also permits TULSA NEUROSPINE to disclose protected health information to another health care provider for treatment, payment, and the operation of their health care facility. Any entity participating in an organized health care arrangement may share protected health information for the benefit of the patient.
 

Following are some examples of the types of uses and disclosures that our office is permitted to make.
 

TREATMENT
We may use medical information about you to provide medical treatment or services. We may disclose PHI about you to other doctors, health care providers, nurses, technicians, medical students, physical therapists, case workers or other personnel who are involved in taking care of you. We may also disclose PHI to family members who are involved in your care.

PAYMENT
Your PHI will be used to bill for services and treatment you receive, and to obtain payment from insurance companies, attorneys, and any other organization or person who might be responsible for the payment of your health care bills. This also includes the process of disclosing health information to obtain payment approval for tests, therapy and/or surgery and admission to a hospital or treatment facility that may be recommended by TULSA NEUROSPINE.

HEALTHCARE OPERATIONS
We may use and disclose your PHI to schedule treatment and services, support the business activities of our office and to evaluate our performance in caring for you. We may use a sign-in sheet at our registration desk where you will be asked to sign your name and indicate any changes in your personal information. We will also call you by name in the waiting room when the physician or other health care provider is ready to see you. Because of space limitations, you may be in the presence of other patients who are seeing the physician and discussing their treatment and services. We may also use or disclose your PHI when necessary to contact you to remind you of an appointment, change in appointment, pre-surgical appointment, or surgery time and date. We will disclose health information to third party associates such as outside transcription services, billing and collection services whenever there is a business associate arrangement that involves the use or disclosure of your PHI.

TREATMENT ALTERNATIVES
We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of benefit to your health. This may be a representative from a brace or collar company, a representative from another treatment option such as a bone growth stimulator, or a therapist.

HEALTH RELATED BENEFITS AND SERVICES
We may use and disclose medical information to tell you about health related benefits or services that we feel may be of benefit to you. This may be a support group or therapy group, which may consist of other patients who have similar conditions.

INTERESTED GROUPS OR INDIVIDUALS
We may disclose information about you and your condition to interested friends and affiliations such as churches and support groups.

INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE
We may release medical information about you to friends or family members who might be involved in your medical care. We may also tell these people about your condition or that you are receiving treatment. If you are unable to agree or object to this type of disclosure, we may disclose such information as we deem necessary if we determine that it is in your best interest based on our professional judgement. We may also give information to someone who helps pay for your care.

EMERGENCIES AND/OR MEDICAL DISASTERS
In the event of what we deem an emergency situation, we may disclose PHI. If this happens, we shall try to obtain your consent as soon as is reasonably practical after the delivery of the emergency treatment. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY
We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or to the health and safety of the public or another person. Any disclosure, however, would only be to someone able to prevent the threat.

WORKERS' COMPENSATION
Your PHI may be disclosed in order to comply with workers' compensation laws and other similar legally established programs.

ATTORNEYS AND INSURANCE COMPANIES
We will disclose medical information to attorneys with proper authorization as well as insurance companies who may be making a determination for payment of treatments and services.

INMATES
We may use or disclose your protected health information if you are an inmate, or in a correctional facility, or under the custody of a law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correction institution.

PERMITTED AND REQUIRED DISCLOSURES THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION OR THE OPPORTUNITY TO OBJECT

We may use or disclose your protected information in the following situations without your authorization. These situations may include:

Required By Law
We will disclose medical information when required to do so by local, state, or federal law. The use or disclosure will be made in compliance with the law, but it is limited to the relevant requirements of the law. You will be notified, as required by law, of any and all disclosures.

Public Health
We may disclose your protected health information for public health activities with connection to a public health authority that is permitted by law to collect or receive the information for which a disclosure is made for the purpose of controlling disease, injury or disability. We may disclose your protected health information, if directed by a public health authority, to a foreign governmental agency that is collaborating with a public health authority.

Communicable Diseases
We may disclose your protected health information to health authorities if you have been identified as a person who may have been exposed to a communicable disease or may otherwise be at risk for contracting or spreading a disease or condition.

Health Oversight
Disclosure of protected health information will be made to health oversight agencies with activities authorized by law, such as audits, investigations, and inspections. These oversight agencies include government agencies that oversee the health care system, government programs, and other government regulatory programs and civil rights laws.

Abuse Or Neglect
We may disclose your protected health information to a public health agency authorized by law to receive reports of child abuse or neglect. In addition, we may disclose health information if we believe that you have been a victim of abuse, neglect or domestic violence. Only a government agency or entity is authorized to receive such information. In this case, the disclosure is made consistent with the requirements of applicable federal and state laws.

Food and Drug Administration
We may disclose your protected health information as required by the Food and Drug Administration to report adverse effects, product problems, biologic product deviations, track products; to enable product recalls; to make replacements or to conduct post marketing surveillance, as required.

Legal Proceedings
We may disclose your protected health information in the course of any judicial administrative proceeding, in response to an order of a court or administrative tribunal in certain conditions in response to a subpoena, discovery, or other lawful process.

Law Enforcement
We may disclose your protected health information as long as applicable requirements are met, for law enforcement purposes. These law enforcement purposes include (1) processes required by law, (2) limited information requests for identification purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of illegal conduct, and (5) in the event that a crime occurs on the premise of a practice.

Coroners, Funeral Directors, and Organ Donation
We may disclose protected health information in request from a coroner or medical  examiner for identification purposes, determining cause of death or for the 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 perform 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
We may disclose protected health information to researchers when their research has been approved by a review board that has reviewed the research proposal and protocols to ensure the privacy of your protected health information.

Criminal Activity
Consistent with applicable federal and state laws, we may disclose your health information, if we believe that the use or disclosure is necessary to prevent or lessen the 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.

We may use or disclose your protected health information if you are an inmate, or in a correctional facility, or under the custody of a law enforcement official. This release would be necessary (1) for the institution to provide you with healthcare; (2) to protect your health and the safety or the health and safety of others; or (3) for the safety and security of the institution.

Military Activity and National Security
When the appropriate conditions apply, we may release protected health information of individuals who are Armed Forces personnel (1) for activities that are deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veteran Affairs of your eligibility for benefits, or (3) to foreign military authorities or a member of that foreign military service. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including the provision of protective services to the President or others legally authorized.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

Following is a statement of your rights with respect to your protected health information and a description of how you may exercise those rights.

Right to inspect and copy
1.  You have the right to inspect and copy protected health information that is used to make decisions about your care for as long as we maintain that health information. However, this does not include psychotherapy notes.
2.  You have the right to inspect and request copies of medical information. Your request must be submitted in writing to TULSA NEUROSPINE. We may charge a fee for the costs of copying and mailing. We are allowed thirty (30) days to accomplish copying. If you wish to inspect copies, we must have sufficient notice to allow someone from our office to sit with you during your inspection.

Right To Amend
1.  If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.
2.  Your request must be made in writing. In addition, we may deny your request to amend information if the information was not created by us, is not part of the medical information kept by us, or is not part of the information you would be permitted to inspect or copy.

Right To Accounting of Disclosures
1.  You have the right to an accounting of disclosures. This is a list of disclosures of medical information we have made about you.
2.  To request this list or accounting of disclosures, you must submit your request in writing and state  the time period for which you want the list made. The list may not be longer than a for a period of 6 years.

Right To Request Restrictions
1..You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment of your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment.

To request restrictions, you must do so in writing to TULSA NEUROSPINE. An appointment will be set up to review your request and comply with our procedure.

Right To Request Confidential Communications
1.  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
2.  To request confidential communications, you must make your request in writing to TULSA NEUROSPINE.

WE RESERVE THE RIGHT TO CHANGE THIS NOTICE. WE RESERVE THE RIGHT TO MAKE THE REVISED OR CHANGED NOTICE EFFECTIVE FOR MEDICAL INFORMATION WE ALREADY HAVE ABOUT YOU AS WELL AS ANY INFORMATION WE RECEIVE IN THE FUTURE. WE WILL POST A CURRENT NOTICE IN THE WAITING ROOM. THE NOTICE WILL CONTAIN ON THE FIRST PAGE, IN THE TOP RIGHT HAND CORNER, THE EFFECTIVE DATE.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with TULSA NEUROSPINE or with the Secretary of the Department of Health and Human Services. To file a complaint with TULSA NEUROSPINE, do so in writing to TULSA NEUROSPINE 6565 South Yale, Suite 709 Tulsa, OK, 74136.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for reasons covered  by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission.