Simon Medical Services Patient Information Practices follows all HIPAA compliancy and privacy regulations pertaining to patients, staff, physicians, hardware and software.

You can click here to see SMS NOTICE OF PATIENT INFORMATION PRACTICES

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Simon Medical Serviecs Patient Information Consent Form
According to HIPAA, every patient is asked to sign the Patient Information Consent Form.

You can click here to get a copy of SMS PATIENT INFORMATION CONSENT FORM for your review, whenever you meet our staff, you can get one for signature.

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HIPAA AND 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.
The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires all of your health care records and other individually identifiable health information ("PROTECTED HEALTH INFORMATION") transmitted or maintained by us in any medium, whether electronically, on paper, or orally, to be kept confidential. This federal law gives you, the patient, significant new rights to understand and control how your PROTECTED HEALTH INFORMATION is used. HIPAA provides penalties for covered entities that misuse protected health information. As required by HIPAA, we have prepared this explanation of how we are required to maintain the privacy of your PROTECTED HEALTH INFORMATION and how we may use and disclose your PROTECTED HEALTH INFORMATION. This notice takes effect on April 14, 2003, and will remain in effect until a revised notice is issued. Revised notices may be sent out because (a) we materially modify our business practices, (b) we modify the information contained in the Notice of Privacy Practices, or (c) the Department of Health and Human Services (DHHS) informs us of an amendment to HIPAA.

Without specific written authorization, we are permitted to use and disclose your health care records for the purposes of treatment, payment and health care operations.

* Treatment means providing, coordinating, or managing health care and related services by one or more health care providers, including consultation between health care providers relating to a patient or the referral of a patient for health care from one health care provider to another. An example of "treatment" would include being fitted for a brace.

* Payment means such activities as obtaining reimbursement for the provision of health care services, confirming insurance eligibility or coverage, billing, claims management or collection activities, and utilization review. An example of "payment" would be billing your insurance company for your orthotic product.

* Health Care Operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, conducting auditing functions, cost-management analysis related to managing our business, and customer service. An example of "health care operations" would include a periodic assessment of our documentation protocols, etc.

In addition, your PROTECTED HEALTH INFORMATION may be used to remind you of an appointment (by phone or mail) or provide you with information about treatment options or other health-related benefits and services that may be of interest to you, We will use and disclose your PROTECTED HEALTH INFORMATION when we are required to do so by law, but the use or disclosure will be limited to the relevant requirements of such law.

We may disclose your PROTECTED HEALTH INFORMATION to public health authorities that are authorized by law to collect information for the purpose of preventing or controlling disease, injury or disability, to a social service agency authorized by law to receive reports of abuse, neglect or domestic violence, to a health oversight agency for activities authorized by law, including audits for oversight of the health care system. We may disclose your PROTECTED HEALTH INFORMATION if you are involved in a lawsuit or similar proceeding, in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made a good faith attempt to (a) inform you in writing of the request, so that you may file objections to the request, or to (b) obtain a qualified protective order protecting the PROTECTED HEALTH INFORMATION that the party has requested.

We may disclose your PROTECTED HEALTH INFORMATION for a law enforcement purpose to a law enforcement official, such as the required reporting of certain types of wounds and for the purpose of locating a fugitive or material witness, subject to certain conditions. We may disclose your PROTECTED HEALTH INFORMATION to a medical examiner or coroner to identify a deceased individual or to determine the cause of death. If necessary, we also may disclose PROTECTED HEALTH INFORMATION in order for funeral directors to perform their duties with respect to a decedent.

We may use or disclose your PROTECTED HEALTH INFORMATION to organizations that handle organ, eye or tissue procurement, banking or transplantation, as necessary to facilitate organ or tissue donation and transplantation. We may use or disclose your PROTECTED HEALTH INFORMATION for research, subject to certain conditions. We may use or disclose your PROTECTED HEALTH INFORMATION when necessary to lessen or prevent a serious and imminent threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization that we believe in good faith is reasonably able to help prevent or lessen the threat, or to the target of the threat.

We may use and disclose your PROTECTED HEALTH INFORMATION if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military authorities, subject to certain conditions. We may disclose your PROTECTED HEALTH INFORMATION to authorized federal officials for lawful intelligence and other national security activities authorized by the National Security Act. We may disclose PROTECTED HEALTH INFORMATION to authorized federal officials in order to protect the President, other officials or foreign heads of state, or to conduct certain investigations. We may disclose your PROTECTED HEALTH INFORMATION to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals or the public.

We may release your PROTECTED HEALTH INFORMATION for workers' compensation and similar programs.
With your agreement, we may disclose your protected health information to members of your family, your close personal friends and others identified by you. In addition, if you are unable to authorize such disclosure due to your incapacity or due to an emergency, we may decide, in the exercise of our professional judgment, that disclosure would be in your best interests notwithstanding our inability to obtain your agreement to the disclosure. In that case, we may disclose the directly relevant health information to family, friends or others to the extent necessary for the health care being provided to you.
Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have certain rights in regard to your PROTECTED HEALTH INFORMATION, which you can exercise by presenting a written request to our Privacy Officer at the business address listed below:

* The right to request restrictions on certain uses and disclosures of PROTECTED HEALTH INFORMATION, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. We are, however, not required to agree to a requested restriction. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it. However, if you are in need of emergency treatment and the restricted health information is needed to provide the emergency treatment, we may use or disclose that information to a health care provider in order to facilitate the provision of emergency treatment to you.

* The right to request to receive confidential communications of PROTECTED HEALTH INFORMATION from us by alternative means or at alternative locations. We must accommodate your request if it is reasonable, specifies the alternative location, and allows us to conduct needed payment and health care operations activities.

* With limited exceptions, the right to access, inspect and obtain copies of your PROTECTED HEALTH INFORMATION. You must make a request in writing to obtain access to your PROTECTED HEALTH INFORMATION.

* The right to request an amendment to your PROTECTED HEALTH INFORMATION. Your request must be in writing, and it must explain why the information should be amended. We may deny your request if we did not create the information you want amended or for certain other reasons. If we deny your request, we will provide you with a written explanation. You may respond with a statement of disagreement to be appended to the information you wanted amended. If we accept your request to amend the information, we will make reasonable efforts to inform others, including persons you may name, of the amendment and to include the changes in any future disclosures of that information.

* The right to receive an accounting of disclosures of PROTECTED HEALTH INFORMATION outside of treatment, payment and health care operations, and certain other activities, since April 14, 2003. We will provide you with the date on which we made the disclosure, the name of the person or entity to whom we disclosed your PROTECTED HEALTH INFORMATION, a description of the health information we disclosed, the reason for the disclosure, and certain other information. If you request this list more than once in any 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.

* The right to obtain a paper copy of this notice from us upon request.

We are required by law to maintain the privacy of your PROTECTED HEALTH INFORMATION and to provide you with notice of our legal duties and privacy practices with respect to PROTECTED HEALTH INFORMATION.

We are required to abide by the terms of the Notice of Privacy Practices currently in effect. We reserve the right to change the terms of our Notice of Privacy Practices and to make the new notice provisions effective for all of your PROTECTED HEALTH INFORMATION that we maintain, including health information we created or received before we made the changes. Before we make a material change in our privacy practices, we will change this notice and send the new notice to you at the time of the change. Revisions to our Notice of Privacy Practices also will be posted on our Internet web-site at "www.simonmedser.com" on the effective date. You may request a written copy of the Revised Notice from this office at any time.

Under certain circumstances, state medical privacy laws may not be superseded by HIPAA because, for example, they are more protective of your privacy rights than are the provisions of HIPAA. Under those circumstances, we may be required to follow additional or alternative state medical privacy law provisions. An example of this type of state law provision would be a provision requiring us to accord special privacy protection to HIV test results.

If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your PROTECTED HEALTH INFORMATION or in response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you in confidence by alternative means or at an alternative location, you may complain to us at our address listed below.

For more information about our Privacy Practices, please contact:
Privacy Officer
Simon Medical Services
16A Tech Circle
Natick, MA. 01760