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
* 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
* 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
* 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
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
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:
Simon Medical Services
16A Tech Circle
Natick, MA. 01760