Privacy Disclosure

We may disclose your healthcare information to other healthcare professionals or team coaches, immediate family members to include spouse, parents, adult children, guardians, and insurance companies for the purpose of treatment, payment, or healthcare operations. (example)

On occasion, it may be necessary to seek consultation regarding your condition from other healthcare providers associated with Professional Orthopaedic Associates, PA.

"It is our policy to provide a substitute healthcare provider authorized by Professional Orthopaedic Associates, PA, to provide assessment and/or treatment to our patients, without advanced notice, in the event of your primary healthcare providers absence due to vacation, sickness, or other emergency situation.

We may disclose your health information to your insurance provider for the purpose of payment or healthcare operations. (example)

As a courtesy to our patients, we will submit an itemized billing statement to your insurance carrier for the purpose of payment to Professional Orthopaedic Associates, PA, for healthcare services rendered. If you pay for your healthcare services personally, we will, as a courtesy, provide an itemized billing to your insurance carrier for the purpose of reimbursement for medical services. The billing statement contains medical information, including diagnosis, date of injury or condition, and codes that describe the healthcare services received.

We may disclose your health information as necessary to comply with State Workers' Compensation Laws.

We may disclose your health information to notify or assist in notifying a family member or another person responsible for your care about your medical condition or in the event of an emergency or of your death.

As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting domestic violence, reporting to the Food and Drug Administration problems with products and reactions to medications, and reporting disease or infection exposure.

We may disclose your health information in the course of any administrative or judicial proceeding.

We may disclose your health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena, and other law enforcement purposes.

We may disclose your health information to coroners or medical examiners.

We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues.

We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.

It may be necessary to disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or to the general public.

We may disclose your health information for military, national security, prisoner, and government benefits purposes.

We may contact you for marketing purposes or fundraising purposes, as described below: (example)

As a courtesy to our patients, it is our policy to call your home on the evening prior to your scheduled appointment to remind you of your appointment time. If you are not at home, we leave a reminder message on your answering machine or with the person answering the phone. No personal health information will be disclosed during this recording or message other than the date and time of your scheduled appointment along with a request to call our office if you need to cancel or reschedule your appointment.

It is our practice to participate in charitable events to raise awareness, food donations, gifts, money, etc. During these times, we may send you a letter, post card, or invitation or call your home to invite you to participate in the charitable activity. We will provide you with in formation about the type of activity, the dates and times, and request your participation in such an event. It is not our policy to disclose any personal health information about your condition for the purpose of Professional Orthopaedic Associates, PA-sponsored fundraising events.

In the event that Professional Orthopaedic Associates, PA, is sold or merges with another organization, your health information/record will become the property of the new owner.

• You have the right to request restrictions on certain uses and disclosures of your health information. Please be advised, however, that Professional Orthopaedic Associates, PA, is not required to agree to the restriction that you requested.
• You have the right to have your health information received or communicated through an alternative method or sent to an alternative location other than the usual method of communication or delivery, upon your request.
• You have the right to inspect and copy your health information.
• You have a right to request that Professional Orthopaedic Associates, PA, amend your protected health information. Please be advised, however, that Professional Orthopaedic Associates, PA, is not required to agree to amend your protected health information. If your request to amend your health information has been denied, you will be provided with an explanation of our denial reason(s) and information about how you can disagree with the denial.
• You have a right to receive an accounting of disclosures of your protected health information made by Professional Orthopaedic Associates, PA.
• You have a right to a paper copy of this Notice of Privacy Practices at any time upon request.

Professional Orthopaedic Associates, PA, reserves the right to amend this Notice of Privacy Practices at any time in the future and will make the new provisions effective for all information that it maintains. Until such amendment is made, Professional Orthopaedic Associates, PA, is required by law to comply with this Notice.

Professional Orthopaedic Associates, PA, is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any pad of this Notice or if you want more information about your privacy rights, please contact Tona Manning by calling the office at (732) 530-4949. If Tona Manning is not available, you may make an appointment for a personal conference in person or by telephone within two working days.

Complaints about your privacy rights or how Professional Orthopaedic Associates, PA, has handled your health information should be directed to Tona Manning by calling the office at (732) 530-4949. If Tona Manning is not available, you may make an appointment for a personal conference in person or by telephone within two working days.

If you are not satisfied with the manner in which this office handles your complaint, you may submit a formal complaint to:

DHHS, Office of Civil Rights
200 Independence Avenue, SW
Room 50SF HHH Building
Washington, DC 20201

This notice Is effective as of 06/01/2003.

FORM 03501