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.

V. Your Rights Regarding Health Information We Maintain About You

  • Right to Inspect and Copy: You have the right to inspect and/or to receive a copy of your health information that that we maintain in designated records and for which we use to make decisions about your care.

    If you wish to inspect and/or receive a copy of your health information, you must submit your request in writing to HIPAA Privacy Officer, Panhandle Orthopaedics, 710 Hospital Drive, Crestview, FL 32539. Your request must state that you want access to your health information and must be signed by you or your personal representative. We may charge you a fee for copying and postage.

    We may deny your request to inspect and/or copy your information in certain limited circumstances. For example, we may deny access if your physician believes it will be harmful to your health, or could cause a threat to others. If you are denied access to your health information, you may request that the denial be reviewed. Another licensed health care professional chosen by Panhandle Orthopaedics will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

  • Right to Request Amendment: If you believe that any health information we have about you is incorrect or incomplete, you have the right to ask us to change the information. You have the right to request an amendment for as long as the information is kept by or for Panhandle Orthopaedics.

    We are not obligated to make all requested amendments but we will give each request careful consideration. We may deny your request if you ask us to amend information that:

    To request an amendment to your health information, your request must be in writing, signed, and submitted to HIPAA Privacy Officer, Panhandle Orthopaedics,

    • Was not created by us, unless the person or location that created the information is no longer available to make the amendment;
    • Is not part of the health information kept by or for us;
    • Is not part of the information that you would be permitted to inspect and copy; or,
    • Is accurate and complete.
    If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records.

  • Right to Request Restrictions on Use and Disclosure: You have the right to request a restriction or limitation on certain uses and disclosures of your health information.

    To request restrictions, you must make your request in writing to HIPAA Privacy Officer, Panhandle Orthopaedics, 710 Hospital Drive, Crestview, FL 32539. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply - for example, if you want to prohibit disclosures for insurance payment, health care operations, for disaster relief purposes, to persons involved in your care, or to your spouse. It must be signed by you or your personal representative.

    We are not required to agree to your request, but we will attempt to accommodate reasonable requests when appropriate. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction.

  • Right to an Accounting of Disclosures: You have the right to receive an "accounting of disclosures" made by us of health information about you, as required by law. This accounting will not include any disclosures for treatment, payment, or health care operations; disclosures that you have authorized or that have been made to you; disclosures for national security or intelligence purposes; disclosures to correctional institutions or law enforcement with custody of you; disclosures that took place before April 14, 2003; and certain other disclosures.

    Your accounting request must be in writing and signed by you or your personal representative, and submitted to HIPAA Privacy Officer, Panhandle Orthopaedics, 710 Hospital Drive, Crestview, FL 32539. Your request must state a time-period for which you would like the accounting. The accounting period may not go back further than six years from the date of the request, and it may not include dates before April 14, 2003. You may receive one free accounting in any 12-month period. We will charge you for additional requests.

  • Right to Request Confidential Communications: You have the right to request that we communicate with you about health issues by alternative means or at an alternative location. For example, you may request that messages not be left on voice mail or sent to a particular address.

    A request for confidential communications must be in writing, signed by you or your personal representative, and submitted to HIPAA Privacy Officer, Panhandle Orthopaedics, 710 Hospital Drive, Crestview, FL 32539. Your request must specify how or where you wish to be contacted, and we may require you to provide information about how confidential payments will be managed. We are required to accommodate all reasonable requests.

  • Right to Receive a Copy of this Notice: You will be provided with a copy of this Notice upon intake. Alternatively, you may decline a copy. In either case you will be required to sign an acknowledgment that you were provided a copy of Panhandle's Notice of Privacy Practices or you declined a copy.

  • Right to Cancel Authorization to Use or Disclose: Other uses and disclosures of your health information not covered by this Notice or the laws that govern us will be made only with your written authorization. You have to right to revoke your authorization in writing at any time, and we will discontinue future uses and disclosures of your health information for the reasons covered by your authorization. We are unable to take back any disclosures that were already made with your authorization, and we are required to retain the records of the care that we provided to you.

  • For further information: If you have questions, or would like additional information, you may contact HIPAA Privacy Officer, Panhandle Orthopaedics, 710 Hospital Drive, Crestview, FL 32539

  • To File a Complaint: If you believe your privacy rights have been violated, you may file a written complaint with us at HIPAA Privacy Officer, Panhandle Orthopaedics, 710 Hospital Drive, Crestview, FL 32539. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services in Washington, D.C., within 180 days of an allegation of a violation of your rights. There will be no retaliation for filing a complaint. We cannot, and will not, require you to waive the right to file a complaint as a condition of receiving treatment from us.

Changes to this Notice: Panhandle Orthopaedics reserves the right to amend, change, or eliminate the terms of this Notice at any time. If we change this Notice, we may make the new Notice's terms effective for all Protected Health Information that we maintain, including any information created or received prior to issuing the new Notice. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our "Notice" or by visiting our reception desk and picking up a copy, or downloading one from our Web site at Panhandle Orthopaedics.com.

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