BY ACCESSING OR USING THIS WEBSITE, YOU AGREE TO
BE BOUND BY THE TERMS AND CONDITIONS AND DISCLAIMERS
SET FORTH BELOW. IF YOU ARE NOT WILLING TO BE BOUND
BY THESE TERMS AND CONDITIONS AND DISCLAIMERS, YOU
MAY NOT USE THIS WEBSITE.
You acknowledge that use of this website is offered
to you as general information only. This website
is intended to help you learn about topics of
interest to you and to help you make your own
health care decisions. The information presented
here is an educational service and is not intended
to be medical advice (which can only be provided
after a detailed medical consultation with a health
care professional).
Peninsula Orthopaedic Associates, P.A., makes
no representations or warranties guarantees that
the information contained herein is in every respect
accurate or complete, and is not responsible for
any errors or omissions, or for the results obtained
from the use of the information. You understand
and agree that there is no warranty associated
with your use of this website and that in no event
shall we be liable to you or any other user of
the website for any direct, indirect, incidental,
consequential, special, exemplary, punitive or
any other monetary or other damages, fees, fines,
penalties, or liabilities arising out of or relating
in any way to this website, or sites accessed
through this website, and/or relating in any way
to the content or information provided on or through
the website. You acknowledge and agree that your
sole and exclusive remedy for dissatisfaction
with this website is to stop using this website.
The material on this website is copyrighted.
It may not be copied without permission of the
owner.
You agree to indemnify us against any damages,
losses, liabilities, judgments, costs or expenses
(including reasonable attorneys' fees and costs)
arising from your use of this website, or any
breach or violation of this Agreement or any other
term or condition contained on this website.
PENINSULA ORTHOPAEDIC ASSOCIATES, P.A.
Notice to Patients of Privacy Practices
This notice describes how medical information about
you may be used and disclosed. We are required by
law to protect the privacy of your protected health
information. This document also explains how you
can gain access to your medical information and
who to contact should you have any complaint. Please
read this document carefully and sign the form to
acknowledge you have received this notice.
A. The general consent for release of medical records
you sign authorizes Peninsula Orthopaedic Associates
to disclose the information in your medical record
for treatment, payment, and health care operations:
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1. For the purpose of providing, coordinating, or
managing your treatment and related services. Your
information may be shared with employees and contractors
of the provider, or with other health care providers
who are treating you or consulting in your care.
2. For the purpose of arranging payment for your
care. Your information may be shared with your insurer
or other third party payor who is responsible for
paying all or part of the cost for your care. This
may include certain activities your health insurance
plan or workers compensation insurer requires before
it approves or pays for health care services we
recommend.
3. For the purpose of health care operations. We
may use and disclose information that is necessary
for our business operations, e.g., internal quality
assessments, contacting other health care providers
about treatment alternatives. We may use information
about you to remind you by telephone, letter, or
postcard of an appointment for treatment of medical
care or to notify you of a diagnostic test result.
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B. You may be asked to sign a specific authorization
for release of medical records, which will authorize
us to make a specific disclosure that is not covered
under section A above. The specific information,
the entity to whom it will be disclosed, and the
purpose for which it will be used will be documented
for your review before signing.
C. You may revoke any consent or authorization provided
to us by giving a written notice of revocation.
D. We may be required by law to disclose your records
that you have not authorized. Examples of these
situations include but are not limited to, complying
with workers compensation laws, receiving a subpoena
for the records, or if public responsibility requires
disclosure, e.g., to protect public health. We will
keep all disclosures of your medical records to
the minimum necessary.
E. Your rights regarding health information about
you:
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1. You have the right to inspect a copy your health
information.
2. If you feel that the health information we have
about you is incomplete or inaccurate, you have
the right to request an amendment to your medical
records. The request must be made in writing with
the reason that supports your request. If we do
not agree with your request, you have the right
to ask that your statement be place in the medical
record.
3. You have the right to find out how your health
information is used and to whom it is disclosed.
You may request an accounting of your medical record
disclosures made by us except for disclosures made
for treatment, payment, and health care operations
covered in Section A.
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F. We are required by law to maintain the privacy
of your protected health information and if you
believe that your rights have been violated, you
may complain to the Secretary of the U.S. Department
of Health and Human Services or complain to us by
talking to us, calling us, or writing to us with
details. Please ask to speak to or contact our privacy
complaints contact person, Susan Calhoun, at our
office. We will not retaliate in any way against
a patient for making a complaint.
G. We reserve the right to change our privacy practices
and to make new policies effective for all protected
health information that we maintain. If we should
do so, we will issue an updated "notice to
patients" to all of our patients.
Form Date 04/14/03 |
