Patient Privacy
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Brown Orthopaedic Surgery & Sports Medicine Center, PA

Dunn - 910.891.2677 - Toll Free 866.891.2677 - 910.891.4611 Fax -

Fuquay-Varina -919.567.3139- 919.567.3671 or 3763 Fax-www.brownorthosports.com

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 CAREFULLY.

Brown Orthopaedic Surgery and Sports Medicine Center, PA (BOSS) is required by law to maintain the privacy and confidentiality of your protected health information and to provide our patients with notice of our legal duties and privacy practices with respect to your protected health information.

DISCLOSURE OF YOUR HEALTH CARE INFORMATION

Treatment

We may disclose your health care information to other health care professionals within our practice for the purpose of treatment, payment, or health care operations.

Example: On occasion, it may be necessary to seek consultation regarding your condition from other healthcare providers associated with BOSS.

It is our policy to provide a substitute health care provider, authorized by BOSS, to provide assessment and/or treatment to our patients, without advance notice, in the event of your primary health care provider’s absence due to vacation, sickness, or other emergency situation.

Payment

We may disclose your health information to your insurance provider for the purpose of payment or health care 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 BOSS for healthcare services rendered.  If you pay for your healthcare services personally, we will, as a courtesy, provide an itemized billing statement to your insurance carrier for the purpose of reimbursement to you.  The billing statement contains medical information, including diagnosis, date of injury or condition, and codes which describe the healthcare services received.

Workers Compensation

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

Emergencies

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

Public Health

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.

Judicial and Administrative Proceedings

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

Law Enforcement

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.

Deceased Persons

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

Organ Donation

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

Research

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

Public Safety

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.

Specialized Government Agencies

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

Marketing

We may contact you for marketing purposes or fundraising purposes

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

appointment.

DISCLOSURE OF YOUR HEALTH CARE INFORMATION

Marketing, continued

It is our practice to participate in charitable events in order to raise awareness, food donations, money, etc.  During these times, we may send you a letter, postcard, invitation, or call your home to invite you to participate in the charitable activity.  We will provide you with information about the type of activity, 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 BOSS sponsored fund raising events.

Change of Ownership

In the event that BOSS is sold or merged with another organization, your health information/record will become the property of the new owner.

Your Health Information Rights

  • You have the right, upon your request, 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.

  • You have the right to inspect and copy your health information.

  • You have a right to request that BOSS amend your protected health information.  Please be advised, however that BOSS 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 BOSS.

  • You have a right to request a paper copy of this Notice of Privacy Practices at any time.

    Changes to this Notice of Privacy Practices

    Brown Orthopaedic Surgery and Sports Medicine Center, 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, BOSS is required by law to comply with this notice.

    BOSS 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 part of this notice, or if you want more information about your privacy rights, please contact:

    Jessica Macklin and Kim Pruitt, Privacy Officers

    (919) 567 - 3139

    If Jessica Macklin and Kim Pruitt are not available, you may make an appointment for a personal conference in person or by telephone within 2 working days.

    Complaints

    Complaints about your Privacy Rights, or how BOSS has handled your health information should be directed to:

    Jessica Macklin and Kim Pruitt, Privacy Officer

    If Jessica Macklin and Kim Pruitt is not available, you may make an appointment for a personal conference in person or by telephone within 2 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 509 F HHH Building

    Washington DC 20201

    I have read the Privacy Notice and understand my rights contained in this notice.

    By way of signature, I provide Brown Orthopaedic Surgery and Sports Medicine Center, PA with my authorization and consent to use and disclose my protected healthcare information for the purposes of treatment, payment, and healthcare operations as described in this Privacy Notice.

    ____________________________________________________________

    Patients Name (print)

    ____________________________________________________________

    Signature - Date

    ____________________________________________________________

    Authorized Facility Signature- Date

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