2320 Thornton Taylor Parkway
Fayetteville, TN 37334
(931) 438-5515

FAX (931) 438-5516


Medical Records and HIPPA Policy

Medical records are confidential and we will not release your medical records to anyone, including your attorney or insurance company, without a signed release. In addition, we may ask you to provide identification if you are not known to our office staff. Please allow us 24 hours notice to prepare your medical records and/or x-rays for your pick-up. We will complete disability and attending physician statements for you if they are duly authorized.

Please mail them to us or drop them off at the receptionist's desk, with instructions of where you wish them mailed upon completion. Please allow 7 working days for completion of your forms. If you are a new patient, please bring with you all relevant medical records, x-ray films, and other test results in order for the physician to properly review your history. If you do not have these available at the time of your appointment, we will have to ask you to reschedule and return with the proper paperwork for review.

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HIPPA NOTICE OF PRIVACY PRACTICES FORM
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HIPPA NOTICE OF PRIVACY PRACTICES

Advanced Orthopaedics
2320 Thornton Taylor Pkwy.
Fayetteville, TN 37334

931-438-5515

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

This Notice of Privacy Practices describes how we may use and disclose your PROTECTED HEALTH INFORMATION (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

Uses and Disclosures of PHI
Your PHI may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the physician's practice, and any other use required by law.

Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your PHI, as necessary, to a home health agency that provides care to you. For example, your PHI may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.

Payment: Your PHI will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay or surgery may require that your relevant PHI be disclosed to the health plan to obtain approval for the hospital admission/surgery.

Healthcare Operations: We may use or disclose, as needed, your PHI in order to support the business activities of your physician's practice. These activities include, but are not limited to, quality assessment activities, employee reviews activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your PHI, as necessary, to contact you about an appointment or test that has been scheduled.
We may use your PHI in the following situations without your authorization. These situations include: as Required by Law, Public Health issues as required by law, Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners, Funeral Directors, and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Worker's Compensation: Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Dept. of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.

Disclosure to our Business Associates: There are some services provided by us through contracts with business associates. When these services are contracted for, we may disclose your PHI to our business associate so that they can perform the job we have asked them to do and to bill you or your third-party payer for services rendered. To protect your PHI, we required the business associate to appropriately safeguard your PHI.

Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization or opportunity to object unless required by law.

You may revoke this authorization at any time, in writing, except to the extent that your physician or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.

Your Rights
Following is a statement of your rights with respect to your PHI.

You have the right to inspect and copy your PHI. Under federal law, however, you may not inspect or copy the following records, psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI.

You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restrictions requested and to whom you want the restriction to apply.

Your physician is not required to agree to a restriction that you may request. If physician believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. You then have the right to use another Healthcare Professional.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively, i.e. electronically.
You may have the right to have your physician amend your PHI. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI.

We reserve the right to change the terms of this notice. Until such changes are made, Advanced Orthopaedics is required by law to comply with this Notice. The revised notice will be posted in the patient waiting area and a paper copy will be available upon request.

Complaints
If you have a complaint, you may contact the Secretary of Health and Human Services if you believe we have violated your privacy rights. You may file a complaint with us by notifying the office manager of your complaint. We will not retaliate against you for filing a complaint.

We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to PHI. If you have any objections to this form, please ask to speak with our HIPPA Compliance Officer in person or by phone at our Main Number, 931-438-5515.

Copyright 2005 Advanced Orthopaedics
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