If you have any questions about this notice,
please contact our Privacy Officer at (800) 411-1388 ext. 15, 90
Hamilton St., New Haven, CT 06511. Email our privacy officer here.
WHO WILL FOLLOW THIS NOTICE
This notice describes the information privacy practices followed
by our employees, staff and other office personnel. The practices
described in this notice will also be followed by health care providers
you consult with by telephone (when your regular provider representative
from our office is not available) who provide "call coverage" for
your provider representative.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about
your health, health status, and the health care and service you
receive at this office.
We are required by law to give you this notice. It will tell
you about the ways in which we may use and disclose health information
about you and describes your rights and our obligations regarding
the use and disclosure of that information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
We may request your written, signed Consent to use and disclose
health information for the following purposes:
For Treatment We may use health information about
you to provide you with medical treatment or services. We may
disclose health information about you to doctors, therapists,
technicians, office staff or other personnel who are involved
in taking care of you and your health.
For example, information obtained by an occupational therapist
or other member of your healthcare team will be recorded in your
record and used to determine the course of treatment that should
work best for you. We may provide your physician or subsequent
healthcare provider with copies of various reports so they can
help determine the most appropriate care for you.
Different personnel in our office may share information about
you and disclose information to people who do not work in our
office in order to coordinate your care, such as phoning in an
order to our fabrication lab, or contacting our suppliers of components
for consultation regarding a specific application. Family members
and other health care providers may be part of your medical care
outside this office and may require information about you that
we have.
For Payment We may use and disclose health information
about you so that the treatment and services you receive by this
office may be billed to and payment may be collected from you,
an insurance company or a third party. For example, we may need
to give your health plan information about a service you received
here so your health plan will pay us or reimburse you for the
service. We may also tell your health plan about a service or
piece of equipment you are going to receive to obtain prior approval,
or to determine whether your plan will cover the service.
For Health Care Operations We may use and disclose
health information about you in order to run the office and make
sure that you and our other patients receive quality care. For
example, if we have HIV or substance abuse information about you,
we cannot release that information without a special signed, written
authorization (different than the Authorization and Consent
mentioned above) from you. In order to disclose these types of
records for purposes of treatment, payment or health care operations,
we will have to have both your signed Consent and a special
written Authorization that complies with the law governing
HIV or substance abuse records.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we
maintain about you:
Right to Inspect and Copy You have the right to
inspect and copy your health information, such as medical and
billing records, that we use to make decisions about your care.
You must submit a written request to the above address attention
Privacy Officer
in order to inspect and/or copy your health information, we may
charge a fee for the costs of copying, mailing or other associated
supplies. We may deny your request to inspect and/or copy in certain
limited circumstances. If you are denied access to your health
information, you may ask that the denial be reviewed. If such
a review is required by law , we will select a licensed health
care professional to review your request and our denial. The person
conducting the review will not be the person who denied your request,
and we will comply with the outcome of the review.
Right to Amend If you believe health information
we have about you is incorrect or incomplete, you may ask us to
amend the information. You have the right to request an amendment
as long as the information is kept by this office.
To request an amendment, complete and submit a Medical
Record Amendment/Correction Form to Privacy
Officer. We may deny your request for an amendment if
it is not in writing or does not include a reason to support the
request. In addition, we may deny your request if you ask us to
amend information that:
- We did not create, unless the person or entity
that created the information is no longer available to make
the amendment.
- Is not part of the health information that
we keep
- You would not be permitted to inspect or copy.
- Is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures".
This is a list of disclosures we made of medical information about
you for purposes other than treatment, payment and health care
operations. To obtain this list, you must submit your request
in writing to Privacy
Officer. It must state a time period, which may not be
longer than six years and may not include dates before April 14,
2003. Your request should include indicate in what form you want
the list (for example, on paper, emailed). We may charge you for
the costs of providing the list. We will notify you of the cost
involved and you may choose to withdraw or modify your request
at that time before any costs are incurred.
Right to Request Restrictions You
have the right to request a restriction or limitation on the health
information we use or disclose about you for treatment, payment
or health care operations. You also have the right to request
a limit on the health information we disclose about you to someone
who is involved in your care or the payment for it, like a family
member or friend. For example, you could ask that we not use or
disclose information about an operation you received.
We are Not Required to Agree to Your Request
If we do agree, we will comply with your request unless the information
is needed to provide you emergency treatment.
Worker's Compensation We may release
health information about you for worker's compensation or similar
programs. These programs provide benefits for work-related injuries
or illness.
Public Health Risks We may disclose
health information about you for public health reasons in order
to prevent or control disease, injury or disability; or report
births, deaths, suspected abuse or neglect, non-accidental physical
injuries, reactions to medications or problems with products.
Health Oversight Activities We may
disclose health information to a health oversight agency for audits,
investigations, inspections, or licensing purposes. These disclosures
may be necessary for certain state and federal agencies to monitor
the health care system, government programs, and compliance with
civil rights laws.
Lawsuits and Disputes If you are
involved in a lawsuit or dispute, we may disclose health information
about you in response to a court or administrative order. Subject
to all applicable legal requirements, we may also disclose health
information about you to a subpoena.
Law Enforcement We may release health
information if asked to do so by a law enforcement official in
response to a court order, subpoena, warrant, summons or similar
process, subject to all applicable legal requirements.
Coroners, Medical Examiners and Funeral
Directors We may release health information to a coroner
or medical examiner. This may be necessary, for example, to identify
a deceased person or determine the cause of death.
Information Not Personally Identifiable
We may use or disclose health information about you in a way that
does not personally identify you or reveal who you are.
Family and Friends We may disclose
health information about you to your family members or friends
if we obtain your verbal agreement to do so or if we give you
an opportunity to object to such a disclosure and you do not raise
an objection. We may also disclose health information to your
family and friends if we can infer from the circumstances, based
on our professional judgment that you would not object. For example,
we may assume you agree to our disclosure of your personal health
information to your spouse when we meet with you and your spouse
during the evaluation and equipment demonstration or while your
equipment is being discussed.
In situations where you are not capable of giving
consent (because you are not present or due to your incapacity
or medical emergency), we may, using our professional judgment,
determine that a disclosure to your family member or friend is
in your best interest. In that situation, we will disclose only
health information relevant to the person's involvement. In your
care. We may use our professional judgment and experience to make
reasonable inferences that it is in your best interest to allow
another person to act on your behalf to pick up, for example,
supplies.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
We will not use or disclose your health information
for any purpose other than those identified in the previous sections
without your specific written Authorization. We must obtain
your Authorization separate from any Consent we
may have obtained from you. If you give us Authorization
to use or disclose health information about you, you may revoke
that Authorization, in writing, at any time. If you revoke
your Authorization, we will no longer use or disclose information
about you for reasons covered by your written Authorization,
but we cannot take back any uses or disclosures already made with
your permission.
We may use your health information to evaluate
the performance of our staff in caring for you. We may also use
health information about all or many of our patients to help us
decide what additional services we should offer, how we can become
more efficient, or whether certain new treatments are effective.
Appointment Reminders We may contact
you as a reminder that you have an appointment for an evaluation,
fitting, or other service by our company or another health care
agency.
Treatment Alternatives We may tell
you about or recommend possible treatment options or alternatives
that may be of interest to you.
Health-Related Products and Services
We may tell you about health-related products or services that
may be of interest to you.
Please notify us if you do not wish to be contacted
for appointment reminders, or if you do not wish to receive communications
about treatment or alternative equipment. If you advise us in
writing ( at the address listed at the top of this notice) that
you do not wish to receive such communications, we will not use
or disclose your information for these purposes.
You may revoke your Consent at any time by giving
us written notice. Your revocation will be effective when we receive
it, but it will not apply to any uses and disclosures which occurred
before that time.
If you do revoke your Consent, we will not be
permitted to use or disclose information for purpose of treatment,
payment or health care operations, and we may therefore choose
to discontinue providing you with equipment and services.
SPECIAL SITUATIONS
We may use or disclose health information about
you without your permission for the following purposes, subject
to all applicable legal requirements and limitations.
To Avert a Serious Threat to Health or Safety
We may use and disclose health information about you when necessary
to prevent a serious threat to your health and safety or the health
and safety of the public or another person.
Require By Law We will disclose
health information about you when required to do so by federal,
state or local law.
Research We may use and disclose
health information about you for research projects that are subject
to a special approval process. We will ask you for your permission
if the researcher will have access to your name, address or other
information that reveals who you are, or will be involved in your
care at the office.
Military, Veterans, National Security and
Intelligence If you were a member of the armed forces,
or part of the national security or intelligence communities,
we may be required by military command or other government authorities
to release health information about you. We may also release information
about foreign military personnel to the appropriate foreign military
authority. To request restrictions, you may complete and submit
the Request For Restriction
On Use /Disclosure Of Medical Information to our Privacy Officer.
Right to Request Confidential Communications
You have the right to request that we communicate with you about
medical matters in a certain way or at a certain location. For
example, you can ask that we only contact you at work or by mail.
To restrict confidential communications, you may
complete and submit the Request
For Restriction On Use /Disclosure Of Medical Information.
We will not ask you the reason for your request. We will accommodate
all reasonable requests. Your request must specify how or where
you wish to be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask
us to give you a copy of this notice at any time. Even if you
have agreed to receive it electronically, you are still entitled
to a paper copy. To obtain such a copy, contact our Privacy
Officer.
CHANGES TO THIS NOTICE
We reserve the right to change this notice, and
to make the revised or changed notice effective for medical information
we already have about you as well as any information we receive
in the future. We will post a summary of the current notice in
the office with its effective date in the top right hand corner.
You are entitled to a copy of the notice currently in effect.
COMPLAINTS
If you believe your privacy rights have been violated,
you may file a complaint with our office or with the Secretary
of the Department of Health and Human Services. To file a complaint
with our office, contact Privacy
Officer at (800) 411-1388 ext. 15, 90 Hamilton St., New Haven,
CT 06511. You will not be penalized for filing a complaint.
Please Note:
This policy does not apply to other websites or
companies that we link to or that contain a link to our website.
