Chapel Hill Foot and Ankle Associates, P.A.
Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU CAN BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Our Legal Duty
We have a legal duty by federal and state laws to protect the privacy of your PHI (Protected
Health Information). We also have a duty to give you this notice about our privacy practices,
our legal duties, and your rights concerning your PHI.
We are required to follow the procedures of this notice. We reserve the right to change the
terms of this notice and our privacy practice if the changes are consistent with applicable law.
You may request a copy of our notice (or any revised notice) at any time. For more
information or questions regarding our privacy notice, please contact the officer listed at the
end of this information.
Uses and Disclosures of Your Protected Health Information
We are allowed by Federal law to use or disclose your PHI for the purposes of treatment,
payment and health care operations without obtaining your written consent.
Treatment
This may include providing, coordinating, or managing healthcare and related services by one
or more healthcare providers, consultations between physicians, nurses, technicians, students,
and other healthcare providers concerning a patient; referrals to other providers for treatment;
referrals to nursing homes, foster care homes, or home health agencies.
Payment
This may include determining your eligibility for benefits or health coverage; procedures done
to obtain reimbursement for services provided, obtaining preauthorization for services;
managing insurance claims; collection activities; discussing with insurance company coverage
under your health plan and billing department.
Health Care Operations
Your PHI may be used or disclosed in order to conduct certain business and operation
activities. These include, but are not limited to: quality assessment, employee review
activities, training of students, licensing, and other business activities.
For example, we will ask for your name, address and insurance information at the registration
desk. You will be called by name when we are ready to seat you in a treatment room. We
may use the PHI to contact you by telephone or mail to remind you of your appointment.
We may share the PHI with business associates for the practice (e.g. billing, transcription).
We may use the PHI to provide you with information about treatment alternatives or other
benefits and services. We may also disclose your PHI for marketing activities: (e.g. you may
receive a newsletter with your name and address on it) you may ask not to receive these
items.
Exception to Notification
We may use or disclose without your authorization. Those circumstance may include: When
use is required by law; necessity by public health activities; when the disclosure relates to
victims of abuse, neglect, or domestic violence, federal health (or other) oversight activities;
judicial or administrative proceedings; for law enforcement purposes; when the use or
disclosure relates to decedents or cadaveric donation; relating to medical research; avoidance
of serious health or safety threat; specialized government functions or correctional institutions.
You may object to some uses or disclosure:
We may disclose to a member of your family, a relative, a close friend or any other person you
identify, your PHI that directly relates to that person’s involvement with your healthcare. If you
are unable to agree or object, we may disclose the information if we determine it is in your best
interested based on our professional judgment. We may use or disclose PHI to notify or assist
in notifying a family member, personal representative, or any other person that is responsible
for your care, of your location, general condition, or death.
You have rights regarding your PHI:
You have the right to request restrictions of disclosures. We are not required to agree to your
request, and even if we do, there may be situations when your restrictions may not be
followed. This would include emergency treatment. Any requests must be in writing.
You have the right to request (in writing) that we contact you in an alternative way (e.g. at
home or work), but we may be unable to honor your request (e.g., if you ask to be contacted
only at night or on weekends).
You may have the right to see and copy PHI about you contained in clinical, billing and other
records related to you. Your request must be in writing, and we may charge you related fees.
Under Federal law, however, you may not inspect or copy the following records:
psychotherapy notes; information compiled in anticipation of or for use in a civil, criminal, or
administrative action or proceeding; and PHI that is subject to a law that prohibits access to
that information. If the request is denied, you may have a right to have that decision reviewed.
You have the right to request that we amend your PHI. Your request must be in writing, and it
must explain why the information should be amended. We may deny your request if we did
not create the information you want amended or for certain other reasons. If we deny your
request, we will provide you with a written explanation. You may respond with a statement of
disagreement to be appended to the information you wanted amended. If we accept your
request to amend the information, we will make reasonable effort to inform others, including
people or entities you name, of the amendments and to include the changes in any future
disclosures of that information.
You have the right to receive an accounting of disclosures after April 14, 2003, and cannot
exceed a period of six years prior to the date of your request. Requests should be in writing to
the Privacy Officer at the end of this notice.
Electronic Notice
If you receive this notice on our website or electronically, you are entitled to receive this notice
in written form. Please contact us using the information listed at the end of this notice to obtain
this notice in written form.
Click Here to download a copy of our Privacy Policy
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the plan or
the Secretary of Health and Human Services. Complaints should be filed in writing with the
Privacy Officer listed in this notice. If you file a complaint, we will not take any action against
you or change our treatment of you in any way.
This notice is effective 5/8/03 (the first day of business for this practice), retroactive to 4/14/03
for patients of the prior, purchased practice.
HIPAA Officer
Alan Bocko, DPM
Chapel Hill Foot and Ankle Associates, PA
1506 Franklin Street, Suite 104
Chapel Hill, NC 27514
919-960-8858 phone
919-960-2882 fax