EFFECTIVE APRIL 14, 2003
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.

Our Legal Duty

The following is the privacy policy of West Michigan Orthopaedics as described by the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA requires our practice to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy policies with respect to your protected health information. We will, as required by law, abide by the terms of this privacy notice.

Uses or Disclosures of Your Protected Health Information

WITHOUT YOUR CONSENT

Without your consent, we may use or disclose your protected health information for treatment, payment and healthcare operation purposes.

Examples of treatment activities include: (a) the provision, coordination, or management of healthcare and related services by healthcare providers; (b) consultation between healthcare providers relating to a patient; and (c) the referral of a patient from one healthcare provider to another.

Examples of payment activities include: (a) billing and collection activities; (b) determining health insurance eligibility or coverage for medical claims processing; (c) medical necessity or utilization review activities; and (d) disclosure to consumer reporting agencies of information relating to collection of payment.

Examples of healthcare operations include: (a) development of clinical guidelines; (b) contacting patients with information about treatment alternatives or communications in connection with case management or care coordination; (c) reviewing the qualifications and training of healthcare professionals; (d) medical review, legal services, and auditing functions; and (e) general administrative activities such as customer service and data analysis.

We may use or disclose your protected health information without your authorization to the extent that law requires such use or disclosure. Examples of instances in which we are required to disclose your protected health information include: (a) public health purposes; (b) victims of abuse, neglect or domestic violence; (c) auditing or criminal investigation purposes; (d) research studies; (e) law enforcement purposes in specific circumstances; (f) workers’ compensation; and (g) emergencies.

We may contact you via telephone or USPS to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

WITH YOUR AUTHORIZATION

Except as otherwise permitted or required as described above, we may not use or disclose your protected health information without your written authorization. Further, we are required to use or disclose your protected health information consistent with the terms of your authorization. You may revoke your authorization to use or disclose any protected health information at any time, except to the extent that we have taken action in reliance on such authorization.

Your Rights With Respect to Your Protected Health Information

Under HIPAA, you have certain rights with respect to your protected health information. The following is a brief overview of your rights and our duties with respect to enforcing those rights. Please note that the below rights require written request forms, which can be obtained from our privacy officer.

Right To Request Restrictions On Use Or Disclosure

You have the right to request restrictions on certain uses and disclosures of your protected health information. Typically, we reserve the option to disclose protected health information to your family members, other relatives or close friends relevant to your treatment, payment, location, general health or death unless otherwise restricted by you. We will consider your request but are not legally required to accept it.

Right To Receive Confidential Communications

You have the right to request and to receive confidential communications of your protected health information by alternative means or alternative locations. We must accommodate all reasonable requests

Right To Inspect And Copy Your Protected Health Information

In most cases, you have the right of access to inspect and obtain a copy your protected health information contained in your chart. If you request copies, we may charge you a reasonable cost-based fee. It is our practice policy to generally provide protected health information that is originated by our practice only.

Right To Amend Your Protected Health Information

You have the right to request that we amend your protected health information that is inaccurate or incomplete.

Right To Receive An Accounting Of Disclosures Of Your Protected Health Information

You have a right to obtain an accounting of disclosures of your protected health information made by our practice within the last six (6) years.

Complaints

You may file a complaint with us and with the DHHS if you believe that your privacy rights have been violated. You may submit your complaint in writing to our privacy officer at the address listed below. A complaint must name the practice that is the subject of the complaint and describe the acts or omissions believed to be in violation. Our privacy officer can provide you with the DHHS address upon request. You will not be retaliated against for filing any complaint.

Amendments to this Privacy Policy

We reserve the right to revise or amend this privacy policy at any time. These revisions or amendments may be made effective for all protected health information we maintain even if created or received prior to the effective date of the revision or amendment. When significant changes are made to our privacy policy, we will post the new notice in our waiting area and to our website.

On-going Access to Privacy Policy

We will provide you with a copy of the most recent version of this privacy policy at any time upon your written request to our privacy officer. For any other requests or for further information regarding the privacy of your protected health information, please contact our privacy officer at the address or telephone number listed below.

If you have any questions or complaints, please contact:
Privacy Officer
West Michigan Orthopaedics
1000 East Paris Avenue SE, Ste 215
Grand Rapids, Michigan 49546
Telephone: (616) 949-8945