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 it carefully.

OUR LEGAL DUTY

We are required by law to maintain the privacy of your medical information. We are also required to provide you with this Notice of our legal duties and privacy practices with respect to your medical information. This Notice takes effect as of October 1, 2018, and will remain in effect until we replace it. We must abide by the terms of this Notice while it is in effect.

We reserve the right to change this Notice at any time. We also reserve the right to make the revised or changed Notice effective for the medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our office. You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION

We must disclose your medical information to you as described in the Patient Rights section of this Notice. We use and disclose medical information about you for treatment, payment, and healthcare operations. For example:

Treatment: We may use or disclose your medical information to doctors or other healthcare providers involved in your treatment.

Payment: We may use and disclose your medical information to bill and receive payment for the services we provided to you.

Worker’s Compensation: We may disclose your medical information as authorized to comply with worker’s compensation laws and other similar legal-established programs.

Healthcare Operations: We may use and disclose your medical information for our internal operations. These include quality assessment and improvement, staff evaluation, accreditation, certification, licensing and training programs. To best protect your privacy, we will remove information that identifies you.

Required By Law: We may use and disclose your medical information when required to do so by law. Food and Drug Administration: We may disclose your medical information to a person/company subject to the jurisdiction of the U.S. FDA with relation to the quality, safety, or effectiveness of an FDA-regulated product or activity.

Abuse, Neglect or Safety: We may disclose your medical information to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect or domestic violence, or the possible victim of other crimes. We may also disclose your medical information to appropriate authorities to the extent necessary to avert a serious threat to your health or safety, or the health or safety of others.

National Security: We may disclose your medical information to authorized federal officials for conducting national security and intelligence activities. We may also disclose medical information of Armed Forces personnel to military authorities under certain circumstances. We may also disclose medical information of inmates to correctional institutions or the custodial law enforcement official under certain circumstances.

Appointment Reminders: We may use and disclose your medical information to contact you with appointment reminders.

SMS: Patients can find our contact information on our website and or our business card. Patients will be verbally asked to consent to SMS reminders, office information, and office directions. By consenting to receive SMS from Elevation Prosthetics and Orthotics, you agree to receive reminders and office information in the form of SMS from us. If you verbally agree to SMS consent, phone numbers and patient information is not shared or collected with any third parties/affiliates.

Your Authorization: You may give us written authorization to use or disclose your medical information to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your medical information for any purpose except those described in this Notice.

Others Involved in Your Healthcare: Unless you object, we may disclose your medical information to a family member, a friend or any other person involved in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose your medical information as necessary if we determine that it is in your best interest based on our professional judgment. We may also use or disclose your medical information to an authorized public or private entity to assist in disaster relief efforts and to coordinate users and disclosures to family or other individuals involved in your healthcare.

Marketing Health-Related Services: We will not use your health information for marketing communications without your written authorization.

PATIENT RIGHTS

Inspect and Copy: You have the right to inspect and copy your medical information. This request must be in writing to our Privacy Officer. We may charge a fee for the cost of copying, mailing and other supplies associated with your request. We may deny all or part of your request to inspect and copy your medical information under limited circumstances. If you are denied access to your medical information, you may, under certain circumstances, request that such denial be reviewed. Any such review will be conducted by a licensed healthcare professional chosen by us. However, the person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Amend: You have the right to request us to amend your medical information. Your request must be in writing to our Privacy Officer. It must include a reason to support your request. We may deny your request under certain circumstances.

Accounting of Disclosures: You have the right to receive an accounting of certain disclosures of your medical information made by us in the past six years, but not before October 1, 2018. If you request this accounting more than once within a 12-month period, we may charge you for the cost associated with providing the list.

Restrictions: You have the right to request restrictions on our use and disclosure of your medical information. Although we are not required to agree with your request, but if we do, we will comply with your request unless the information is needed to provide you emergency treatment.

Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. The request must be in writing and must specify how or where you wish to be contacted. We will accommodate all reasonable requests.

QUESTIONS AND COMPLAINTS

If you have questions or concerns about our privacy practices, please contact our Privacy Officer. If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact our Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Privacy Officer: Michael F. Carlson, CPO
Address: 106 N. Sunrise Ave, Ste. C8 Roseville, CA 95661
Telephone: 916-297-7853
Fax: 916-297-7852