HIPAA NOTICE OF PRIVACY PRACTICES

Effective Date: September 23, 2013. Revision Dates: 02/24, 08/25, 02/26

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR PROTECTED HEALTH INFORMATION IS IMPORTANT TO US.

The terms of this Notice of Privacy Practices ("Notice") apply to Spine Hospital of Louisiana AKA "SHOLA", its affiliates, workforce, and its employees. SHOLA will share protected health information of patients as necessary to carry out treatment, payment, and health care operations as permitted by law. This notice describes how your health information will be handled in various situations.

We are required by law to secure, protect, and maintain the privacy of our patients' protected health information and to provide patients with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this Notice for as long as it remains in effect. We reserve the right to change the terms of this Notice as necessary and to make a new notice of privacy practices effective for all protected health information maintained by SHOLA.

This Notice of Privacy Practices explains that we will obtain your written authorization to release information about you unless SHOLA is allowed or required by law to disclose the information without authorization.

We are required to notify you in the event of a breach of your unsecured protected health information. We are also required to inform you that there may be a provision of state law that relates to the privacy of your health information that may be more stringent than a standard or requirement under the Federal Health Insurance Portability and Accountability Act ("HIPAA"). A copy of any revised Notice of Privacy Practices or information pertaining to a specific State law may be obtained by mailing a request to the Privacy Officer at the address below.

 

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION:

Authorization and Consent: Except as outlined below, we will not use or disclose your protected health information for any purpose other than treatment, payment or health care operations unless you have signed a form authorizing such use or disclosure. You have the right to revoke such authorization in writing, with such revocation being effective once we actually receive the writing; however, such revocation shall not be effective to the extent that we have taken any action in reliance on the authorization, or if the authorization was obtained as a condition of obtaining insurance coverage, other law provides the insurer with the right to contest a claim under the policy or the policy itself

 

Uses and Disclosures for Treatment: We will make uses and disclosures of your protected health information as necessary for your treatment. Doctors and nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to your course of treatment that may include procedures, medications, tests, medical history, etc.

 

Uses and Disclosures for Payment: We will make uses and disclosures of your protected health information as necessary for payment purposes. During the normal course of business operations, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you. We may also use your information to prepare a bill to send to you or to the person responsible for your payment.

 

Uses and Disclosures for Health Care Operations: We will make uses and disclosures of your protected health information as necessary, and as permitted by law, for our health care operations, health oversight activities, and agencies authorized by law to conduct audits, investigations, inspectorswhich may include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your protected health information for purposes of improving clinical treatment and patient care. For Substance Use Disorder (SUD) records, in program oversight, audits, and reviews, we may share information with governmental agencies or organizations that review our programs to make sure we are following the law and providing quality care.

 

Individuals Involved In Your Care: We may from time to time disclose your protected health information to designated family, friends and others who are involved in your care or in payment of your care in order to facilitate that person's involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval. We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster reliefefforts for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.

 

Health Information Exchange/Regional Health Information Organization: Federal and state laws may permit us to participate in organizations with other healthcare providers, insurers, and/or other health care industry participants and their subcontractors in order for these individuals and entities to share your health information with one another to accomplish goals that may include but not be limited to: improving the accuracy and increasing the availability of your health records; decreasing the time needed to access your information; aggregating and comparing your information for quality improvement purposes; and such other purposes as may be permitted by law. You may request to opt out of participation in these organizations.

Contact the FPO if you want to opt-out.

 

Business Associates: Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, outcomes data collection, legal services, etc. At times it may be necessary for us to provide your protected health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these associates to appropriately safeguard the privacy of your information.

 

Appointments and Services: We may contact you to provide appointment updates or information about your treatment or other health-related benefits and services that may be of interest to you. These communications may be in the form of email, cellular telephone, or text usage for appointment reminders and other healthcare communications and may be unsecured and may contain Protected Health Information.

These communications may also be from SHOLAs affiliates, business associates, or associated vendors. You have the right to request, and we will accommodate reasonable requests by you to receive communications regarding your protected health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, or email, we will accommodate reasonable requests. With such request, you must provide an appropriate alternative address or method of contact. You also have the right to request that we not send you any future marketing materials and we will use our best efforts to honor such request.

You have the right to opt out of these communications at any time by revoking this agreement and must do so in writing, including your name and address, and sending such writing to the Privacy Officer at the address below.

Research: In limited circumstances, we may use and disclose your protected health information for research purposes. In all cases where your specific authorization is not obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board which oversees the research or by representations of the researchers that limit their use and disclosure of your information.

 

Fundraising: We may use your information to contact you for fundraising purposes. We may disclose this contact information to a related foundation so that the foundation may contact you for similar purposes. If you do not want us or the foundation to contact you for fundraising efforts, you must send such a request in writing to the Privacy Officer at the address below.

 

Other Uses and Disclosures: We are permitted and/or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization for the following:

• Any purpose required by
• Public health activities such as required reporting of immunizations, disease, injury, birth and

death, or in connection with public health investigations. For SUD records, your health information will be deidentified.

• If we suspect child abuse or neglect; if we believe you to be a victim of abuse, neglect or domestic -
• To the Food and Drug Administration to report adverse events, product defects, or to participate m product recalls.
• To your employer when we have provided health care to you at the request of your
• To a government oversight agency conducting audits, investigations, civil or criminal
• Court or administrative ordered subpoena or discovery
• To law enforcement officials as required by law if we believe you have been the victim of abuse, neglect or domestic We will only make this disclosure if you agree or when required or authorized by law.
• To coroners and/or funeral directors consistent with
• If necessary to arrange an organ or tissue donation from you or a transplant for
• If you are a member of the military, we may also release your protected health information for national security or intelligence activities; and
• To workers' compensation agencies for workers' compensation benefit
• To comply with Court orders, or complaints made to state agencies, and administrative agencies that govern SHOLA; and
• Bioterrorism, public health

 

DISCLOSURES REQUIRING AUTHORIZATION:

Psychotherapy Notes: We must obtain your specific written authorization prior to disclosing any psychotherapy notes in accordance with 42 CFR Part 2, unless otherwise permitted by law. However, there are certain purposes for which we may disclose psychotherapy notes, without obtaining your written authorization, including the following: (1) to carry out certain treatment, payment or healthcare operations (e.g., use for the purposes of your treatment, for our own training, and to defend ourselves in a legal action or other proceeding brought by you), (2) to the Secretary of the Department of Health and Human Services to determine our compliance with the law, (3) as required by law, (4) for health oversight activities authorized by law, (5) to medical examiners or coroners as permitted by state law, or (6) for the purposes of preventing or lessening a serious or imminent threat to the health or safety of a person or the public.

Disclosures of Substance Use Disorder (SUD) Notes and Records:

Substance Use Disorder (SUD) treatment records that we create, maintain, receive, or transmit are protected by federal confidentiality laws, including 42 CFR Part 2, which offers more robust privacy protections than HIPAA. We are prohibited from using or disclosing SUD information-even for purposes typically permitted under HIPAA, such as treatment, payment, or healthcare operations-unless you provide written consent or a specific exception under federal law applies.

1. Legal Proceedings

SUD records may not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without your written consent or a court order that meets stringent requirements under federal law, specifically 42 CFR Part 2, which protects the confidentiality of substance use disorder patient records. This restriction applies regardless of whether we created the SUD records or received them from another provider.

2. Right to Restrict Disclosures

You have the right to request restrictions on the use or disclosure of your SUD records. While we are not obligated to agree to all requested restrictions, we will comply with all legally mandated limitations on disclosure.

3. Re Disclosure of Information

If we disclose your SUD information based on your written consent, the recipient may be prohibited from further disclosing the information unless you provide additional consent or federal law allows it. We will notify you when information we share is subject to redisclosure limitations under Part 2.

4. Right to Out ofFundraising Communications

If we intend to use SUD information for fundraising communications, you will be afforded the opportunity to opt out prior to receiving such communications. You must let us know if you do not want to receive any fundraising communications by using the information at the end of this Notice of Privacy Practices to contact us.

5. Medical Emergencies

If you have a medical emergency and cannot tell us what care you want, or when we are closed during a declared disaster and are unable to obtain your consent, we may share limited information about your substance use treatment with emergency medical staff to help keep you safe. We only share what is needed to treat you at this that time.

 

Genetic Information: We must obtain your specific written authorization prior to using or disclosing your genetic information for treatment, payment or health care operations purposes. We may use or disclose your genetic information, or the genetic information of your child, without your written authorization only where it would be permitted by law.

 

Marketing: We must obtain your authorization for any use or disclosure of your protected health information for marketing purpose. This includes any communication about a product or service that encourages you to purchase or use the product or service. The exception to this requirement is if the communication is in the form of (1) a face-to-face communication with you, or (2) a promotional gift of nominal value.

 

Sale of Protected Information: We must obtain your authorization prior to receiving direct or indirect remuneration in exchange for your health information; however, such authorization is not required where the purpose of the exchange is for:

• Public health activities and purposes.
• Research purposes provided that we receive only a reasonable, cost-based fee to cover the cost to prepare and transmit the information for research purposes.
• Treatment and payment
• Health care operations involving the sale, transfer, merger or consolidation of all or part of our business and for related due diligence.
• Payment we provide to a business associate for activities involving the exchange of protected health information that the business associate undertakes on our behalf (or the subcontractor undertakes on behalf of a business associate) and the only remuneration provided is for the performance of such
• Providing you with a copy of your health information or an accounting of
• Disclosures required by
• Disclosures of your health information for any other purpose permitted by and in accordance with the Privacy Rule ofHIPAA, as long as the only remuneration we receive is a reasonable, cost-based fee to cover the cost to prepare and transmit your health information for such purpose or is a fee otherwise expressly permitted by other law; or
• Any other exceptions allowed by the Department of Health and Human Services. 

RIGHTS THAT YOU HAVE REGARDING YOUR PROTECTED HEALTH INFORMATION:

 

Access to Your Protected Health Information: You have the right to copy and/or inspect much of the protected health information that we retain on your behalf For protected health information that we maintain in any electronic designated record set, you may request a copy of such health information in a reasonable electronic format, if readily producible. Requests for access must be made upon written request that complies with The Spine Hospital of Louisiana's (SHOLA) HIPAA compliant Authorization for Release of Patient Information pursuant to 45 CFR §164.508" and signed by you or your legal representative. You may obtain SHOLA's HIPAA Compliant Release of Patient Information from the front office person or utilize our electronic Release oflnformation (eROI) request button on our website under 'For Patients, then Request Medical Records' You will be charged a reasonable copying fee and actual postage and supply costs for your protected health information. If you request additional copies, you will be charged a fee for copying and postage. By consenting to the release of your Protected Health Information (PHI), including Substance Use Disorder (SUD) records, to a third party, you acknowledge that you may forfeit certain enhanced HIPAA protections.

 

Amendments to Your Protected Health Information: You have the right to request in writing that protected health information that we maintain about you be amended or corrected. We are not obligated to make requested amendments, but we will give each request careful consideration. All amendment requests must be in writing, signed by you or legal representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made, we may notify others who work with us if we believe that such notification is necessary. You may obtain an "Amendment Request Form" from the front office person or individual responsible for medical records.

 

Accounting for Disclosures of Your Protected Health Information: You have the right to receive an accounting of certain disclosures made by us of your protected health information after April 14, 2003. Requests must be made in writing and signed by you or your legal representative. "Accounting Request Forms" are available from the front office person or individual responsible for medical records. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period. You will be notified of the fee at the time of your request.

Restrictions on Use and Disclosure of Your Protected Health Information: You have the right to request restrictions on uses and disclosures of your protected health information for different areas of access and disclosure. We generally do not need your release to use and disclose your protected health information for the purposes of treatment, payment, or health care operations, but you have the right to request. We are not required to agree to most restriction requests but will attempt to accommodate reasonable requests when appropriate. You do, however, have the right to restrict disclosure of your protected health information to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the protected health information pertains solely to a health care item or service for which you, or someone other than the health plan on your behalf, has paid SHOLA in full. If we agree to any discretionary restrictions, we reserve the right to remove such restrictions as appropriate. We will notify you if we remove a restriction imposed in accordance with this paragraph. You also have the right to withdraw, in writing or orally, any restriction by communicating your desire to do so to the individual responsible for medical records. Requests must be made in writing and signed by you or your legal representative. "Accounting Request Forms" are available from the front office person or the Privacy Officer at 225-768-2736.

Right to Notice of Breach: We take very seriously the confidentiality of our patients' information, and we are required by law to protect the privacy and security of your protected health information through appropriate safeguards. We will notify you in the event a breach occurs involving or potentially involving your unsecured health information and inform you of what steps you may need to take to protect yourself.

Paper Copy of this Notice: You have a right, even if you have agreed to receive notices electronically, to obtain a paper copy of this Notice. To do so, please submit a request to the Privacy Officer at the address below.

Complaints: If you believe your privacy rights have been violated, you can file a complaint in writing with to us or to the Secretary of the U.S. Department of Health and Human Services at the below address. There will be no retaliation for filing a complaint.

The Spine Hospital of Louisiana - (225) 768-2736; Privacy & Compliance Officer: Kristie Miller, 10105 Park Rowe Circle, Suite 250, Baton Rouge, LA 70810;

The NeuroMedical Center Clinic - (225) 768-2104;

The NeuroMedical Center Rehabilitation Hospital - (225) 906 - 3820 Centralized Case Management Operations

U.S. Department of Health and Human Services 200 Independence Avenue, S.W.

Room 509F HHH Bldg.

Washington, D.C. 20201

HIPAA Complaint Process I HHS.gov [email protected]

Office for Civil Rights Department of HHS

Jacob Javits Federal Building 26 Federal Plaza - Suite 3312 New York, NY 10278

Voice Phone (212) 264-3313

FAX (212) 264-3039 TDD (212) 264-2355

For Further Information: If you have questions, need further assistance or would like to submit a request pursuant to this Notice, you may contact the SHOLA Privacy Officer listed above by phone at (225) 768-2736 or at the following address: 10105 Park Rowe Cir, Baton Rouge, LA 70810.

 

This Notice of Privacy Practices is also available on our web page at http://www.spinehola.com/.

 

We reserve the right to modify this notice at any time. Any such modifications will apply to all health information we maintain about you. If we update our practices, we will publish a revised HIPAA Notice of Privacy Practices on our website indicated below. This notice is available to you upon request. This Notice of Privacy Practices is also available on our web page at http://www.spinehola.com/.