NOTICE
OF PRIVACY PRACTICES
For DJO Incorporated, LLC
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.
If
you have any questions about this Notice please contact our Privacy
Officer: Dale Hammer (800) 551-6911 Ext. 4742
dj
Orthopedics is committed to protecting your privacy and understands
the importance of safeguarding your medical information. We are
required by federal law to maintain the privacy of health information
that identifies you or that could be used to identify you (known
as "Protected Health Information" or "PHI").
We also are required to provide you with this Notice of Privacy
Practices, which explains our legal duties and privacy practices,
as well as your rights, with respect to PHI that we collect and
maintain. DJO Incorporated is required by federal law to abide by
this Notice. However, we reserve the right to change the privacy
practices described in this Notice and make the new practices
effective for all PHI that we maintain. Should we make such a
change, you may obtain a revised Notice by calling our office
and requesting a revised copy be sent in the mail, or accessing
our website at www.djortho.com.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
A.
Routine Uses and Disclosures of Protected Health Information
We
are permitted under federal law to use and disclose PHI, without
your written authorization, for certain routine uses and disclosures,
such as those made for treatment, payment, and the operation of
our business. The following are examples of the types of routine
uses and disclosures of PHI that we are permitted to make. While
this list is not exhaustive, it should give you an idea of the
routine uses and disclosures we are permitted to make.
For
Treatment: We will use and disclose your PHI to provide,
coordinate, or manage your treatment. For example, we will disclose
your PHI, as necessary, to the physician that referred you to
us.
For
Payment: Your PHI will be used, as needed, to obtain payment
for the health care services we provide you. For example, we may
tell your health plan about an orthotic device you will receive
to determine whether your plan will cover the device.
For
Health Care Operations: We may use or disclose your PHI
in order to support the business activities of this facility.
These activities include, but are not limited to, quality assessment,
employee review, legal services, licensing, and conducting or
arranging for other business activities.
Treatment
Alternatives: We may use or disclose your PHI or contact
you to provide you with information about treatment alternatives
or other health-related benefits and services that may be of interest
to you.
Sale
of the Business: If we decide to sell, transfer or merge
all or part of our business to or with another entity, we may
share your PHI with the new owners.
B.
Uses and Disclosures That May Be Made Without Your Authorization
or Opportunity to Object
We
may use or disclose your PHI in the following situations without
your authorization or providing you the opportunity to object.
Required
by the Secretary of Health and Human Services: We may
be required to disclose your PHI to the Secretary of Health and
Human Services to investigate or determine our compliance with
the requirements of the final rule on Standards for Privacy of
Individually Identifiable Health Information.
Required
By Law: We may use or disclose your PHI to the extent
that the use or disclosure is otherwise required by federal, state
or local law.
Public
Health: We may disclose your PHI for public health activities,
such as disclosures to a public health authority or other government
agency that is permitted by law to collect or receive the information
(e.g., the Food and Drug Administration).
Health
Oversight: We may disclose PHI to a health oversight agency
for activities authorized by law, such as audits, investigations,
and inspections. Oversight agencies include government agencies
that oversee the health care system, government benefit programs,
other government regulatory programs and civil rights laws.
Abuse
or Neglect: If you have been a victim of abuse, neglect,
or domestic violence, we may disclose your PHI to a government
agency authorized to receive such information. In addition, we
may disclose your PHI to a public health authority that is authorized
by law to receive reports of child abuse or neglect.
Judicial
and Administrative Proceedings: We may disclose your PHI
in response to an order of a court or administrative tribunal
(to the extent such disclosure is expressly authorized), and,
in certain conditions, in response to a subpoena, discovery request
or other lawful process.
Law
Enforcement: We may disclose your PHI, so long as applicable
legal requirements are met, for law enforcement purposes, such
as providing information to the police about the victim of a crime.
Coroners
and Funeral Directors: We may disclose your PHI to a coroner,
medical examiner, or funeral director if it is needed to perform
their legally authorized duties.
Organ
Donation: If you are an organ donor, we may disclose your
PHI to organ procurement organizations as necessary to facilitate
organ donation or transplantation.
Research:
Under certain circumstances, we may disclose your PHI to researchers
when their research has been approved by an institutional review
board that has reviewed the research proposal and established
protocols to ensure the privacy of your PHI.
Serious
Threat to Health or Safety: We may disclose your PHI if
we believe it is necessary to prevent a serious and imminent threat
to the public health or safety and it is to someone we reasonably
believe is able to prevent or lessen the threat.
Specialized
Government Functions: When the appropriate conditions
apply, may disclose PHI for purposes related to military or national
security concerns, such as for the purpose of a determination
by the Department of Veterans Affairs of your eligibility for
benefits.
Workers'
Compensation: We may disclose your PHI as necessary to
comply with workers' compensation laws and other similar programs.
Inmates:
We may use or disclose your PHI if you are an inmate of a correctional
facility and we created or received your PHI in the course of
providing care to you.
C.
Uses and Disclosures That May Be Made Either With Your Agreement
or the Opportunity to Object
Unless
you object, we may disclose to a member of your family, a relative,
a close friend or any other person you identify, orally or in
writing, your PHI that directly relates to that person's involvement
in your health care. If you are unable to agree or object to such
disclosure, we may disclose such information as necessary if we
determine that it is in your best interest based on our professional
judgment. We may use or disclose your 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 or general
condition.
D.
Uses and Disclosures of Protected Health Information Based upon
Your Written Authorization
Other
uses and disclosures of your PHI, not described above, will be
made only with your written authorization. You may revoke your
authorization, at any time, in writing, except to the extent that
we have taken action in reliance on the authorization.
YOUR
RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You
have certain rights regarding your PHI, which are explained below.
You may exercise these rights by submitting a request in writing
to our Privacy Officer.
A.
You have the right to inspect and copy your PHI. If you would
like to see or copy your PHI that is contained in a designated
record set (e.g., medical and billing records), we are required
to provide you access to such PHI for inspection and copying within
30 days after receipt of your request (60 days if the information
is stored off-site). We may charge you a reasonable fee to cover
duplication, mailing and other costs incurred by us in complying
with your request. In addition, there are situations where we
may deny your request for access to your PHI. For example, we
may deny your request if we believe the disclosure will endanger
your life or that of another person. Depending on the circumstances
of the denial, you may have a right to have this decision reviewed.
B.
You have the right to request a restriction of your PHI. This
means you may ask us not to use or disclose any part of your PHI
for purposes of treatment, payment or health care operations.
You may also request that any part of your PHI not be disclosed
to family members or friends who may be involved in your care
or for notification purposes as described in this Notice. Your
request must state the specific restriction requested and to whom
you want the restriction to apply. We are not required to agree
to a restriction that you may request. If we agree to the requested
restriction, we may not use or disclose your PHI in violation
of that restriction unless it is needed to provide emergency treatment.
C.
You have the right to request to receive confidential communications
from us by alternative means or at an alternative location.
We will accommodate reasonable requests. We may also condition
this accommodation by asking you for information as to how payment
will be handled or specification of an alternative address or
other method of contact.
D.
You have the right to amend your PHI. This means you may request
an amendment of your PHI in our records that is contained in a
designated record set (e.g., medical and billing records) for
as long as we maintain the PHI. We will respond to your request
within 60 days (with up to a 30-day extension if needed). We may
deny your request if, for example, we determine that your PHI
is accurate and complete. If we deny your request, we will send
you a written explanation and allow you to submit a written statement
of disagreement.
E.
You have the right to receive an accounting of certain disclosures
that we have made of your PHI. You have the right to receive
an accounting of certain disclosures we have made, if any, of
your PHI. This right only applies to disclosures for purposes
other than treatment, payment or health care operations as described
in this Notice. It also excludes disclosures we may have made
to you, your family members or friends involved in your care.
The right to receive this information is subject to certain exceptions,
restrictions and limitations. You must specify a time period,
which may not be longer than 6 years and cannot include any date
before April 14, 2003. You may request a shorter timeframe. You
have the right to one free request within any 12-month period,
but we may charge you for any additional requests in the same
12-month period. We will notify you about any such charges, and
you are free to withdraw or modify your request in writing before
any charges are incurred.
F.
You have the right to obtain a paper copy of this notice from
us.
COMPLAINTS
If
you believe that we have violated your privacy rights, you may
file a complaint with us by notifying our Privacy Officer in writing
at the following address:
DJO Incorporated
2985 Scott Street
Vista, CA 92081
Attn: Dale Hammer