Notice Privacy Practice

THIS NOTICE DESCRIBES HOW TRI COUNTY ORTHOPAEDICS MAY USE AND DISCLOSE YOUR HEALTHCARE INFORMATION AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Tri County Orthopaedics is required by law to maintain the privacy of your protected health information. This information consists of all records related to your health, including demographic information, either created by Tri County Orthopaedics or received by Tri County Orthopaedics from other healthcare providers.

We are required to provide you with notice of our legal duties and privacy practices with respect to your protected health information. These legal duties and privacy practices are described in this Notice. Tri County Orthopaedics will abide by the terms of this Notice, or the Notice currently in effect at the time of use or disclosure of your protected health information

Tri County Orthopaedics reserves the right to change the terms of this Notice and to make any new provisions effective for all protected health information that we maintain. Patients will be provided a copy of any revised Notices upon request. An individual may obtain a copy of our current Notice at any time.

Permitted Uses and Disclosures of Your Protected Health Information
Without Consent

Tri County Orthopaedics may use you protected health information, without your written consent or authorization, for certain treatment, payment and healthcare operations. There are certain restrictions on uses and disclosures of treatment records, which include registration and all other records concerning individuals who are receiving, or who at any time have received services for mental illness, development disabilities, and alcoholism or drug dependence. There are also restrictions on disclosing HIV test results.

Treatment may include:

• Providing, coordinating, or managing healthcare services by one or more healthcare provider

• Consultations with other healthcare providers

• Referrals to other providers

• Referral to nursing homes, diagnostic centers, physical therapy or home health
agencies

For example Tri County Orthopaedics may set up an MRI for you and in doing so provide certain healthcare information to that provider

Payment activities may include:

• Activities undertaken by Tri County Orthopaedics to obtain reimbursement for services
provided to you.

• Determining eligibility of benefits or pre-certification of servies..

• Collection activities to obtain payment for services provided to you.

•Reviewing healthcare services with your insurance company to justify medical necessity
of certain servies.

For example Tri County Orthopaedics will submit claims to your insurance company on your behalf. This claim will provide your name, address, diagnosis and services provided to you.

Healthcare operations may include:

• Contacting patient and healthcare providers about treatment options.

• Conducting quality assessment and improvement activites.

• Case management or care coordination.

•Conducting or arranging for medical review, legal services and auditing functions.

For example Tri County Orthopaedics may assess the effectiveness of your treatment by reviewing your outcome, diagnosis and treatment.

Tri County Orthopaedics may contact you, by telephone or mail, to provide appointment reminders. You must notify us if you do not wish to receive appointment reminders or notices about missed appointments.

There are additional situations in which we are permitted or required to use or disclose your protected health information without your consent:
As permitted by law. We may be required to report abuse, neglect, domestic violence or certain physical injuries. We are required to report gunshot wounds or injuries which may have occurred as the result of a crime.
Judicial and Administrative Proceedings. Records may be disclosed pursuant to a lawful court order or subpoena.
For activities related to death. We may disclose information in order to complete a medical certificate or investigation of death.
For workers compensation. We may disclose information as reasonably related to any injury for which workers compensation is claimed.

Tri County Orthopaedics will not make any other use or disclosure of your protected health information without your written authorization. You may revoke such authorization at any time, except in the extent that Tri County has taken action in reliance thereon. Any revocation must be in writing.

Your Rights Regarding Your Protected Health Information

You have the right to request that restrictions be placed on certain uses of your protected health information. You must request such a restriction in writing. We do not have to agree to your request but if we do we have to abide by the restriction except in the case of emergency medical treatment or as required by law.

You have the right to review and obtain copies of your health record, with the exception of psychotherapy notes, or information compiled for us in a civil, criminal, or administrative action or proceeding. We may charge a reasonable fee for copying your records.

You have the right to receive confidential communications regarding your health information. You may wish to request that information not be sent to a particular address. The request must be in writing and we will accommodate reasonable request by you.

You have the right to request that we amend portions of your health information as long as the information is maintained by us.
You must submit the request in writing and under certain circumstances the request might be denied.

You may request an accounting of disclosures of your protected health information for the six years prior to the date of the request, beginning with disclosures made after April 14th, 2003. We are not required, however to record disclosures we make pursuant to a signed consent or authorization.

You may request and receive a copy of the Notice, if you had previously received or agreed to receive the Notice electronically.

Any person or patient may make a complaint with Tri County Orthoapedics and /or the Secretary of Health and Human Services if they believe their privacy rights have been violated. To file a complaint with tri County Orthopaedics, please contact the Privacy Officer at the following:

Narinder S. Aujla MD

Tri County Orthopaedics

317 N Mangoustine Ave

Sanford, Fl 32771

Phone: (407) 323-2577

It is the policy of Tri County Orthopaedics that no retaliatory action will be made against any individual who submits or conveys a complaint of suspected or actual non-compliance or violation of the privacy standards.

This Notice of Privacy Practices is effective April 14th, 2003.