HIPAA NOTICE OF PRIVACY PRACTICES
Metropolitan Orthotic
Laboratory, Inc.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law.  It also describes your rights to access and control your protected health information. Protected health information (PHI) means any of your written and oral health information, including your demographic data, which can be used to identify you.  This is health information that created or received by your health care provider and that relates to your past, present, or future physical or mental health or condition.

USES AND DISCLOSURES OF  PROTECTED HEALTH INFORMATION

Your PHI may be used and disclosed by your orthotist, our office staff, and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you.
Your PHI will be used, as needed, to obtain payment for your health care services.  This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you.
We may use or disclose, as needed, your PHI in order to support the business activities of this clinic.  These activities include, but are not limited to, quality assessment activities, employee review activities, legal services, licensing, and conducting or arranging for other business activities.
If we decide to sell this practice or merge or combine with another practice, we may share your PHI with the new owners.

Uses and Disclosures of PHI Based Upon Written Authorization

Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below.  You may revoke your authorization at any time in writing.  You understand that we cannot take back any use or disclosure we may have made under the authorization before we received your written revocation, and that we are required to maintain a record of the medical care that has been provided to you.
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.

Uses and Disclosures of PHI Permitted Without Written Authorization

We may use or disclose your PHI in the following situations without your authorization or the opportunity to object:
· To the extent that the use or disclosure is required by federal, state, or local law
- For public health activities and purposes to a public health authority that is permitted by law to collect or receive the information
· If authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition
· To a health oversight agency for activities authorized by law, such as audits, investigations, and inspections
· To a public health authority that is authorized by law to receive reports of child abuse or neglect
· As required by military command authorities, if you are a member of the military
· To a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, or track products
· In the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized ), in certain conditions in response to a subpoena, discovery request, or other lawful process
· For law enforcement purposes, so long as applicable legal requirements are met
· To a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law
· Under certain circumstances, 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
· Consistent with applicable federal and state laws, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public
· Of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities, (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service
· To comply with workers’ compensation laws and other similar legally-established programs that provide benefits for work-related illnesses and injuries
· If you are an inmate of a correctional facility.

Under the law, we must make disclosures to you and when required by the Secretary of the Department 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.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

· You have the right to inspect and copy your PHI.
· You have the right to a restriction of your PHI.
· You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
· You may have the right to have your orthotist amend your PHI.

We may deny any request that is not in writing or does not state a reason supporting the request.  We may deny you request for an amendment of any information that:
1. Was not created by us, unless the person that created the information is no longer available to amend the information;
2. Is not part of the PHI kept by or for us;
3. Is not part of the information you would be permitted to inspect or copy; or
4. Is accurate and complete.

· You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI.
· You have the right to obtain a paper copy of this notice from us.

COMPLAINTS

You may complain to us or to the Security of Health and Human Services if you believe your privacy rights have been violated by us.  You may file a complaint with us by notifying our privacy contact of your complaint.  We will not retaliate against you in any way for filing a complaint, either with us or with the Secretary.

CHANGES TO THIS NOTICE

We reserve the right to change the privacy practices that are described in the Notice of Privacy Practices. We also reserve the right to apply these changes retroactively to PHI received before the change in privacy practices.  You may obtain a revised Notice of Privacy Practices by calling the office and requesting a revised copy be sent in the mail, asking for one at the time of your next appointment, or accessing our website.


All requests, complaints, comments, or questions should be directed to :
                                Debby Merritt, Business Manager
                                (612) 879-9000
                                debby@metro-ortho.com

                                Metropolitan Orthotic Laboratory, Inc.
                                2800 Chicago Ave. S LL05
                                Minneapolis, MN 55407