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Notice of
Privacy Practices Effective April 14, 2003
As required by the Privacy Regulations
created as a result of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA)
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Our
Commitment to Your Privacy
Our practice is dedicated to maintaining the
privacy of your protected health information
(PHI). In conducting our business, we will
create records regarding you and the
treatment and services we provide to you. We
are required by law to maintain the
confidentiality of health information that
identifies you. We are also required by law
to provide you with this notice of our legal
duties and the privacy practices that we
maintain in our practice concerning your
PHI. By federal and state law, we must
follow the terms of the notice of privacy
practices that we have in effect at the
time.
We realize that these laws are complicated,
but we must provide you with the following
important information:
•
How we may use and disclose your PHI
•
Your privacy rights in your PHI
•
Our obligations concerning the use and
disclosure of your PHI
The terms of this notice apply to all
records containing your PHI that are created
or retained by our practice. We reserve the
right to revise or amend this Notice of
Privacy Practices. Any revision or amendment
to this notice will be effective for all of
your records that our practice has created
or maintained in the past, and for any of
your records that we may create or maintain
in the future. Our practice has a copy of
our current notice posted in our office in a
visible location at all times, and you may
request a copy of our most current notice at
any time. |
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Uses and
Disclosures of Protected Health Information
(PHI)
1. TREATMENT. Our practice may use
your PHI to treat you. For example, we may
ask you to have laboratory tests, and we may
use the results to help us reach a
diagnosis. We might use your PHI in order to
write prescriptions for you, or we might
disclose your PHI to a pharmacy when we
order a prescription for you. Many of the
people who work for our practice –
including, but not limited to, our doctors –
may disclose your PHI in order to treat you
or to assist others in your treatment.
Additionally, we may disclose your PHI to
others who may assist in your care, such as
your spouse, children or parents. Finally,
we may also disclose your PHI to other
health care providers for purposes related
to your treatment.
2. PAYMENT. Our practice may use and
disclose your PHI in order to bill and
collect payment for the services and items
you receive from us. For example, we may
contact your health insurer to certify that
you are eligible for benefits, and we may
provide your insurer with details regarding
your treatment to determine if your insurer
will cover, or pay for, your treatment. We
also may use and disclose your PHI to obtain
payment from third parties that may be
responsible for such costs, such as family
members. Also, we may use your PHI to bill
you directly for services and items. We may
disclose your PHI to other health care
providers and entities to assist in their
billing and collection efforts.
3. HEALTH CARE OPERATIONS. Our
practice may use and disclose your PHI to
operate our business. As examples of the
ways in which we may use and disclose your
information for our operations, our practice
may use your PHI to evaluate the quality of
care you received from us or to conduct
cost-management and business planning
activities for our practice. We may disclose
your PHI to other health providers and
entities to assist in their health care
operations.
4. DISCLOSURES REQUIRED BY LAW. Our
practice will use and disclose your PHI when
we are required to do so by federal, state
or local law. |
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Uses and
Disclosure of Your PHI in Certain Special
Circumstances
The following categories describe unique
scenarios in which we may use or disclose
your identifiable health information:
1. PUBLIC HEALTH RISKS. Our practice
may disclose your PHI to public health
authorities that are authorized by law to
collect information for the purposes of
reporting certain situations. For example:
abuse or neglect, communicable diseases or
Food and Drug Administration requirements.
2. HEALTH OVERSIGHT ACTIVITIES. Our
practice may disclose your PHI to a health
oversight agency for activities authorized
by law. Oversight activities can include,
for example, investigations, inspections,
audits, surveys, licensure and disciplinary
actions; civil, administrative and criminal
procedures or actions; or other activities
necessary for the government to monitor
government programs, compliance with civil
rights laws and the health care system in
general.
3. LAWSUITS AND SIMILAR PROCEEDINGS.
Our practice may use and disclose your PHI
in response to a court or administrative
order, if you are involved in a lawsuit or
similar proceeding. We also may disclose
your PHI in response to a discovery request,
subpoena or other lawful process by another
party involved in the dispute, but only if
we have made an effort to inform you of the
request or to obtain an order protecting the
information the party has requested.
4. LAW ENFORCEMENT. We may release
PHI if asked to do so by a law enforcement
official. For example in response to a
warrant, summons, court order, subpoena or
similar legal process.
5. DECEASED PATIENTS. Our practice
may release PHI to a medical examiner or
coroner to identify a deceased individual or
to identify the cause of death. If
necessary, we also may release information
in order for funeral directors to perform
their jobs.
6. ORGAN AND TISSUE DONATION. Our
practice may release your PHI to
organizations that handle organ, eye or
tissue procurement or transplantation,
including organ donation banks, as necessary
to facilitate organ or tissue donation and
transplantation if you are an organ donor.
7. SERIOUS THREATS TO HEALTH AND SAFETY.
Our practice may use and disclose your PHI
when necessary to reduce or prevent a
serious threat to your health and safety or
the health and safety of another individual
or the public. Under these circumstances, we
will only make disclosures to a person or
organization able to help prevent the
threat.
8. MILITARY. Our practice may
disclose your PHI if you are a member of the
U.S. or foreign military forces (including
veterans) and if required by the appropriate
authorities.
9. NATIONAL SECURITY. Our practice
may disclose your PHI to federal officials
for intelligence and national security
activities authorized by law.
10. INMATES. Our practice may
disclose your PHI to correctional
institutions or law enforcement officials if
you are an inmate or under the custody of a
law enforcement official.
11. WORKER’S COMPENSATION. Our
practice may release your PHI for Worker’s
Compensation programs. |
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Your Rights
Regarding Your PHI
You have the following rights regarding the
PHI that we maintain about you:
1. CONFIDENTIAL COMMUNICATIONS. You
have the right to request that our practice
communicate with you about your health and
related issues in a particular manner or at
a certain location. In order to request a
type of confidential communication, you must
make a written request to: Richard T.
Dauphine, M.D., Inc., Attn: Privacy Officer,
980 Cass Street, Monterey, CA 93940,
specifying the requested method of contact
or the location where you wish to be
contacted. Our practice will accommodate
reasonable requests. You do not need to give
a reason for your request.
2. REQUESTING RESTRICTIONS. You have
the right to request a restriction in our
use or disclosure of your PHI for treatment,
payment or health care operations.
Additionally, you have the right to request
that we restrict our disclosure of your PHI
to only certain individuals involved in your
care or the payment of your care, such as
family members and friends. We are not
required to agree to your request; however,
if we do agree, we are bound by our
agreement except when otherwise required by
law, in emergencies or when the information
is necessary to treat you. In order to
request a restriction in our use or
disclosure of your PHI, you must make your
request in writing to Richard T. Dauphine,
M.D., Inc., Attn: Privacy Officer, 980 Cass
Street, Monterey, CA 93940. Your request
must describe in a clear and concise fashion
the information you wish restricted; whether
you are requesting to limit our practice’s
use, disclosure or both; and to whom you
want the limits to apply.
3. INSPECTION AND COPIES. You have
the right to inspect and obtain a copy of
the PHI that may be used to make decisions
about you, including patient medical records
and billing records, but not including
psychotherapy notes. You must submit your
request in writing to: Richard T. Dauphine,
M.D., Inc., Attn: Privacy Officer, 980 Cass
Street, Monterey, CA 93940 in order to
inspect and/or obtain a copy of your PHI.
Our practice may charge a fee for the costs
of copying, mailing, labor and supplies
associated with your request. Our practice
may deny your request to inspect and/or copy
in certain limited circumstances; however
you may request a review of our denial.
4. AMENDMENT. You may ask us to amend
your health information if you believe that
it is incorrect or incomplete, and you may
request an amendment for as long as the
information is kept by or for our practice.
To request an amendment, your request must
be made in writing and submitted to: Richard
T. Dauphine, M.D., Inc., Attn: Privacy
Officer, 980 Cass Street, Monterey, CA
93940. You must provide us with a reason
that supports your request for amendment.
Our practice will deny your request if you
fail to submit your request (and the reason
supporting your request) in writing. Also,
we may deny your request if you ask us to
amend information that is in our opinion (a)
accurate and complete; (b) not part of the
PHI kept by and for the practice; (c) not
part of the PHI which you would be permitted
to inspect or copy; or (d) not created by
our practice, unless the individual or
entity that created the information is not
available to amend the information.
5. RIGHT TO A PAPER COPY OF THIS NOTICE.
You are entitled to receive a paper copy of
our notice of privacy practices. You may ask
us to give you a copy of this notice at any
time.
6. RIGHT TO FILE A COMPLAINT. If you
believe your privacy rights have been
violated, you may file a complaint with our
practice or with the Secretary of the
Department of Health and Human Services. To
file a complaint with our practice, contact:
Richard T. Dauphine, M.D., Inc., Attn:
Privacy Officer, 980 Cass Street, Monterey,
CA 93940. All complaints must be submitted
in writing. You will not be penalized for
filing a complaint.
7. RIGHT TO PROVIDE AN AUTHORIZATION FOR
OTHER USES AND DISCLOSURES. Our practice
will obtain your written authorization for
uses and disclosures that are not identified
by this notice or permitted by applicable
law. Any authorization you provide to us
regarding the use and disclosure of your PHI
may be revoked at any time in writing. After
you revoke your authorization, we will no
longer use or disclose your PHI for the
reasons described in the authorization.
Please note we are required to retain
records of your care. |
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DR.
DAUPHINÉ WAS THE FIRST ORTHOPEDIST IN THE MONTEREY
BAY AREA TO OFFER: |
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Operative Arthroscopy
(1976) |
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Comprehensive
Orthopedic/Physical Therapy in one location at the
Monterey Sports Medicine Center (1981) |
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Outpatient Arthroscopic
Meniscus Repair (1983) |
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Outpatient Arthroscopic
Anterior Cruciate Ligament Repair (1983) |
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Outpatient Arthroscopic
Shoulder Rotator Cuff Repair (1996) |
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Minimally Invasive Repicci Partial Knee Replacement (UKA 2001) |
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Outpatient Partial Knee
Replacement (2001) |
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Minimally Invasive
Total Knee Replacement (TKA 2004) |
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Oxford Mobile Bearing
Partial Knee Replacement (UKA 2006) |
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ConforMIS iPD
arthroscopic treatment for early osteoarthritis of
the knee (2007) |
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