BY ACCESSING OR USING THIS WEBSITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS AND DISCLAIMERS SET FORTH BELOW. IF YOU ARE NOT WILLING TO BE BOUND BY THESE TERMS AND CONDITIONS AND DISCLAIMERS, YOU MAY NOT USE THIS WEBSITE.
The material on this website is copyrighted. It may not be copied without permission of the owner.
You agree to indemnify us against any damages, losses, liabilities, judgments, costs or expenses (including reasonable attorneys' fees and costs) arising from your use of this website, or any breach or violation of this Agreement or any other term or condition contained on this website.
PENINSULA ORTHOPAEDIC ASSOCIATES, PA
Notice to Patients of Privacy Practices
This notice describes how medical information about you may be used and disclosed. We are required by law to protect the privacy of your protected health information. This document also explains how you can gain access to your medical information and whom to contact should you have any complaints. Please read this document carefully and sign the form to acknowledge you have received this notice.
A. The general consent for release of medical records you sign authorizes Peninsula Orthopaedic Associates to disclose the information in your medical record for treatment, payment, and health care operations:
B. You may be asked to sign a specific authorization for release of medical records, which will authorize us to make a specific disclosure that is not covered under section A above. The specific information, the entity to whom it will be disclosed, and the purpose for which it will be used will be documented for your review before signing.
C. You may revoke any consent or authorization provided to us by giving a written notice of revocation.
D. We may be required by law to disclose your records that you have not authorized. Examples of these situations include, but are not limited to, complying with workers compensation laws, receiving a subpoena for the records, or if public responsibility requires disclosure to protect public health. We will keep any disclosures of your medical records to the minimum necessary.
E. Your rights regarding health information about you:
F. We are required by law to maintain the privacy of your protected health information and if you believe that your rights have been violated, you may complain to the Secretary of the U.S. Department of Health and Human Services or complain to us in person, over the phone, or in writing. Please contact our privacy complaints contact person, Susan Calhoun, at our office. We will not retaliate in any way against a patient for making a complaint.
G. We reserve the right to change our privacy practices and to make new policies effective for all protected health information that we maintain. If we should do so, we will issue an updated "notice to patients" to all of our patients.
Form Date 04/14/03
|1675 Woodbrooke Drive Salisbury, MD 21804
(410) 749-4154 Office hours are by appointment from 8 a.m. to 5 p.m. M-F.|