THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED, DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Hand to Shoulder Center of Wisconsin may use and disclose your protected health information for purposes that are permitted or required by law. This Notice of Privacy Practices will provide you with information about our responsibilities concerning the use and disclosure of your protected health information, how your protected health information may be used or disclosed, and your rights regarding your protected health information.
These privacy practices will be followed by:
- All of our health care professionals who care for you at any one of our locations.
- All locations, departments and units that are a part of our organization and staffed by our workforce, regardless of geographical location.
- All members of our workforce including employees, medical staff and students.
Hand to Shoulder Center of Wisconsin is required by law to:
- Maintain the privacy and security of your protected health information.
- Abide by the terms of this notice and provide you with a copy.
- Inform you when a breach occurs that may have compromised the privacy or security of your protected health information.
- Not use or share your information other than described in this Notice unless authorized by you in writing. Any changes to your authorization must be submitted in writing.
Hand to Shoulder Center of Wisconsin reserves the right to change the terms of this Notice and make the new provisions effective for all protected health information that it maintains. We also reserve the right to change the terms of this notice with respect to any applicable limited uses and disclosures. The revised Notice of Privacy Practices will be posted at our facilities, on our website at https://handtoshoulderwisconsin.com and is also available upon request.
Uses and Disclosures of Protected Health Information
Hand to Shoulder Center of Wisconsin is permitted by the federal privacy rule to use or disclose your protected health information for treatment, payment or healthcare operations. Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, pay your health care bills, support the operation of the physician’s practice and any other use required by law. Your medical record may be a combination of paper and electronic records.
Treatment – We may use or disclose your protected health information in the provision, coordination or management of your health care and any related services. For example, your information may be shared with another physician to assist with diagnosis for your condition.
Payment – Your protected health information will be used, as needed, to obtain reimbursement for the health care services you received. For example we may give information about you to your health insurance plan or other responsible party to receive payment for the treatment and services provided.
Healthcare Operations – We can use and share your protected health information to support business activities of our practice and improve the quality or cost of your care. Examples include, but are not limited to: evaluation of patient care services, evaluating the performance of health care providers, training of medical students, activities relating to compliance with the law, business planning or development or evaluation of billing services.
Other Permitted and Required Uses and Disclosures – Hand to Shoulder Center of Wisconsin may use or disclose your protected health information in the following situations without your authorization:
- Helping with public health issues (preventing disease, product recalls, reporting medication reactions, reporting abuse, neglect, or domestic violence, preventing threats to anyone’s health or safety)
- Complying with the law (state or federal law, including the Department of Health and Human Services to show our compliance)
- Responding to organ and tissue donation requests
- Working with a medical examiner or funeral director
- Addressing worker’s compensation, law enforcement, and other government requests (including health oversight agencies, military and national security)
- Responding to lawsuits and legal actions or proceedings
Notification and Communication With You and With Your Family/Friends – We may use your information to assist in communicating with you about appointment reminders, test results, and treatment information. Our communications to you may be by telephone, cell phone, email, patient portal, or mail. If you are able and available to agree or object, we will give you the opportunity prior to making any notifications to your family, friends, or others involved in your care. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communicating with your family and friends.
Authorizations – Except for the situations listed above and for treatment, payment, or healthcare operation purposes, the use or disclosure of your protected health information will be made only with your authorization. If you sign an authorization form, you may withdraw your authorization at any time as long as your withdrawal is in writing except to the extent that our facility has taken action in reliance on the use or disclosure indicated in the authorization.
You have the right to inspect or obtain an electronic or paper copy of your health care record. This request must be submitted in writing to our Medical Records Department and may not apply to certain types of psychotherapy notes. Hand to Shoulder Center of Wisconsin may charge a reasonable fee for a copy of your health care records.
You have the right to request an amendment to your health care record if you believe your health information is incorrect or incomplete. You may be asked to make this request in writing and state the reason why your health record should be changed. If Hand to Shoulder Center of Wisconsin did not create the health information you believe is incorrect, or if our facility disagrees with you, we may deny your request.
You have the right to request Hand to Shoulder Center of Wisconsin communicate to you in a specific way or send mail to a different address. We will say “yes” to all reasonable requests.
You have the right to ask us not to use or share certain health information for treatment, payment or healthcare operations. We are not required to agree to your request, and may deny it if it would affect your care. If you pay for a service out-of-pocket in full, you can ask us not to share your protected health information with your health insurance. We will say “yes” unless we are required by law to share the information.
You have the right to an accounting of disclosures of your protected health information that Hand to Shoulder Center of Wisconsin has made in compliance with state and federal law for six years prior to the date requested. The accounting will include all disclosures except for those about treatment, payment, healthcare operations and certain other disclosures (ones you requested). The accounting will describe the dates of each disclosure, a brief description of information disclosed, the employee disclosing and the reason for disclosure. You will receive one accounting per year at no charge. However, Hand to Shoulder Center of Wisconsin may charge you a reasonable fee for each subsequent request.
You have the right to obtain a paper copy of the Notice of Privacy Practices upon request. For example, if you received the Notice of Privacy Practices electronically, you may also request that Hand to Shoulder Center of Wisconsin provide a paper copy of the Notice of Privacy Practices.
You have the right to have someone make choices about your health information (power of attorney for healthcare or legal guardian). Hand to Shoulder Center of Wisconsin will confirm this person has authority and can act for you before we take any action.
Patient Complaint Process
If you believe your privacy rights have been violated, you may file a complaint with Hand to Shoulder Center of Wisconsin or with the U.S. Department of Health and Human Services Office for Civil Rights. There will be no retaliation against you for filing a complaint.
Question or Concerns
If you have any questions or concerns regarding your privacy rights or the information in this notice, please contact Hand to Shoulder Center of Wisconsin’s Privacy Officer.
Hand to Shoulder Center of Wisconsin
2323 North Casaloma Drive
Appleton, WI 54913
Phone: (920) 730-8833
Fax: (920) 738-1974
Email: [email protected]
Effective Date: This Notice of Privacy Practices is effective 8/1/2012, Revised 3/10/2017, 12/29/2020.