NOTICE OF PRIVACY PRACTICES
For DJO, LLC
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
If you have any questions about this Notice please contact
our Privacy Officer: Dale Hammer (800) 551-6911 Ext. 4742
DJO, LLC is committed to protecting your privacy and understands
the importance of safeguarding your medical information. We are required by
federal law to maintain the privacy of health information that identifies
you or that could be used to identify you (known as "Protected Health
Information" or "PHI"). We also are required to provide you
with this Notice of Privacy Practices, which explains our legal duties and
privacy practices, as well as your rights, with respect to PHI that we collect
and maintain. DJO, LLC is required by federal law to abide by this Notice.
However, we reserve the right to change the privacy practices described in
this Notice and make the new practices effective for all PHI that we maintain.
Should we make such a change, you may obtain a revised Notice by calling our
office and requesting a revised copy be sent in the mail, or accessing our
website at www.djortho.com.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
A. Routine Uses and Disclosures of Protected Health Information
We are permitted under federal law to use and disclose PHI,
without your written authorization, for certain routine uses and disclosures,
such as those made for treatment, payment, and the operation of our business.
The following are examples of the types of routine uses and disclosures of
PHI that we are permitted to make. While this list is not exhaustive, it should
give you an idea of the routine uses and disclosures we are permitted to make.
For Treatment: We will use and disclose your PHI
to provide, coordinate, or manage your treatment. For example, we will disclose
your PHI, as necessary, to the physician that referred you to us.
For Payment: Your PHI will be used, as needed,
to obtain payment for the health care services we provide you. For example,
we may tell your health plan about an orthotic device you will receive to
determine whether your plan will cover the device.
For Health Care Operations: We may use or disclose
your PHI in order to support the business activities of this facility. These
activities include, but are not limited to, quality assessment, employee review,
legal services, licensing, and conducting or arranging for other business
activities.
Treatment Alternatives: We may use or disclose
your PHI or contact you to provide you with information about treatment alternatives
or other health-related benefits and services that may be of interest to you.
Sale of the Business: If we decide to sell, transfer
or merge all or part of our business to or with another entity, we may share
your PHI with the new owners.
B. Uses and Disclosures That May Be Made Without Your Authorization
or Opportunity to Object
We may use or disclose your PHI in the following situations
without your authorization or providing you the opportunity to object.
Required by the Secretary of Health and Human Services:
We may be required to disclose your PHI to the Secretary 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.
Required By Law: We may use or disclose your PHI
to the extent that the use or disclosure is otherwise required by federal,
state or local law.
Public Health: We may disclose your PHI for public
health activities, such as disclosures to a public health authority or other
government agency that is permitted by law to collect or receive the information
(e.g., the Food and Drug Administration).
Health Oversight: We may disclose PHI to a health
oversight agency for activities authorized by law, such as audits, investigations,
and inspections. Oversight agencies include government agencies that oversee
the health care system, government benefit programs, other government regulatory
programs and civil rights laws.
Abuse or Neglect: If you have been a victim of
abuse, neglect, or domestic violence, we may disclose your PHI to a government
agency authorized to receive such information. In addition, we may disclose
your PHI to a public health authority that is authorized by law to receive
reports of child abuse or neglect.
Judicial and Administrative Proceedings: We may
disclose your PHI in response to an order of a court or administrative tribunal
(to the extent such disclosure is expressly authorized), and, in certain conditions,
in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may disclose your PHI, so
long as applicable legal requirements are met, for law enforcement purposes,
such as providing information to the police about the victim of a crime.
Coroners and Funeral Directors: We may disclose
your PHI to a coroner, medical examiner, or funeral director if it is needed
to perform their legally authorized duties.
Organ Donation: If you are an organ donor, we
may disclose your PHI to organ procurement organizations as necessary to facilitate
organ donation or transplantation.
Research: Under certain circumstances, we may
disclose your PHI 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.
Serious Threat to Health or Safety: We may disclose
your PHI if we believe it is necessary to prevent a serious and imminent threat
to the public health or safety and it is to someone we reasonably believe
is able to prevent or lessen the threat.
Specialized Government Functions: When the appropriate
conditions apply, may disclose PHI for purposes related to military or national
security concerns, such as for the purpose of a determination by the Department
of Veterans Affairs of your eligibility for benefits.
Workers' Compensation: We may disclose your PHI
as necessary to comply with workers' compensation laws and other similar programs.
Inmates: We may use or disclose your PHI if you
are an inmate of a correctional facility and we created or received your PHI
in the course of providing care to you.
C. Uses and Disclosures That May Be Made Either With Your
Agreement or the Opportunity to Object
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. If you are unable to agree or object to such disclosure, we may
disclose such information as necessary if we determine that it is in your
best interest based on our professional judgment. We may use or disclose your
PHI to notify or assist in notifying a family member, personal representative
or any other person that is responsible for your care of your location or
general condition.
D. Uses and Disclosures of Protected Health Information Based
upon Your Written Authorization
Other uses and disclosures of your PHI, not described above,
will be made only with your written authorization. You may revoke your authorization,
at any time, in writing, except to the extent that we have taken action in
reliance on the authorization.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have certain rights regarding your PHI, which are explained
below. You may exercise these rights by submitting a request in writing to
our Privacy Officer.
A. You have the right to inspect and copy your PHI. If
you would like to see or copy your PHI that is contained in a designated record
set (e.g., medical and billing records), we are required to provide you access
to such PHI for inspection and copying within 30 days after receipt of your
request (60 days if the information is stored off-site). We may charge you
a reasonable fee to cover duplication, mailing and other costs incurred by
us in complying with your request. In addition, there are situations where
we may deny your request for access to your PHI. For example, we may deny
your request if we believe the disclosure will endanger your life or that
of another person. Depending on the circumstances of the denial, you may have
a right to have this decision reviewed.
B. You have the right to request a restriction of your PHI.
This means you may ask us not to use or disclose any part of your PHI for
purposes of treatment, payment or health care operations. You may also request
that any part of your PHI not be disclosed to family members or friends who
may be involved in your care or for notification purposes as described in
this Notice. Your request must state the specific restriction requested and
to whom you want the restriction to apply. We are not required to agree to
a restriction that you may request. If we agree to the requested restriction,
we may not use or disclose your PHI in violation of that restriction unless
it is needed to provide emergency treatment.
C. You have the right to request to receive confidential
communications from us by alternative means or at an alternative location.
We will accommodate reasonable requests. We may also condition this accommodation
by asking you for information as to how payment will be handled or specification
of an alternative address or other method of contact.
D. You have the right to amend your PHI. This means you
may request an amendment of your PHI in our records that is contained in a
designated record set (e.g., medical and billing records) for as long as we
maintain the PHI. We will respond to your request within 60 days (with up
to a 30-day extension if needed). We may deny your request if, for example,
we determine that your PHI is accurate and complete. If we deny your request,
we will send you a written explanation and allow you to submit a written statement
of disagreement.
E. You have the right to receive an accounting of certain
disclosures that we have made of your PHI. You have the right to receive
an accounting of certain disclosures we have made, if any, of your PHI. This
right only applies to disclosures for purposes other than treatment, payment
or health care operations as described in this Notice. It also excludes disclosures
we may have made to you, your family members or friends involved in your care.
The right to receive this information is subject to certain exceptions, restrictions
and limitations. You must specify a time period, which may not be longer than
6 years and cannot include any date before April 14, 2003. You may request
a shorter timeframe. You have the right to one free request within any 12-month
period, but we may charge you for any additional requests in the same 12-month
period. We will notify you about any such charges, and you are free to withdraw
or modify your request in writing before any charges are incurred.
F. You have the right to obtain a paper copy of this notice
from us.
COMPLAINTS
If you believe that we have violated your privacy rights, you
may file a complaint with us by notifying our Privacy Officer in writing at
the following address:
DJO Incorporated
1430 Desicion Street
Vista, CA 92081
Attn: Dale Hammer
We will not retaliate against you in any way for filing a complaint.
You may also submit your complaint to the Secretary of Health and Human Services.
This is a revision to a notice that was first published and effective
April 14, 2003. This notice is effective on October 15, 2004.