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.
1. Our Commitment to Your Privacy
DF Ortho MD is committed to protecting the privacy of your health
information. We are required by law to:
- Maintain the privacy of your protected health information (PHI)
-
Provide you with this Notice of our legal duties and privacy practices
- Notify you following a breach of your unsecured PHI
-
Follow the duties and privacy practices described in this Notice
2. Uses and Disclosures of Your PHI
We may use and disclose your PHI for the following purposes without your
written authorization:
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your
health care and any related services. For example:
-
Sharing information with other physicians, nurses, or staff involved
in your care
- Consulting with specialists regarding your treatment
-
Coordinating care with physical therapists or rehabilitation services
- Referring you to other healthcare providers
Payment
We may use and disclose your PHI to bill and receive payment for
treatment and services. For example:
- Submitting claims to your insurance company
-
Providing information to your health plan for prior authorization
- Responding to requests from your insurance company
-
Providing billing information to collection agencies (with your
consent)
Healthcare Operations
We may use and disclose your PHI for our healthcare operations, which
include:
- Quality assessment and improvement activities
- Employee review and training programs
- Medical review and compliance activities
- Business planning and development
- Investigations and audits
Other Permitted Uses and Disclosures
We may also use or disclose your PHI for:
-
Public Health Activities: Reporting diseases,
injuries, births, deaths, or suspected abuse/neglect
-
Victims of Abuse, Neglect, or Domestic Violence:
Reporting to government authorities as required
-
Health Oversight Activities: Investigations,
inspections, or audits by health oversight agencies
-
Judicial and Administrative Proceedings: Responding
to court orders, subpoenas, or other legal processes
-
Law Enforcement: Responding to law enforcement
requests as permitted or required by law
-
Coroners, Medical Examiners, and Funeral Directors:
Identifying decedents or determining cause of death
-
Organ and Tissue Donation: Sharing with organ
procurement organizations
-
Research: Under an IRB waiver or with your written
authorization
-
To Avert a Serious Threat to Health or Safety: When
necessary to prevent a serious threat
-
Military Activity and National Security: When
required by military command or national security authorities
-
Workers' Compensation: Processing workers'
compensation claims
-
Inmates: If you are an inmate of a correctional
institution
3. Uses and Disclosures Requiring Your Authorization
We must obtain your written authorization before using or disclosing
your PHI for:
-
Most uses and disclosures of psychotherapy notes (if maintained)
- Marketing purposes (except in limited circumstances)
- Sale of PHI (receiving remuneration for the disclosure)
- Any other use or disclosure not described in this Notice
You may revoke an authorization at any time, in writing, except to the
extent that we have already acted based on your authorization.
4. Your Rights Regarding Your PHI
You have the following rights regarding your PHI:
Right to Access
You have the right to inspect and obtain a copy of your PHI in a
designated record set. We may charge a fee for the cost of copying,
mailing, or electronic transmission.
Response Time: Within 30 days of your request
Right to Amend
You have the right to request an amendment to your PHI if you believe
it is incorrect or incomplete. We may deny your request under certain
circumstances.
Response Time: Within 60 days of your request
Right to an Accounting of Disclosures
You have the right to request an accounting of certain disclosures we
have made of your PHI. This does not include disclosures made for
treatment, payment, or healthcare operations.
Response Time: Within 60 days of your request
Right to Request Restrictions
You have the right to request restrictions on certain uses and
disclosures of your PHI. However, we are not required to agree to a
restriction unless you are requesting a restriction on disclosure to a
health plan and you have paid in full for the service.
Right to Request Confidential Communications
You have the right to request that we communicate with you in a
certain way or at a certain location. For example, you may request
that we contact you only at work or by mail.
Right to a Paper Copy of This Notice
You have the right to receive a paper copy of this Notice at any time,
even if you have agreed to receive it electronically.
Right to Be Notified of a Breach
You have the right to be notified if there is a breach of your
unsecured PHI.
5. Changes to This Notice
We reserve the right to change this Notice and make the new provisions
effective for all PHI we maintain. We will post a copy of the current
Notice in our office and on our website. The Notice will contain the
effective date on the first page.
6. Complaints
If you believe your privacy rights have been violated, you may file a
complaint with us or with the Secretary of the U.S. Department of Health
and Human Services:
Office for Civil Rights, U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
Toll-free: 1-800-368-1019
TDD: 1-800-537-7697
You will not be penalized or retaliated against for filing a
complaint.
7. Contact Information
For questions about this Notice or to exercise your rights, please
contact our Privacy Officer:
8. Effective Date
This Notice is effective as of April 23, 2026.
Acknowledgment
We are required by law to provide you with this Notice and to obtain
your written acknowledgment that you have received it. Our Notice of
Privacy Practices is also available at our office and on our website.