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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.

The Health Insurance Portability & Accountability Act of 1996 (“HIPAA”), as amended, is a federal program that requires that all medical records and other individually identifiable health information (“Personal Health information”) used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. HIPAA gives you, the patient, significant rights to understand and control how your Personal Health Information is used. We are required by law to, among other things: (a) maintain the privacy of your Personal Health Information; (b) provide you this notice of our legal duties and privacy practices with respect to your Personal Health Information; and follow the terms of this notice. We reserve the right to change the terms of this NPP and to make any new NPP provisions effective for all Personal Health Information that we maintain. In such cases, we will provide a revised NPP in accordance with law. Failure by us to comply with HIPAA can result in significant penalties.

To better educate you, our patient, we have prepared this explanation of how we are required to maintain the privacy of your Personal Health Information and how we may use and disclose your Personal Health Information. In general, we will use and disclose your medical records only for the purpose of ensuring high quality care and the efficient handling of payment and insurance issues related to that care. The following are uses we will make of your Personal Health Information: 

  • Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. This includes the physical examination, scheduling other exams or appointments with other providers, calling in prescription refills, physician-to-physician discussion for coordination of care and physician to staff discussion for coordination of care. 
  • Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization review. An example of this would be sending a bill to your insurance company for payment. 
  • Health care operations include the business aspects of running our practice on a daily basis. These functions include the entire staff having access to your file to obtain authorization of medications or medical procedures, filing of paperwork, recording phone messages or vitals from your visit, confirming your appointments with our office, scheduling your appointments with our office and obtaining the medical complaint for your visit, writing referrals for other physicians, and dictating notes to an outside source of your visit. 

In the course of fulfilling the foregoing functions, we may find it necessary to share your Personal Health Information with third party “business associates” that perform various activities (for example, billing or transcription services) for our practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your Personal Health Information, we will have a written contract that contains terms that will protect the privacy of your Personal Health Information and that requires our business associate to comply with all requirements of law. In addition to the foregoing uses of your Personal Health Information, we may disclose your Personal Health Information in certain circumstances:

  • Where Required by Law Or For Public Health Activities. We will disclose Personal Health Information when required by federal, state or local law. Examples include providing Personal Health Information to a governmental agency or regulator with health care oversight responsibilities, in cases of abuse or neglect, or in cases of health emergencies such as communicable diseases.
  • For Research. The Virginia Spine Institute has on-going research projects in collaboration with the Spinal Research Foundation or researchers whose work has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your Personal Health Information. In addition, with your written authorization, your Personal Health Information may be used and shared for research purposes in accordance with law, and officials of federal or state government agencies may inspect and photocopy your research record. When the results of the research are published or discussed in conferences, no information will be included that would reveal your identity. While your authorization is voluntary and does not expire, it may be removed by written request to the Privacy Officer identified in this notice at any time. You may rest assured that your authorization will never affect your medical treatment.
  • For Health-Related Benefits or Services. We may use Personal Health Information to provide you with information about health-related benefits and services available to you, or to provide appointment reminders.
  • For Law Enforcement, Regulatory or Legal Proceedings, or Specific Government Functions. We may disclose Personal Health Information in response to a request by proper authority. Examples would be a court order, subpoena, warrant, summons or similar legal process, military or national security concerns, for the protection of the President, or for any other reason required by law.

The following uses and disclosures of your Personal Health Information will be made only with your specific authorization: (i) uses and disclosures for marketing purposes, including subsidized treatment communications; (ii) disclosures would constitute a “sale” of your Personal Health Information under applicable law; and (iii) other uses and disclosures not described in this notice. We may provide certain information to the Spinal Research Foundation (“SRF”). From time to time the SRF may also send you fundraising communications related to spinal care and health, and the SRF may use certain information (name, address, telephone number or e-mail information, age, date of birth, gender, health insurance status, dates of service, department of service information, treating physician information or outcome information) to contact you for the purpose of raising money for the Spinal Research Foundation. You will have the right to opt out of receiving such communications with each solicitation. The money raised will be used to expand and improve the services and programs we provide the community. You are free to opt out of fundraising solicitation, and your decision will have no impact on your treatment or payment for services at Virginia Spine Institute. We reserve the right to update these practices at any given time and the updated practices will be available at our office upon request. We will notify you promptly if we learn of any impermissible use or disclosure of your Personal Health Information that constitutes a breach under controlling law and regulations. 

You have the following rights with respect to your Personal Health Information, which you can exercise by presenting a written request to the Privacy Officer: 

  • You have the right to request a full or partial restriction or limitation on Personal Health Information we use or disclose about you for treatment, payment or health care operations, or that we disclose to someone who may be involved in your care or payment for your care (for example, a family member or close friend). While such requests will generally be honored following written notice to the Privacy Officer, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply (for example, disclosures to your family for significant others). Requests to restrict Personal Health Information uses or disclosures that are legally required, or which are necessary to administer our business, will not be honored. In addition, we reserve the right to reject requests for certain restrictions unless you have paid for services out-of-pocket, in full, and you request that we not disclose Personal Health Information related solely to those services to a health plan.
  • The right to reasonable requests to receive confidential communications of Personal Health Information from us by alternative means or alternative locations. Your request should be as specific as possible, and we reserve the right to reject requests that we cannot meet without undue burden. For example, you can ask that we only contact you at work or by mail. To do so, please contact our Privacy Officer.
  • The right to inspect and copy your Personal Health Information. We may charge you a fee for the costs of copying, mailing or other supplies associated with your request. However, certain types of Personal Health Information will not be made available for inspection and copying. An example would be Personal Health Information collected by us in connection with, or in reasonable anticipation of any claim or legal proceeding.
  • The right to amend your Personal Health Information that you believe is incorrect or incomplete. Such requests must be in writing and must include the reason you believe amendment is warranted. We reserve the right to reject requests to amend Personal Health Information we believe is complete and accurate, was not created by us, is not part of our records, or is not part of the Personal Health Information which you are entitled to inspect and copy. 
  • The right to receive an accounting of disclosures of Personal Health Information, though such accountings will not include disclosures made for treatment, payment, health care operations, for purposes of national security or to law enforcement.
  • The right to obtain a paper copy of this notice from us upon request, as well as a copy of this notice or your Personal Health Information in electronic form if it is readily producible. The electronic copy may be provided to an entity or person you designate in writing. 

This notice is effective as of August 26, 2013, and we are required to abide by the terms of the Notice of Privacy Practices and to make the notice provisions effective for all Personal Health Information that we maintain. We will post and you may request a written copy of the revised Notice of Privacy Practices from this office. You have recourse if you feel that your privacy protections have been violated. You have the right to file a formal, written complaint with our office or with the Department of Health & Human Services, Office of Civil Rights, about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint. 

Please contact us for more information by asking to speak to our Privacy Officer. For written inquires and requests, 

note “Attention Privacy Officer” at: 

Virginia Spine Institute
1831 Wiehle Avenue
Suite 200
Reston, VA 20190 
703.709.1114 
(Fax) 703.709.1117
PrivacyOfficer@spinemd.com

For more information about HIPAA or to file a complaint: 

The U.S. Department of Health & Human Services 
Office of Civil Rights 
200 Independence Avenue, S. W. Washington, D.C. 20201 
(202) 619-0257, or Toll Free: 1-877-696-6775