MSK GROUP, PC D/B/A ORTHOSOUTH
NOTICE OF PRIVACY PRACTICES (“NOTICE”)

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. WE CARE ABOUT THE PRIVACY OF YOUR INFORMATION.

YOUR RIGHTS

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information in a timely manner. We may charge a reasonable, cost-based fee.
• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say "no" to your request, but we will tell you why in writing within 60 days.
• You can ask us to contact you in a specific way (e.g., home or office phone) or to send mail to a different address. We will say "yes" to all reasonable requests.
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say "yes" unless a law requires us to share that information.
• You can ask for a list (accounting) of the times we have shared your health information for 6 years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (e.g., any you asked us to make). We will provide one accounting per year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months. To request a list, contact the Privacy Liaison at 901-259-4675.
• You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will provide you with a paper copy promptly.
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for your before we take any action.
• You can complain to OrthoSouth's Privacy Liaison if you feel we have violated your rights by calling 901-259-4675. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

YOUR CHOICES

• Caregivers and Family Involved in Your Care: For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, let us know. Tell us what you want us to do, and we will follow your instructions.
• In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care; and
• Share information in a disaster relief situation.
• If you are not able to tell us your preference, for example, if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
• In these cases, we never share your information unless you give us written permission:
• Marketing purposes;
• Sale of your information; and
• Most sharing of psychotherapy notes. However, OrthoSouth does not create or maintain psychotherapy notes.
• We may contact you for purposes of fundraising. You have a right to refuse to receive these communications. If you do not wish to receive information related to our fundraising, contact the Privacy Liaison at 901-259-4675.

OUR USES AND DISCLOSURES

• Treatment: We can use your health information and share it with other professionals who are treating you. For example, a doctor treating you for an injury asks another doctor about your overall health condition.
• Health Care Operations: We can use and share your health information to run our practice, improve your care, and contact you when necessary. For example, we use health information about you to manage your treatment and services.
• Appointment Reminders, Treatment Alternatives, and Health-Related Services: We can use and disclose your health information to contact you to remind you that you have an appointment for medical care, or to contact you to tell you about possible treatment options, alternatives, or health related benefits and services that may be of interest to you.
• Payment: We can use and share your health information to bill and get payment from health plans or other entities. For example, we give information about you to your health insurance plan so it will pay for your services.
• Public Health: We can share health information about you for certain situations, such as:
• Preventing disease;
• Helping with product recalls;
• Reporting adverse reactions to medications;
• Reporting suspected abuse, neglect, or domestic violence; or
• Preventing or reducing a serious threat to anyone's health or safety.
• Business Associates: We can use trusted service providers and technology vendors, known as business associates, to help us deliver care, document visits, process payments, bill insurance companies, and operate our practice. These business associates are legally required to protect your information and use it only as permitted by law and our agreements with them.
• Research: We can use or share your information for health research.
• Health Information Exchange: We participate in secure electronic Health Information Exchange (HIE) networks, such as Carequality, to support coordination of care, improve treatment decisions, and promote interoperability between healthcare systems. We may securely access your medical information from other participating providers and may share portions of your medical record with them when they are involved in your care. These exchanges are used only to support your treatment and essential healthcare operations, and are conducted in compliance with all applicable federal and state privacy and security laws. You may request restrictions on sharing your information through these exchanges where permitted by law.
• As Required By Law: We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
• Organ and Tissue Donation Requests: We can share health information about you with organ procurement organizations or other organizations engaged in obtaining, banking, or transplanting organs for the purpose of aiding organ donation and transplantation.
• Medical Examiner or Funeral Director: We can share health information with a coroner, medical examiner, or funeral director in the unfortunate event of death.
• Law Enforcement: We can use or share health information about you:
• For law enforcement purposes or with a law enforcement official;
• With health oversight agencies for activities authorized by law; and
• For special government functions, such as military, national security, and presidential protective services.
• Emergency: We can share your health information if you need emergency treatment or if we are required by law to treat you, but we are unable to obtain your consent. If this happens, we will try to obtain your consent as soon as reasonably possible after we treat you.
• Minors: We can disclose the PHI of minor children to their parents or guardians unless such disclosure is otherwise prohibited by law.
• Legal Proceedings: We can share health information about you in response to a court or administrative order, or in response to a subpoena.
• Workers Compensation: We may use or disclose PHI for workers' compensation or similar programs that provide benefits for work-related injuries or illness.

OUR RESPONSIBILITIES

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this Notice and give you a copy of it.
• We will not use or disclose your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
• We can change the terms of this Notice and the changes will apply to all information we have about you. The new Notice will be available upon request and on our website.

Special Protections for HIV, Alcohol and Substance Abuse, Mental Health, and Genetic Information

Special privacy protections apply to HIV-related information, mental health, and genetic information. Some parts of the general Notice of Privacy Practices may not apply to these kinds of PHI. For example, if we give you a test to determine if you have been exposed to HIV, we will not disclose the fact that you have taken the test to anyone without your written consent unless otherwise required by law.

If we receive or keep information about you from a substance use disorder treatment program covered by 42 CFR Part 2 (called a "Part 2 Program") through a general consent you gave that program for treatment, payment, and/or health care operations, we may use and share your record for those same purposes as explained in this Notice, except for uses and disclosures for civil criminal administrative, and legislative proceedings against you. We will never use or share your Part 2 Program record, or any testimony about what is in your Part 2 Program record, in any civil, criminal, administrative, or legislative proceeding by any federal, state, or local authority against you, unless you give written permission or a court issues an order after notifying you.