Notice of Privacy Practices

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.

Privacy Contact

Practice Manager
Metro Foot & Ankle, P.C.
3231 S Country Club Way, Suite 108, Tempe, AZ 85282
Phone: 480-831-0700 | Fax: 480-831-0748
www.metrofootandankle.com

Your Rights

• Inspect or obtain an electronic or paper copy of your medical record and other health information we maintain about you. We generally respond within 30 days; a permitted extension may apply. A reasonable, cost-based fee may be charged when allowed by law.
• Ask us to amend health information you believe is incorrect or incomplete. We may deny the request in circumstances permitted by law and will explain a denial in writing.
• Ask us to communicate with you in a reasonable alternative way or at a different location.
• Ask us to restrict certain uses or disclosures. We are not required to agree to every request. If you pay in full out-of-pocket for an item or service, you may ask us not to disclose that information to your health plan for payment or health care operations when the law permits the restriction.
• Receive an accounting of certain disclosures of your health information made during the six years before your request.
• Receive a paper copy of this Notice at any time, including when you agreed to receive it electronically.
• Have a legally authorized personal representative exercise your privacy rights, after we verify that person’s authority.
• Complain to us or to the U.S. Department of Health and Human Services if you believe your privacy rights were violated. We will not retaliate against you for making a complaint.

Your Choices

When applicable, you may tell us how you want us to share information with family members, friends, or others involved in your care or payment for your care, and in disaster-relief situations. If you cannot tell us your preference, we may use professional judgment and applicable law to act in your best interests or to address a serious and imminent threat.

• We generally need your written authorization for most uses of psychotherapy notes, most marketing uses, and any sale of protected health information.
• If you authorize a use or disclosure, you may revoke that authorization in writing, except to the extent we already relied on it.
• We do not currently conduct fundraising using protected health information. If that changes, we will provide any notice and opt-out rights required by law.

How We May Use and Disclose Your Health Information

Treatment: We may use and disclose health information to physicians, hospitals, laboratories, pharmacies, therapists, suppliers, and other professionals involved in your treatment or coordination of care.

Payment: We may use and disclose information to bill you, your health plan, Medicare, Medicaid, workers’ compensation programs, or other responsible payers and to obtain payment or coverage determinations.

Health care operations: We may use and disclose information to operate the practice, improve quality, train staff, conduct audits, manage risk, perform credentialing, arrange business services, and contact you about your care.

Business associates: We may share information with vendors and contractors that perform services for us when appropriate safeguards and required agreements are in place.

People involved in your care: When permitted, we may share relevant information with a family member, friend, caregiver, or other person involved in your care or payment for your care, consistent with your preferences and applicable law.

Required or permitted by law: We may disclose information for public health and safety activities, health oversight, reports of suspected abuse or neglect, organ and tissue donation, coroners and funeral directors, workers’ compensation, certain law-enforcement and government functions, research permitted by law, and judicial or administrative proceedings when legal requirements are met.

Averting a serious threat: We may use or disclose information when permitted by law to prevent or lessen a serious and imminent threat to health or safety.

Specially Protected Information

Substance use disorder records. If we maintain records protected by 42 CFR Part 2, we will not use or disclose information from those records in a civil, criminal, administrative, or legislative investigation or proceeding against you unless you provide written consent or the disclosure is supported by the court process required by Part 2. Additional Part 2 restrictions and consent rules apply.

Arizona confidentiality protections. Arizona law may impose additional limits on the disclosure of medical and payment records and on certain categories of information, including communicable-disease-related information, behavioral health information, and genetic testing information. When Arizona or another applicable law is more protective than HIPAA, we will follow the more protective requirement.

Other uses and disclosures. Uses or disclosures not described in this Notice will be made only with your written authorization unless another law permits or requires them.

Our Responsibilities

• We are required by law to protect the privacy and security of protected health information and to follow the duties and privacy practices described in the Notice currently in effect.
• We will provide legally required notification if a breach compromises the privacy or security of your protected health information.
• We will not retaliate against you for exercising a privacy right or filing a complaint.
• We may change this Notice. A revised Notice may apply to information we already have and information we receive later. The current Notice will be available in our office, on our website, and upon request.

Questions or Complaints

Contact the Practice Manager at 480-831-0700 or write to Metro Foot & Ankle, P.C., 3231 S Country Club Way, Suite 108, Tempe, AZ 85282. You may also file a HIPAA privacy complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201; telephone 1-877-696-6775; or through the HHS Office for Civil Rights complaint resources at www.hhs.gov/hipaa/filing-a-complaint.

Website note: Please do not send protected health information, medical records, or clinical images through this website. Call the office to discuss anything clinical.