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. Download PDF

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share
  • Get a list of those with whom we’ve shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition
  • Provide disaster relief
  • Include you in a hospital directory
  • Provide mental health care
  • Market our services and sell your information
  • Raise funds

Our Uses and Disclosures

We may use and share your information as we:

  • Treat you
  • Run our organization
  • Bill for your services
  • Help with public health and safety issues
  • Do research
  • Comply with the law
  • Respond to organ and tissue donation requests
  • Work with a medical examiner or funeral director

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of you medical record

  • 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 t
  • We will provide a copy or a summary of your health information, usually within 30 days of your

Request.  We may charge a reasonable, cost-based fee.

Ask us to amend your medical record

  • You can ask us to amend health information about you that you think is incorrect or inco  Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 day

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different addr
  • We will say ‘”yes” to all reasonable request

Ask us to limit what we use or share

  • 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 car
  • 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.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and wh
  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting per year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this notice.  You can ask for a paper copy of this notice at any time.

Choose someone to act for you

  • If you haven’t 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 ensure the person has this authority before we take any action.

Your Choices

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, talk to us. 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
  • Share information in a disaster relief situation

If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest.  We may also share information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share our information unless you give us written permission:

  • Marketing purposes    Most sharing of psychotherapy notes   •    Sale of your information

In the case of fundraising we may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

We typically use or share your health information in the following ways.

We can use your health information and share it with other professionals who are treating you.

We can use and share your health information lo run our practice, improve your care, and contact you when necessary. We can use and share your health information to bill and get payment from health plans or other entities.

Electronic Exchange. Your information may be shared w/ other providers, labs and radiology groups through our EHR system as listed:

eClinical Works, LLC

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to

the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see:

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease   Preventing or  reducing a serious threat to anyone’s health or safety
  • Helping with product recalls  Reporting  suspected abuse, neglect or domestic violence
  • Reporting adverse reactions to medications

Do research.  Comply with the law.  Respond to organ and tissue donation requests.  Work with medical examiner or funeral director

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’re complying with federal privacy law.

We can use or share health information about you:

For workers’ compensation claims   •  For law enforcement purposes or with a law enforcement official

  • With health oversight agencies for activities authorized by law
  • For special government functions as military, national security, and presidential protective services
  • Respond to lawsuits and legal actions

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 describe d in this notice and give you a copy of it.
  • We will not use or share 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:

Changes to the Terms of this Notice

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, in our office, and on our website.

You Have A Right To File A Complaint If You Feel Your Privacy Has Been Violated

  • If you feel your Privacy Rights have been violated, please ask our staff for a Privacy Complaint Form. Our Security Officer will review the form and promptly notify you of the actions our office will t
  • or You can file a complaint with the S. Department of Health and Human Service Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201; calling 1-877-696-6775;

Or by visiting

  • We will not retaliate against you for filing a complain

Bay Area Orthopaedic Specialists, LLC

HIPAA Compliance Officer: Cherie Carter

Phone:  727 – 209 – 6677

This Notice of Privacy Practices is effective February1, 2018

Notice Informing Individuals About Nondiscrimination and Accessibility Requirement s

Bay Area Orthopaedic Specialists, LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, co lo r, national origin , age, disability, or sex. Our practice does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Bay Area Orthopaedic Specialists, LLC, provides at no cost aids and services to people with disabilities to communicate effectively with us,   such as: qualified sign language interpreters, written in formation in other formats (large print, audio, accessible elec. formats, other formats). Provides at no cost language services to people whose primary language is not English, such as: qualified interpreters; information written in other languages. If you need these services please tell our front desk or any staff member.

If you believe our practice has failed to provide these services or discriminated in another way on the basis of race , co lo r, national origin , age, disability, or sex, you can file a grievance with: Civil Rights Coordinator: Cherie Carter, 4820 Park Blvd N, Pinellas Park, Florida 33781 , 727-209-6677. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services , Office for Civil Rights, electronic ally through the Office for Civil Rights Comp lain t Portal, available at,  or by mail or pho ne at: U.S. Department of Health and Human Services 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201. 1 -800-368-1 019, 800-537-7697

(TDD) Complaint forms are available at filing-a-complaint/index.html

Proficiency of Language Assistance Services

ATTENT ION: If you s peak any of the language s below, language assistance services, free of charge, are available to you. ATENC ION: si habla espanol, tiene a su disposicion se rvicios gratuitos de asistencia linguistica. Llame al.

CH U Y: Neu ban noi Tieng Viet. co cac dich vu ho tro ngon ngu mien phi danh cho ban. Goi so.

PA UNA WA: Kung nagsasalita ka ng Tagalog , maaari kang gumamit ng mga serbis yo ng tulong sa wika nang walang bayad. Tumawag sa

ATANSYON : Si w pale Kreyol Ay isyen, gen sevis ed pou lang ki disponib gratis pou ou. Rele.

ATTENTION : Si vous parlez francais, des services d’aide linguistique vous sont proposes gratuitement. Appelez le.

UWAGA: Jezeli mowisz po polsku, mozesz skorzystac z bezplatnej pomocy jezykowej. Zadzwon pod Numer.

ATENCAO: Se fala portugues, encontram-se disponiveis servicos linguisticos, gratis. Ligue para.

ATTENZ IONE: In caso la lingua parlata sia l’italiano , sono disponibil i serviz i di ass istenza linguistica gra tuiti. Chiamare il nu me ro.

CHTUNG : Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche.