Patient Privacy Practices (HIPAA) Summary

After filling out the form, you may hand deliver it to any of The Orthopedic Partners locations. The form can also be emailed to medrecords@toportho.com or mailed to the address listed below:

The Orthopedic Partners 
900 Round Valley Drive, Suite 100
Park City, UT 84060

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Patients First: How We Protect Your Privacy

At The Orthopedic Partners, we are committed to providing you with the highest quality of care. An essential part of this commitment is our dedication to protecting the privacy and the confidentiality of your medical information.

Our patient privacy pamphlet has been prepared in response to federal regulations that enforce the Health Insurance Portability and Accountability Act of 1996, which is known by the acronym HIPAA. More recent regulations, effective April 14, 2003, set forth certain legal requirements regarding how healthcare providers must protect your medical information. To comply, our Clinic must provide you with a Notice of Privacy Practices, which describes how your medical information may be used and disclosed. This notice also discusses your rights as a patient under the law.

We encourage you to read the information contained in this handbook in its entirety. It will explain how The Orthopedic Partners may use and disclose your medical information and it will help you understand your rights as a patient. For your convenience, what follows is a summary of key provisions of this notice.

The Orthopedic Partners may use and disclose your medical information to:

• Medical staff and personnel who provide you with care.
• Remind you about an appointment.
• Talk to family or friends involved in your care.
• Ensure that we follow the rules of regulatory agencies regarding quality of care and effective use of resources.
• Comply with legal requirements, subpoenas or court orders for mandatory reporting, such as with cases involving child or elder abuse.
• Research personnel as they develop and seek out the best possible treatments for diseases and medical conditions. All researchers must follow specific regulations to ensure the privacy of patient information.
• Tell you about care-related benefits or services that may be of interest.
• Request payment from your insurance company.
• Your medical record is the physical property of The Orthopedic Partners, but the information contained in the record belongs to you. You have important rights concerning your medical information.

You have a right to:

• See and obtain a copy of the medical information used to make decisions about your care.
• Ask us to amend the medical information we have about you, if you feel the information we have is wrong or incomplete.
• Ask us to restrict or limit the medical information we use and share about you.
• Ask us to communicate with you about medical matters in a certain way or location.
• Obtain a list of individuals or entities that have received your medical information from The Orthopedic Partners for reasons other than treatment, payment or healthcare operations.
• Submit a complaint.

If you have any questions or would like to report a concern or problem regarding the handling of your medical information, please contact our Medical Records Department or Administration at (435) 655-6603.