Spokane Orthopedics logo

(509) 489-2851

Monday-Friday: 8:30 AM - 4:30 PM

Franklin Park Medical Center
220 E Rowan Ave, Suite 100
Spokane, WA 99207

Office (509) 489-2851
Fax (509) 484-0103

Office Hours:
8:30 AM - 4:30 PM

Patient Rights, Privacy Policy, & Authorization

Private Health Information is required to properly evaluate and treat each patient of Spokane Orthopedics. This information includes, but is not limited to symptoms, past history, test results, treatment plan, records from previous physicians and hospitals, registration information for insurance carriers, and any other information received pertaining to you.

This record is the physical property of the Clinic, but you have rights associated with the information contained in the record or “chart”:

  • You may request a review of your chart in which you will be provided an appointment time to inspect the original chart with a member of the staff. (You may not alter, remove, or add documents).
  • You may request copies of any part or your entire chart by providing written documentation at least 2 weeks in advance. (45 CFR 164.524) Cost associated with the duplication is in accordance with Washington State Law and paid prior to record duplication.
  • Request an amendment to your records. (45 CFR 164.528)
  • Provide a written request to have your records forwarded to another physician or institution. (One time at no cost).
  • Restrict who may or may not receive information from your record. (45 CFR 164.522)

Requests to make copies of your records should be submitted to the Records Clerk. All requests for amendments or restrictions must be submitted in writing to the Privacy Officer of the Clinic. Unless otherwise directed, we may use any and all information necessary to accomplish quality care for our patients and submit requirements for payment. Any restriction of information to insurance carriers may inhibit our ability for reimbursement and such restriction MUST be provided BEFORE treatment is initiated. Restrictions received after treatment has begun will only be recognized for treatment following the date of the request.

As we have always done, regardless of law, no information will be extended outside this office unnecessarily. Our directive is to provide the highest quality of patient care and make every effort to protect your privacy. If we refer you to another physician, physical therapy, home health care, or other provider, information necessary for them to evaluate and treat you properly will be provided to them. Nursing Home & transportation agents will also be coordinated to accommodate your care. Using our best judgment, we will provide information to concerned family members involved in your care, unless otherwise directed by you.

Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. No PHI will be out sourced.

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Questions and Complaints concerning this policy should be directed to the Privacy Officer of the Clinic. If, after sufficient time, complaints have not been addressed to your satisfaction, you may file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W. Room 509F, HHH Building, Washington, D.C. 20201. Complete office policy available for review, by request.

HIPAA 10-16-02
Revised 03-20-03

I have received a copy of the Patients Rights, Privacy Policy & Authorization, and acknowledge my rights until replaced, revoked, or amended.

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