Billing and Insurance
JPRC participates in several health insurance plans and will bill most insurance carriers in the area. Statements are sent on a monthly or bi monthly basis. All balances are due within 30 days of the initial statement date unless prior arrangements are made.
Accepted forms of payments are cash, personal checks, VISA, Mastercard and Discover. Credit card payments may be made in person or by Telephone.
Out Billing office can assist you by calling 855-778-9995, Option 1.
Find out everything you need to know before coming in, as well as important materials and documentation needed before your first visit.
Please note: In order to make a payment online you must be registered. Please call our billing office if you don’t already have an account registered.
A Patient’s Guide to Diagnostic Tests for Spine Problems
Diagnosis: Before a health care professional can diagnose your condition and design a treatment plan, a complete history and physical examination are necessary. There are so many possible internal causes of pain; it is important to determine what is and is not causing the problem. After the physician has a better idea of what is causing your discomfort, diagnostic tests of may be recommended.
History: First, you will be asked for a complete physical history of your condition. This may begin by filling out a written form that asks you a number of questions relating to your pain. The more information you share with the provider, the easier your problem will be to diagnose.
Your physical history is important because it helps your doctor understand: when the pain began, anything that could have caused an injury, your lifestyle, physical factors that might be causing the pain, and your family history of similar problems. After reading through your written history, your physician will ask more questions that relate to the information you have given.
Some typical questions include:
- When did the pain begin?
- Was there an injury that could be related to the pain?
- Where do you feel the pain?
- What is the intensity?
- Does the pain radiate to other parts of the body?
- What factors make the pain feel better or worse?
- Have you had problems with your bladder or bowels?
- Is there a history of osteoporosis in your family?
Physical Examination Procedure:
After taking your history, the physician will give you a physical examination. This allows the doctor to rule out possible causes of pain and try to determine the source of your problem. The areas of your body that will be examined depend upon where you are experiencing pain – neck, lower back, arms, legs, etc.
The following are some of the things that are checked in a typical exam:
Motion of Spine and Neck – ls there pain when you twist, bend, or move? If so, where? Have you lost some flexibility?
Weakness – Your muscles will be tested for strength. You might be asked to try to push or lift your arm, hand, or leg when light resistance is put against them.
Pain – The doctor may try to determine if you have tenderness of certain areas.
Sensory Changes – Can you feel certain sensations in specific areas of the feet or hands?
Reflex changes – Your tendon reflexes might be tested, such as under the kneecap and under the Achilles tendon on your ankle.
Motor skills – You might be asked to do a toe or heel walk.
Special signs – The physician will also check for any “red flags” that could indicate something other than spinal/vertebrae problems. Some signs of other problems include tenderness in certain areas, a fever, an abnormal pulse, chronic steroid use (leads to loss of bone mass), or rapid weight loss.
Once persistent pain evolves into complex chronic pain, single modality treatments-oral medications, injections, physical therapy-become less effective. In these complicated cases, physical, psychosocial, and emotional components are active and must be addressed simultaneously in a multidisciplinary chronic pain program for effective recovery.
Behavioral Health Objectives
- Improve pain control without addicting drugs when possible
- Improve physical conditioning and restore physical function
- Improve psychological function
- Return patients to work and productivity
- Promote self-management and reduce reliance on health care system
- Decrease cost of medical care associated with the Chronic Pain Syndrome
- Increase control over pain
- Decrease pain and accompanying suffering
Our Behavioral Health Objectives incorporate a multi-disciplinary approach to pain management including:
- Physical Medicine
- Rehabilitation Group and Individual Counseling-Consultants
- Behavioral Health Treatments-Consultants
- Physical Therapy-Consultants
- Individual psychological therapy-Consultants
- Group pscychological therapy-Consultants
We have ample evidence that coordinated pain rehab improves multiple parameters and we help patients focus on coping skills and help them increase tolerance for physical activity. Successful patients are able to thus gain control over their pain and its consequences.
The key to successful headache treatment is YOU! The more involved you become in your treatment, the more likely you are to get relief. In order to assist us with your treatment please bring this entire guide with you to your appointment.
You Play a Key Role in Controlling Your Headache Pain
If you are tormented by headaches, you are not alone. Each year, 45 million people in the United States seek medical treatment because of headache pain. Many others try to deal with their pain on their own without help from doctors. Headaches can affect every aspect of your life – from your job, to your relationships with people. This guide will help us find relief for your headache pain – so that you can get back to all of the things you enjoy in life. You are the most important person when it comes to taking charge of your headaches. You are the one who knows most about your headaches – what they feel like, when they occur, and other symptoms you experience. Telling your doctor all you can about your headaches will help in making the correct diagnosis. It will also help us choose the best treatment options so that you get the relief you want. The next few pages will help in providing needed information about you and your headaches. Complete the guide and bring it with you when you visit your doctor. This entire guide is needed in order for you to be seen by the doctor. “It is truly important that we in the health care profession develop and show our fellow man the best methods of healing and self-healing. This refined advancement of an old technique must be fully researched and applied as soon as possible to relieve our fellow man’s suffering”.
John K-5 Lee, M.D. Founder
Important Guides To Fill Out:
- Your Headache History
- Headache Calendar
- Your Medication History
- Headache Triggers
Your Guide To Getting Migraine Relief
The Headache Calendar is your most important tool. It helps you and your doctor track your headaches and the success of your treatment. It will also help in identifying headache triggers that may be causing your headaches. Record your information as accurately and completely as you can. Then bring this entire guide to your appointment.
How to Use The Headache Calendar
The following instructions will explain how to complete each section of the calendar. As you look at the calendar on the next few pages, you will see numbers from 1 to 31 representing the days of the month.
In this section, each day is broken down into morning, afternoon, and evening. On the days
you have headache pain, write a number in the appropriate box from 1 to 3 that describes your pain:
“1” = mild
“2” = moderate
“3” = severe
Disability for the Day
Using numbers 0 to 3, record how your headache pain affected your activities for the day. For example, “0” = no effect; “1” = you were able to carry out your activities fairly well; “2” = you had difficulty with usual activities and cancelled less important ones; “3” = you missed work for at least half the day, or stayed in bed for part of the day.
There are many things that can trigger a headache. The key on the next page assigns a number to each trigger. For example, chocolate is No. 6 and strong lights is No. 23. Record the numbers of the triggers you have been exposed to on the day of your headache.
For Women Only: Menstrual Periods
Some women tend to get headaches around the time of their menstrual period. Place and “X” on the days you have your menstrual period.
Write the names of any medicines you take to relieve your headache pain – including the dose. Below each medicine, use numbers Oto 3 to indicate the overall level of relief you got from the medicine. For example, “0” = no relief; “1” = slight relief; “2” = moderate relief; and “3” = complete relief.
List the name and dose of any medicines you take to prevent headaches. Every time you take the medicine, check (V) off the day on the calendar.
Overall Severity for this Month
Using a scale of 0 to 10, circle the number that best summarizes the overall severity of your headache problem for the entire month. “0” = no problem; “10” = your headaches were unbearable.
What Causes Headaches?
Just like other medical conditions, headaches are caused by a physical problem that may affect the body’s muscles, blood vessels, or even the chemicals in the brain.
Genetics Play a Key Role
Your family history can make you genetically more susceptible to migraines. If one of your parents suffers from migraines, there’s a 40% chance that you will get migraines too. There’s a 75% chance you will have migraines if both of your parents have them.
Physical Changes Occur in Your Brain
Although there are many theories as to what is happening in the brain to cause headache pain and other migraine symptoms, most theories point to a physical disturbance in the brain (electrical or biochemical) that leads to:
- Swelling of the blood vessels on the surface of the brain
- Irritation of the nerves in the brain
- Other symptoms that originate in the brain (aura, nausea, and sensitivity to light and sound)
An imbalance in one type of brain chemical, serotonin, is thought to play a key role in causing migraine headaches.
You Don’t Have to Lose Another Day to Headache Pain
Headache treatments have come a long way over the past several years. There are more treatment options now than ever before, and they are helping thousands of people get relief! The Migraine Center can help you by:
- Reducing the number of your headaches
- Reducing the severity of your headaches
- Relieving your headache pain fast
Most of all, controlling your headaches will help you get your life back. We will help with the right treatment for you. Controlling your headaches means feeling well enough to enjoy your life each day!
Medication management of pain is part of the multidisciplinary approach to treatment and is designed to enable the patient to resume normal daily activities. Because the pain persists, extended drug treatment becomes necessary. Even though several different drugs are used in managing chronic pain, the effectiveness of most medications has not been demonstrated by controlled clinical trials. The physician always considers these issues along with patient-specific factors, including other medical problems and side effects of medications, and federal and state regulatory requirements when selecting the most appropriate drug treatment for a patient with chronic pain.
In a survey conducted in November of 1998, when asked to rate the effectiveness of the pain medicine they had tried, chronic pain sufferers gave opioid (narcotic) drugs the highest score. Approximately half of the patients who had taken narcotics reported concerns about addictions – fears that experts believe are often exaggerated or misplaced. When it comes to medication management, every chronic pain patient should ask themselves if they have any fears or concern s about pain medications.
Many people are reluctant to take pain medications because of concerns about side effects. Others are worried they will become “hooked” or addicted. Contrary to the patient’s opinion, most physicians consider chronic administration of narcotics as detrimental to the patient’s health and also often causing addiction.
Several medications are available for treating chronic pain of varying intensity apart from narcotics:
- Most commonly used drugs are known as non-steroidal anti-inflammatory drugs (NSAIDS). These are used mainly for mild to moderate pain. These are available over-the-counter, as well as with prescription. These include aspirin, Tylenol, ibuprofen, and numerous other drugs such as Lodine ®, Daypro ®, Celebrex ®, Naprosyn ®, and Cambia ® for migraine headache.
- The second group of drugs used is narcotics. Generally narcotics are indicated only for severe pain. There are numerous types of narcotics available in the market which range from mild drugs such as Darvocet ®, Darvon ®, and Ultram ® to moderately potent drugs such as Talwin ®, Stadel ®, Hydrocodone (most commonly known as Lortab ®, Lorcet ®, Vicodin ®, etc), and in the high range, the most potent drugs are Oxycodone (also known as OxyContin ®, Percodan ®, Percocet ®, or Tylox), Demerol, Morphine, and Methadone.
- Other drugs used in managing chronic pain include muscle relaxants, medications used for depression and anxiety, medications used in convulsions, and medications given into the epidural space or spinal cord which include steroids and morphine.
- Tylenol or acetaminophen is useful for mild pain. However, Tylenol does not have anti inflammatory benefits whereas others do. It is believed to reduce pain by inhibiting the generation of peripheral pain impulses and transmission of central nociceptive impulses. Tylenol is a relatively safe drug because it causes few side effects. However, it has the potential to cause liver toxicity, especially in people who consume mor e than three alcoholic drinks per day or who have liver dysfunction, or who take more than six tablets of Tylenol a day.
Non-steroidal anti-inflammatory drugs have pain-relieving effects similar to Tylenol and at the same time, have anti-inflammatory effects which reduce the inflammation and fever. These drugs work by inhibiting cyclooxygenase (more formally known as Cox Pathways) by inhibiting the production of prostaglandins. Cox pathways are further divided into two types: Cox I, which is present in most tissues and Cox II, which is induced by various substances in the body including endotoxins, so-called mitogens, and cytokines. The majority of non-steroidal anti-inflammatory drugs which are currently on the market and used in the treatment of arthritis or pain, non-selectively inhibit both Cox I and Cox II. Of course, some of the drugs work more on Cox II than Cox I. In 1998 Celebrex ® (a selective Cox II inhibitor) was introduced. While Cox II inhibitors may be safer, the effectiveness either is equal or better.
Non-steroidal anti-inflammatory agents are the most frequently prescribed medications for chronic pain. Low doses, such as Ibuprofen 400 mg, three times a day, provide pain relief, whereas higher doses, such as Ibuprofen 800 mg, three times a day, are needed for full anti inflammatory action. However, it is not known whether there is any type of inflammation present in chronic pain at all. In general, evidence shows that these agents work better than sugar pills. Because prostaglandins work to maintain gastrointestinal tract integrity, normal kidney blood flow, and balance among various substances in the body, non-steroidal anti inflammatory drugs have the potential to cause important adverse events, especially among the elderly.
NSAIDS cause significant gastrointestinal effects with stomach upset and occasional ulceration, along with damage to the kidney and kidney failure, especially in patients with compromised kidney function. They may also cause liver disease, and occasionally cause sodium and fluid retention, especially in patients with heart failure. NSAIDS may also result in increased blood pressure in patients with coronary artery disease, and finally, they may cause increased levels of potassium in diabetic patients.
Ultram® and Conzip® (Tramadol ER®) is a mixed agent functioning centrally on the brain cells, which is effective in the management of moderate to severe pain. It has been shown in studies to be equivalent to the effects produced by Tylenol #3. It presents with two types of actions, one is a narcotic type of action and the other one is similar to antidepressant medications. Even though it is considered to have a low potential for abuse or dependence, it is not advised to be used in patients with a history of abuse or drug dependence.
Pure narcotic agents produce pain relief by binding to opioid receptors at spinal and supraspinal sites. Narcotic analgesics mainly are used to treat severe pain. Their duration of action ranges from three to six hours with Codeine or Oxycodone, to three days with long-acting drugs like Fentanyl patches. Many physicians are reluctant to recommend extended use of narcotic medications for chronic non-cancer pain due to the safety and addiction potential. Various types of narcotic agents include Codeine (Tylenol #2, #3, and #4), Percodan ®, Percocet ®, Tylox ®, OxyContin®, Exalgo®, Xartemis XR®, Opana ER®, Oxymorphone ER®, Oxycodone, Morphine, Hydromorphone (Dilaudid®), Propoxyphene (Darvocet® or Darvon®), Hydrocodone (Lortab ®, Lorcet ®, Zohydro ®, Vicoprofen ®, and Vicodin®) Butrans® and Fentanyl (Duragesic ® patches).
Muscle relaxants have a limited role in the treatment of chronic pain because muscle spasm is unlikely to be the source of chronic pain even though numerous patients complain of this. In addition, these drugs produce undesirable side effects which include drowsiness with long-term use. In addition, they have not been shown to be effective in chronic pain management in various studies.
Antidepressants are useful in patients with chronic pain with or without clinical depression. In patients with depression, higher doses are used to counteract depression and also help pain. However, antidepressants have been shown to be helpful in managing chronic pain, especially pain coming from damage to the nerve endings.
Anticonvulsants or medications used in epilepsy and seizures are also useful in chronic pain management, especially with nerve injury or damage.
Medication management is an extremely important aspect of pain management. Medication management of chronic pain always poses a challenge to primary care physicians. In selective pain medications, the physician must consider the intensity and duration of chronic pain, as well as a number of other factors, including patient’s age, other medical problems, other medications, and serious side effects, as well as potential for drug abuse. Regardless of any type of management, medication should be part of the multidisciplinary approach that should include medication management in conjunction with other treatments.
The Federation of State Medical Boards of the United States, Inc. has developed model guidelines for the use of controlled substances for the treatment of pain. These guidelines were developed from a working group, which included members of the American Academy of Pain Medicine, American Pain Society, American Society of Law, Medicine, and Ethics, Pain and Policy Studies Group, University of Wisconsin, and various State Boards. These are only model guidelines and have not been implemented by all State Medical Boards. Salient features of these guidelines are:
- Comprehensive evaluation of the patient
- Written treatment plan
- Informed consent and agreement for treatment including controlled substances agreement
- Periodic review
- Appropriate consultations as necessary
- Maintain medical records
- Compliance with controlled substances loss and regulation
Office visit Authorization/Referral
Some insurance companies require you to obtain an authorization/ referral from your primary care physician before your appointment. If you are requested to get an authorization/ referral from your primary physician this must be done prior to your appointment at Jefferson Pain and Rehab Center or the Ambulatory Surgery Center at Jefferson Pain and Rehab Center. This is to ensure that we have the authorization needed before you come in so that there is no delay in your visit with one of our doctors. It is important to get this referral because if you arrive for your appointment without it, we may be required to reschedule your appointment.
Authorization for diagnostic testing services
Jefferson Pain and Rehab Center will handle authorizations for MRI, Synvisc, and RFA (radiofrequency ablations).
Because of insurance companies have their own rules regarding diagnostic testing services, a receptionist from Jefferson Pain and Rehab Center will contact your insurance company to obtain authorization for test requested by the doctor.
Following authorization, you will be notified by the office to schedule your MRI or Synvisc injection
We are accepted by all major insurances. If you have any questions about whether we are part of your insurer’s plan, please call our business office at (412) 885-5400 EXT. 10. When making your first appointment you will need to provide us with your insurance information. Please bring your insurance cards or insurance numbers to your appointment. Also, if your insurance carrier requires that you have a letter from your referring doctor, please make sure to bring that letter to your first appointment with us. Our staff is knowledgeable and compliant with these processes.
Uses and Disclosures Permitted
The following describes ways that our center may use and disclose your PHI by various categories. Not every use or disclosure will be listed. However, all of the ways our center is permitted to use and disclose your PHI falls within one of the categories. Uses and disclosures our center may make are as follows:
We may use your PHI to provide you with healthcare treatment and/or services. We may disclose your health information to physicians, nurses, technicians, health students, therapists, or any other personnel who are part of your care. For example, we may disclose your PHI, as necessary to another physician who may be treating you for health needs. We may also disclose your PHI for purposes of consultation, to obtain x-rays to perform lab tests, to prepare prescriptions or for any other treatment purpose.
We may disclose your PHI by calling you by name in the waiting room when you are ready to be seen for your office visit. We may use or disclose your PHI, to contact you and to remind you of your appointments.
Our center will use your PHI to obtain payment for your healthcare services. For example, we may need to give your health plan or coverage program information about your care and treatment so that our Center will be paid or for you to be reimbursed for the charges related to the services we provided. In addition, we may share your PHI with your health plan or coverage program to obtain prior approval or to determine whether or not your health plan or coverage program will cover the treatment or procedure being planned or considered.
Our Center may use or disclose your PHI to support necessary business activities. These business activities include quality assurance programs, employee review scenarios and/or training of staff. We may use your PHI to review your treatment and services and to evaluate our performance in caring for you. For example, we may use PHI to aggregate data and information to determine whether our Center should provide new or additional services, if certain services should be discontinued, whether certain procedures or treatment protocols are effective, or to periodically assess the need for any focused improvement efforts.
We will share your PHI with certain contractors, defined under the Privacy Rule as Business Associates, to perform activities necessary for treatment, payment, and/or healthcare operations. However, in these instances, we will maintain a written agreement with such Business Associates to protect your PHI from unlawful uses or disclosures.
Required by Law:
We may use or disclose your PHI to the extent that the use or disclosure is required by federal, state or local law. The use or disclosure will be made in compliance with law and will be limited to the relevant requirements. You will be notified of any such uses or disclosures when the law requires such notification.
Department of Health:
We may disclose your PHI for certain public health programs to a public health authority that is permitted by law to collect or receive your health information. This disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the appropriate public health authority, to a foreign government agency that is working with a public health authority.
We may disclose your PHI, if authorized by law, to individuals who may have been exposed to a communicable disease or who may be at risk of contracting or spreading the disease or condition.
We may disclose your PHI to a health oversight agency for activities authorized by law, such as those related to investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, and other government regulatory programs and civil rights laws.
Abuse or Neglect:
Our Center must disclose your PHI to a human services or law enforcement authority authorized by law to receive reports of child abuse or neglect. We must disclose your PHI if we believe in good faith that you have been a victim of abuse, neglect, or domestic violence and such disclosure is to a government agency authorized to receive such information. Such disclosure will comply with the requirements in federal and state laws.
Food and Drug Administration:
Our Center may disclose your PHI due to an incident related to and as required by the Food and Drug Administration to report adverse events, product defects or problems, biological produce deviation, to track FDA-regulated products, to enable product recalls, repairs or replacements, to conduct post marketing surveillance and for look-back, i.e., to locate and notify persons having received products since withdrawn or recalled.
We may disclose your PHI in the course of judicial or administrative proceedings, in response to an order of a court or tribunal (to the extent expressly authorized), and in certain conditions in response to a subpoena, discovery request, or other lawful processes.
We may disclose your PHI when necessary for law enforcement purposes and when applicable legal standards and requirements have been met. These purposes include requests for information for (1) legal processes required by law; (2) identifications and location purposes; (3) victims of a crime; (4) suspicions that death has occurred as a result of criminal behavior; (5) crimes that have occurred on our Center premises; and (6) if a medical emergency arises away from our Center premises and it is likely that a crime has occurred.
Coroners, Funeral Directors and Organ Donation:
Our Center may disclose your PHI to a coroner or medical examiner for identification purposes, to determine cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose your PHI to a funeral director, as authorized by law, to permit the funeral director to carry out necessary duties. We may disclose information in reasonable anticipation of death. In addition, your PHI may be used and disclosed if you are an organ, eye, tissue, or cadaver donor.
If you are participating in a clinical research program approved by an Institutional Review Board (IRB) and if you have signed a specific research participation agreement and consent form that has been provided to our Center, then we may disclose your PHI to the designated researchers in conformance with the established research collection protocols.
Where applicable federal and state laws indicate, our Center may disclose your PHI if we believe the use or disclosure is necessary to prevent or lesson a serious and imminent threat to the health or safety of a person or the public. We may also disclose your PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
Our Center may use or disclose your PHI if you are an inmate of a correctional facility and our Center created or received your PHI in the course of providing care to you.
Military Activity and National Security:
In certain situations, our Center may use or disclose your PHI if you are deemed to be Armed forces personnel in the following situations: (1) for activities deemed necessary by appropriate military command authorities; (2) for a determination by the Department of Veteran Affairs of you eligibility for benefits; or (3) to a foreign military authority if you are a member of that foreign military service. We may also disclose your PHI to authorized officials conducting national security or intelligence activities including the provision of protective services to the President or others as authorized by law.
Our Center may disclose your PHI to comply with worker compensation laws and other similar programs established by law.
Required Use and Disclosures:
The Privacy Rule mandates that we make disclosures when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the Privacy Rule and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Specifically, the requirements of Section 164.500 et seq.
Health-Related Services and Treatment Alternatives:
We may use your PHI to inform you about health-related services, options, or alternatives that may be helpful to you.
Your Rights Regarding Your Protected Health Information
Our Center understands that your PHI and matters related to your health are personal. We are committed to protecting your PHI and to informing you about your rights in respect to your PHI. These statements are related to your rights, your PHI, and how you may exercise your rights.
If you have questions about this Notice of Privacy Practices or Your Rights as described, please contact our Office Manager by calling (412) 885-5400. If you have special requests, restrictions, or directions for us to consider or coordinate in respect to your PHI, this Notice, or Your Rights, you must communicate with us in writing that is signed, dated and addressed to:
Ambulatory Surgery Center at the Jefferson Pain & Rehabilitation Center Attn: Office Manager
4735 Clairton Boulevard
Pittsburgh, PA 15236
Right to Request Restrictions on Uses and Disclosures:
You have the right to ask our Center not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You also have the right to request our Center to restrict the use or disclosure of PHI to family members or personal representatives. However, we are not required to agree to any restriction you may request. But, if we do agree to your requested restriction and believe it to be in your best interest, we may not violate your requested restriction except as necessary to the delivery of emergency medical care. Requests are to be made in writing to our Office Manager.
Right to Access Your PHI:
In most cases, you have the right to inspect and obtain a copy of your PHI that we maintain about you. To receive a copy of your PHI, we may charge you the cost of copying, mailing and supplies associated with your request. Certain types of PHI will not be available for inspection and copying. This includes PHI collected by us in connection with or in reasonable anticipation of legal claims or proceedings. In limited circumstances we may deny your request to inspect and obtain a copy of your PHI. If we deny your request to inspect and obtain a copy, you may request that the denial be reviewed. An individual chosen by our Center who is not involved in the original decision to deny your request will conduct the review. Our Center will comply with the outcome of the review. In these matters, please contact and write to our Office Manager.
Right to Amend Your PHI:
You have the right to request that your PHI be amended if you believe your PHI maintained by our Center is incorrect or that an important part of your PHI is missing. We may deny your request if your request is not in writing or does not include a reason that supports your request. If your request to amend your PHI is declined, you have the right to prepare a statement of disagreement to be included with your PHI. At our discretion, we have the right to include a rebuttal to your statement with your PHI; however, we will provide you with a copy. In regard to your right to amend your PHI, please write to our Office Manager.
Right to Receive an Accounting of Disclosure:
You have a right to request an accounting of the disclosures of your PHI that our Center has made, if any, for reasons other than disclosures for treatment, payment, healthcare operations or disclosures that have been made pursuant to proper authorization by you. Your right to an accounting of our Center’s disclosures of your PHI applies only to your PHI and cannot exceed a period of six (6) years prior to the date of your request. The initial accounting you request within a twelve (12) month period will be free. However, we may charge you for any additional accounting requests. We will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred. Regarding these requests, please write to our Office Manager.
Right to Receive Confidential Information:
You have the right to request communications involving your PHI be provided to you at an alternative location or by an alternative means of communication. Our Center is required to accommodate any reasonable request if the normal method of disclosure may endanger you. Write to our Office Manager with this request and briefly describe the reason for your request.
Right to File a Complaint:
You have the right to file a complaint with our Center or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. All complaints must be submitted in writing. You will not be penalized or retaliated against in any way for filing a complaint. If you have questions on filing a complaint, please contact our Office Manager by calling (412) 885-5400. Please submit complaints in writing to our Office Manager.
Right to Receive a Paper Copy of This Notice:
Upon request, even if you have previously agreed to accept this Notice electronically, you have a right to request a paper copy of this Notice. Make such requests in writing addressed to our Office Manager.
Effective Date of Notice:
This notice was published and made effective in 2010.
Additional Information or Change to This Notice:
We reserve the right to add information or change the terms of this Notice at any time. The effective date of this Notice and any revised Notice may be found on the last page at the bottom right hand of the printed copy of the PHI forms. You may request a copy of a revised Notice by mail or email, but we will only deliver the Notice by email if email delivery is offered by our Center and if you have agreed to such delivery. A copy of our Notice is also available at our Center. Write to our Office Manager for a copy of this Notice.
You may have other rights under various but related laws. You may always request information on our policies and practices by writing to our Office Manager.
Patient Acknowledgement of Receiving Notice of Privacy Practices and Clinic Documentation:
You will be requested to acknowledge your receipt of this Notice of Privacy Practices by signature on a form designed for that purpose. Our Center will retain that form, once signed by you, within the medical record established for you by our Center. If you refuse or are unable to sign the acknowledgement form that we provided you with this Notice, we will document your medical record accordingly as part of our good faith effort to promote your review and understanding of this Notice of Privacy Practices.
Effective Date – 2010
This section describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this information carefully.
If you have any questions about this Notice of Privacy Practices or Your Rights as described in this Notice, please let us know so we can help you stay informed.
Your personal health and medical information is defined as Protected Health Information (PHI) by a federal law known as HIPAA. More specifically, PHI is information about you, including demographic information that may identify you and information that relates to your past, present, and future condition or health, mental or physical, and other related healthcare services.
This notice of Privacy Practices (NOTICE) describes how our center may use and disclose your PHI to provide treatment, obtain payment or carry out healthcare operations and for other purposes permitted or required by law. This notice also describes your rights as a patient to access and control your health information.
Our center may change terms of our notice, at such time as needed. If we change this notice, we will change our practice of handling PHI to comply with the changednotice as of its effective date. You may request a revised copy of the notice by calling our Privacy Officer or by visiting our office and requesting that a revised copy be sentto you.