MONTGOMERY ORTHOPAEDIC SURGEONS, INC.

PRIVACY STATEMENT     

 

 

THIS NOTICE DESCRIBES HOW PERSONAL HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION, PLEASE REVIEW IT CAREFULLY

 

Your Privacy is Important to Us

Montgomery Orthopaedic Surgeons, Inc.  (MOS) is committed to protecting the information you share with us, and in turn respecting your privacy.   This Privacy Statement will explain the type of information we collect, how we use that information and how we protect that information.   MOS reserves the right to change this Privacy Statement at any time and will notify you of any changes as required by law.

 

Who Will Follow This Notice

This notice describes information about privacy practices followed by our employees, staff and other office personnel.

 

What Information We Collect

MOS collects information from you on registration forms, medical history forms, authorizations, consents, and releases.   This information can include name, address and social security number, insurance ID number, past, present, family, social and medical history.      We collect this information to:   1) Accurately identify you  2) Protect and administer your account  3) Understand your needs 4) Provide you, a guardian, or responsible party with necessary information  5) Provide for your treatment, Receive Payment, and for Healthcare Operations.

 

What Information We May Disclose

We disclose information of a personal nature to your insurance company during the submission and processing of claims on your behalf, other medical providers such as laboratories, imaging facilities and other non-affiliated healthcare providers involved with your care.     This information will be shared on an as-needed basis and only to the extent necessary for continuity of care or as required by law.

 

Protecting Your Personal Information

MOS takes the security of your information very seriously and has established security standards and procedures to prevent unauthorized access to patient information.   We maintain physical, electronic and procedural safeguards to protect your information.  Only authorized personnel within our organization who need to service your account see your information.  These individuals are trained to properly handle personal information and must abide by the terms of a confidentiality agreement.

 

Patient Rights – Patient has the right to receive a copy of the Privacy Statement and Notice of Privacy Practices of MOS and to request an amendment or correction be made to their medical record with the understanding that MOS reserves the right to deny such request as outlined in the Privacy Policy.

 

We will adhere to the information policies and procedures described in the current privacy policy.  If you have any questions regarding this notice, please contact 937-832-4773 or 1-800-925-1674 and ask for the Administrator.   

 

Acknowledgement of Receipt of Privacy Notice

 

I have been presented with a copy of Montgomery Orthopaedic Surgeons’ Notice of Privacy Policies, detailing how my health information may be used and disclosed as permitted under Federal and State law.

I understand the contents of the Notice, and that I may request restrictions concerning use my personal medical information.