Cole Orthotic Pediatric Center is a leading and innovative pediatric orthotic facility servicing children of all ages in Northwest Ohio and Southeast Michigan for over 80 years.

If you have any questions about this notice, please contact Daniel Cole of our office at 419-476-4248, Cole Orthotic & Prosthetic Center, 723 Phillips Avenue, Bldg F, Toledo OH 43612 or 419-690-8365, 3048 Navarre Avenue, Oregon OH 43616.
This notice describes the information privacy practices followed by our employees, staff and other office personnel. The practices described in this notice will also be followed by health care providers you consult with by telephone (when your regular health care provider from our office is not available) who provide “call coverage” for your health care provider.
This notice applies to the information and records we have about your health, health status, and the health care and services you receive at Cole Orthotic & Prosthetic Center.
We are required by law to give you this notice. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.
We must have your written, signed Consent to use and disclose health information for the following purposes:
For Treatment We may use health information about you to provide you with medical services. We may disclose health information about you to doctors, practitioners, technicians, office staff or other personnel who are involved in taking care of you and your health.
For example, your practitioner may be fitting you for an orthosis and may need to know if you have other health problems that could complicate your treatment. The practitioner may use your medical history to decide what treatment is best for you. The practitioner may also tell another practitioner about your condition so they can help determine the most appropriate care for you.
Different personnel in our office may share information about you and disclose information to people who do not work in our office in order to coordinate your care, such as phoning in an order to our central fabrication lab, or contracting our suppliers of components for consultation regarding a specific application. Family members and other health care providers may be part of your medical care outside this office and may require information about you that we have.
For Payment We may use and disclose health information about you so that the treatment and services you receive at this office may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give you health plan information about a service you received here so your health plan will pay us or reimburse you for the service. We may also tell your health plan about a treatment or service you are going to receive to obtain prior approval, or to determine whether your plan will cover the treatment.
For Health Care Operations We may use and disclose health information about you in order to run the office and make sure that you and our other patients receive quality care. For example,
Workers’ Compensation We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products.
Health Oversight Activities We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. Subject to all applicable legal requirements, we may also disclose health information about you in response to a subpoena.
Law Enforcement We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.
Coroners, Medical Examiners and Funeral Directors We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
Information Not Personally Identifiable We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.
Family and Friends We may disclose health information about you to your family members or friends if we obtain your verbal agreement to do so of if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose health information to your family or friends if we can infer from the circumstances, based on our professional judgment that you would not object. For example, we may assume you agree to our disclosure of your personal health information to your spouse when you bring your spouse with you into the exam room during treatment or while treatment is discussed.
In situations where you are not capable of giving consent (because you are not present or due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to your family member or friend is in your best interest. In that situation, we will disclose only health information relevant to the person’s involvement in your care. We may use our professional judgment and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up, for example, supplies.
We will not use or disclose your health information for any purpose other than those identified in the previous sections with your specific, written Authorization. We must obtain your Authorization separate from any Consent we may have obtained from you. If you give us Authorization to use or disclose health information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, but we cannot take back any uses or disclosures already made with your permission.
To request restrictions, you may complete and subject the Request for Restrictions on Use/Disclosure Of Medical Information to Daniel Cole.
Right to Request Confidential Communications You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you may complete the subject the Request for Restriction on Use/Disclosure Of Medical Information And/Or Confidential Communication to Daniel Cole. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of This Notice You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive it electronically, you are still entitled to a paper copy. To obtain such a copy, contact Daniel Cole.
We reserve the right to change this notice, and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a summary of the current notice in the office with its effective date in the top right hand corner. You are entitled to a copy of the notice currently in effect.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact Daniel Cole, Cole Orthotic & Prosthetic Center, 723 Phillips Avenue, Bldg F, Toledo OH 43612 (419) 476-4248. You will not be penalized for filing a complaint.

Effective 01/13/03

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