Overview

For our patient’s safety and In compliance with Massachusetts law related to opioid prescribing and in response to the January 1, 2013 Massachusetts Medical Use of Marijuana law, Boston Orthopaedic & Spine, LLC has created this policy. Our medical providers evaluate each patient’s situation and carefully develop a plan that considers all available pain relief options, including non-pharmacologic and non-opioid pharmacologic options.

Narcotic and Opiate/Opioid Policy

Our medical providers can not issue a more than 7-day supply opiate prescription to an adult patient for outpatient use for the first time. There are exemptions to this law for adult patients with acute medical conditions such as treatment of chronic pain management, pain associated with a cancer diagnosis or for palliative care. These conditions are generally not applicable to our patients and therefore patients requiring more than a 7-day supply of an opiate prescription will likely be referred to a their primary care physician or a pain management facility for further evaluation. In the event our patient is prescribed an opiate for more than a 7-day supply, the patient’s medical record will state (1) the condition triggering the prescription and (2) that a non-opiate alternative was not appropriate to address the medical condition.

In compliance with Massachusetts law, patients may direct their pharmacist to dispense less Opiate/Opioid pain medication than the full quantity indicated on the prescription. This notation will be included on all Schedule II opioid prescriptions, as required by law. The remaining quantity of the prescription not dispensed per the patient’s discretion is void to any quantity not dispensed.

Narcotics and any other pain medications will NOT be refilled on evenings, holidays, or weekends. Patients must anticipate their medication needs and, if needed, contact the office during regular business hours to request refills of their medication.

Prior to issuing an extended-release long-acting opioid, we are required by law to (1) evaluate the patient’s current condition, risk factors, history of substance abuse, if any, and current medications; and (2) inform the patient and note in the patient’s electronic medical record that the prescribed medication, in the prescriber’s medical opinion, is an appropriate course of treatment based on the medical need of the patient. In the event our medical providers recommend that an extended-release long-acting opioid be utilized during the course of long-term pain management, the prescribing provider and the patient are required to enter into a written pain management treatment agreement which will be included in the patient’s electronic medical record. This agreement will address the benefits as well as the risk factors for abuse or misuse of the prescribed substance.

Effective October 15th, 2016 under the Massachusetts Prescription Monitoring Program all prescribers, before writing a prescription for narcotic drugs, are required to check the patient’s Prescription Monitoring Profile maintained in the Massachusetts Online Prescription Monitoring Program. This database is maintained and operated by the Massachusetts Department of Public Health (DPH).

Effective December 1st, 2016, The Department of Public Health (DPH) established a voluntary non-opiate directive form. This form indicates to all practitioners that the patient shall not be administered or offered a prescription or medication order for an opiate. The patient or their legal guardian may file a voluntary non-opiate directive form with our office which will be included in the patient’s electronic medical record. The patient or their legal guardian may revoke the voluntary non-opiate directive for any reason and may do so at any time, in writing or verbally.

Medical Marijuana Policy

At this time, our medical providers at Boston Orthopaedic & Spine, LLC will not be authorizing medical marijuana due to the lack of efficacy and potential risk to our patients. It is our hope that all patients will acknowledge and respect the decisions of our medical providers regarding the authorization of medical marijuana.

Overview

In compliance with the Americans with Disabilities Act (ADA) and Massachusetts General Law (Chapter 272: Section 98A) Boston Orthopaedic & Spine, LLC has created this policy to assure that all patients and/or visitors with disabilities, who are accompanied by services animals, are provided access to Boston Orthopaedic & Spine, LLC. As specified in this policy, Boston Orthopaedic & Spine, LLC will accommodate service animals, but not pets.

How “Service Animal” is Defined

The ADA defines “service animal” as dogs that are individually trained to do work or perform tasks for people with disabilities. Service animals are working animals, not pets. The work or task a dog has been trained to provide must be directly related to the person’s disability.

Examples of such work or tasks include:

• Guiding people who are blind.
• Alerting people who are deaf.
• Pulling a wheelchair.
• Alerting and protecting a person who is having a seizure.
• Reminding a person with mental illness to take prescribed medications.
• Calming a person with Post Traumatic Stress Disorder during an anxiety attack.
• Performing other duties.

Where Service Animals Are Allowed

In accordance with the ADA, Boston Orthopaedic & Spine, LLC allows service animals to accompany people with disabilities in all areas of the Clinic where the public is normally allowed to go. However, service animals may be excluded from certain clinical areas, after a determination is made by your provider, where the animal’s presence may compromise a sterile environment.

Service Animals Must Be Under Control

Under the ADA, service animals must be harnessed, leashed, or tethered, unless these devices interfere with the service animal’s work or the individual’s disability prevents using these devices. In that case, the individual must maintain control of the animal through voice, signal, or other effective controls.

Inquiries, Exclusions, and Other Specific Rules Related to Service Animals

• If you are not certain whether an animal is a service animal, only limited inquiries are allowed. You may ask the person who has the animal (1) if it is a service animal required because of a disability, and (2) what work or task has the dog been trained to perform. Staff cannot ask about the person’s disability, require medical documentation, require a special identification card or training documentation for the dog, or ask that the dog demonstrate its ability to perform the work or task.
• Visitors with service animals may not be segregated from other visitors, exclusively because of the presence of the service animal. Under the ADA, allergies and fear of dogs are not valid reasons for denying access or refusing service to people using service animals. When a person who is allergic to dog dander and a person who uses a service animal must spend time in the same room or facility, they should both be accommodated by assigning them, if possible, to different locations within the room or different rooms in the facility. Staff or visitors of Boston Orthopaedic & Spine, LLC who express concern about the service animal should be notified of the animal’s purpose and, if they remain concerned, given an opportunity to relocate elsewhere.
• Under the ADA, a person with a disability cannot be asked to remove their service animal from the premises unless: (1) the dog is out of control and the handler does not take effective action to control it or (2) the dog is not housebroken. In such circumstances at Boston Orthopaedic & Spine, LLC, the Office Manager or designee should be promptly notified to evaluate the appropriate action to take which may include: (1) asking the individual to control the animal’s behavior, (2) asking the individual to relocate to another area, where the service animal’s behavior can be controlled, and/or (3) asking the individual to remove the service animal from the premises.
• People with disabilities who use service animals cannot be isolated from other patrons or treated less favorable than other patrons.
• Boston Orthopaedic & Spine, LLC is not required to provide food, care and/or a special location for service animals. The care and supervision of service animals is the sole responsibility of their owners.

Pets

Boston Orthopaedic & Spine, LLC does not allow pets to accompany patients and/or visitors in any areas of the clinic. Due to potential problems associated with pet visitation, we ask that you please make arrangements to have a person, with familiarity in handling the pet, to bring the pet to a designated area outside the building where the visit will take place. Pets will not be allowed in any patient care area.

Boston Orthopaedic & Spine, LLC complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, religious creed, sexual orientation or sex (including gender identity and gender stereotyping). We do not exclude people or treat them differently because of race, color, national origin, age, disability, religious creed, sexual orientation or sex (including gender identity and gender stereotyping).

Boston Orthopaedic & Spine, LLC provides free aid and services to people with disabilities to communicate effectively with us. If you need these services, contact our office at 1-617-738-8642. If you believe that Boston Orthopaedic & Spine, LLC has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, religious creed, sexual orientation or sex (including gender identity and gender stereotyping), you can file a grievance with:

Amy Lynch Compliance Officer

71 Border Road, Suite 200
Waltham, MA 02451,

1-617-588-3057
alynch@mybostonortho.com

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office of Civil Rights (OCR) by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Ave, SW Room 509F, HHH Building
Washington, D.C. 20201

Telephone: 1-800-368-1019, 1-800-537-7697 (TDD)

Revised date: 01/01/2026

Notice to Patients: “Right to Receive a Good Faith Estimate of Expected Charges” Under the No Surprises Act

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate orally and in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to personally save a copy or picture of your Good Faith Estimate. A scanned copy of your Good Faith Estimate will be saved to your Boston Orthopaedic & Spine Electronic Medical Record.

Questions

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or contact our Billing Department by phone at 617-588-3098 or by email at billing@mybostonortho.com

Boston Orthopaedic & Spine, LLC provides free interpreter services upon request to non-English speaking, limited-English speaking, Deaf, and Hard of Hearing patients.

We coordinate interpreters in face-to-face settings whenever possible. If an interpreter is unavailable at the time of your appointment, we will use a telephone interpreter (video remote interpreter for Deaf and Hard of Hearing patients). When booking your medical appointment, make sure to indicate that you would like an interpreter for the visit.

For more information please call our office at 617-738-8642.

• Your right to a medical interpreter
• Nondiscrimination Statement

Prohibited behavior includes but is not limited to:

• Inappropriate words
• Profane, disrespectful, insulting, demeaning, hostile, or abusive language
• Shaming others for negative outcomes
• Threats of harm, intimidation, or coercive behavior
• Inappropriate arguments with patients, family members, staff or other care providers
• Outbursts of anger and/or rudeness
• Behavior that others would describe as bullying
• Intimidating or harassing staff or other patients and/or visitors
• Physically assaulting or threatening to inflict bodily harm
• Possessing firearms or any weapon while in the office
• Offensive comments or gestures about others’ race, accent, religion, gender, sexual orientation, or other personal traits. Refusing to see a clinician or other staff member based on these personal traits.

If you are subjected to any of these behaviors or witness inappropriate behavior, please report it to the office’s supervisor and/or manager. We welcome and appreciate your feedback about your experience. We strive to provide a safe and healthy environment for staff, visitors, patients, and their families. Your input helps us to continue and improve the care we provide.

Thank you for your cooperation.

Boston Orthopaedic & Spine, LLC is participating in a Medicare Shared Savings Program Accountable Care Organization

What’s An Accountable Care Organization (ACO)?

• An ACO is a group of doctors and other health care providers who voluntarily work together with Medicare to give you high quality service and care at the right time in the right setting. Boston Orthopaedic & Spine, LLC is participating in Mount Auburn Cambridge Independent Practice Association (MACIPA) and Beth Israel Deaconess Care Organization (BIDCO) a Medicare Shared Savings Program ACO.
• An ACO is not a Medicare Advantage Plan, (like an HMO or PPO), or an insurance plan.
• ACO’s don’t change your Medicare benefits.

How Will An ACO Help My Doctor Coordinate My Care?

• Your doctors will have a more complete picture of your health through talking with your other doctors.
• To help you get a better, more coordinated care, Medicare will share certain health information with us about the care you get from your doctors and other health care providers unless you ask Medicare not to share it. Medicare may also share your health information with other ACO’s in which your other doctors or health care providers participate.
• Boston Orthopaedic & Spine, LLC may continue to recommend that you see particular doctors for specific health needs, but it’s always your choice about what doctors you see or hospitals you visit.

What Do I Need To Do?

• If you want Medicare to share information about care you received with us, there’s nothing more you need to do.
• If you do not want Medicare to share your health care information with Boston Orthopaedic & Spine, LLC, or other ACO providers who provide care to you, call 1-800-MEDICARE (1-800-633-4227) and tell the representative that your doctor is part of an ACO and you don’t want Medicare to share your health care information. TTY users should call 1-877-486-2048.
• If you do not call 1-800-Medicare and request not to share your health care information, it will be shared with your ACO and with other ACOs in which any of your doctors or other healthcare providers participate for the purposes of care coordination and quality improvement.
• If you change your mind in the future, call 1-800-MEDICARE and tell the representative what you have decided.
• Even if you decline to share your health care information, Medicare will still use your information for some purposes, including certain financial calculations and determining the quality of care given by your health care providers participating in ACOs. Also, Medicare may share some of your health information with the ACOs when measuring the quality of care given by healthcare providers participating in the ACOs.

Questions

If you have questions or concerns, you can talk with a Boston Orthopaedic & Spine, LLC provider at any time, and you can request more information about the Medicare Shared Savings Program and how to decline to share your health information with ACOs.

You can also visit https://www.cms.gov/priorities-innovation-key-concepts-accountable-care-accountable-care-organizations or call 1-800-MEDICARE (TTY users should call 1877-486-2048).

Boston Orthopaedic & Spine is committed to providing a safe and inclusive environment at our practice and follows a zero-tolerance policy for aggressive behavior against our staff, patients, and visitors. Anyone who does not comply with this Code of Conduct is subject to removal from the office and/or discharge from the practice. Our staff is dedicated to providing the highest quality of care to our patients. Please show them the respect they deserve as they carry out their duties.

Prohibited behavior includes but is not limited to:

• Inappropriate words
• Profane, disrespectful, insulting, demeaning, hostile, or abusive language
• Shaming others for negative outcomes
• Threats of harm, intimidation, or coercive behavior
• Inappropriate arguments with patients, family members, staff or other care providers
• Outbursts of anger and/or rudeness
• Behavior that others would describe as bullying
• Intimidating or harassing staff or other patients and/or visitors
• Physically assaulting or threatening to inflict bodily harm
• Possessing firearms or any weapon while in the office
• Offensive comments or gestures about others’ race, accent, religion, gender, sexual orientation, or other personal traits. Refusing to see a clinician or other staff member based on these personal traits.

If you are subjected to any of these behaviors or witness inappropriate behavior, please report it to the office’s supervisor and/or manager. We welcome and appreciate your feedback about your experience. We strive to provide a safe and healthy environment for staff, visitors, patients, and their families. Your input helps us to continue and improve the care we provide.

Thank you for your cooperation.

Our Promise. The privacy of your Protected Health Information (“PHI”) is important to us. We understand that your PHI is personal and we are committed to protecting it. This notice describes how we may use and disclose your PHI to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI. PHI is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.

Our Legal Duty. We are required by law to maintain the privacy of your PHI; give you this notice of our legal duties and privacy practices with respect to your PHI and follow the terms of our notice that are currently in effect. We may change the terms of our notice at any time. The new notice will be effective for all PHI that we maintain at the time as well as any information we receive in the future. You can obtain any revised HIPAA Notice of Privacy Practices by contacting our Compliance Officer.

How We May Use and Disclose Your PHI. We are permitted to use and disclose your PHI for the following purposes. However, our office may never have reason to make some of these disclosures. The following examples describe different ways that we may use and disclose your PHI.

• For Treatment. We will use and disclose your PHI to provide, coordinate, or manage your health care treatment and any related services. We may also disclose PHI to other physicians who may be treating you. For example, your PHI may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose and treat you. In addition, we may disclose your PHI to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment.
• Patient Record Sharing. Our EHR uses CommonWell and CareQuality, a secure record sharing system, that allows your providers to gather your patient information from outside care sites, agnostic of what EHR system another provider may be using. As a result, approximately 75 percent of eligible Epic sites and 30 percent of eligible Cerner sites via CommonWell and Carequality are able to share their information with Boston Orthopaedic & Spine, LLC.
• For Medication History Download. Our EHR uses Surescripts, Inc., a prescription system that allows prescriptions and related information to be exchanged between your providers and the pharmacy. The information sent between these systems may include details of any and all prescription drugs you are currently taking and/or have taken in the past. This information will be utilized to Boston Orthopaedic & Spine, LLC. This information may include disclosure of prescription information related to alcohol and drug abuse, mental health treatment, and/or confidential HIV related information by Surescripts, Inc. to Boston Orthopaedic & Spine, LLC.
• For Payment. Your PHI will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan or a third party may undertake before it approves or pays for health care services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.
• For Health Care Operations. We may use and disclose your PHI for health care operation purposes. These uses and disclosures are necessary to make sure that all of our patients receive quality care and for our operation and management purposes. For example, we may use our PHI to internally review the treatment and services you receive to check on the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians, medical students, and other personnel for educational purposes.
• Appointment Reminders/Treatment Alternatives/Health-Related Benefits and Services. We may use and disclose your PHI to contact you to remind you that you have an appointment for treatment or medical care, or to contact you to tell you about possible treatment options or alternatives or health related benefits and services that may be of interest to you.
• Fundraising Activities. We may use or disclose your demographic information and the dates that you received treatment from your physician, as necessary, in order to contact you for fundraising activities supported by our office. If you do not want to receive these materials, please contact our office and request that these fundraising materials not be sent to you.
• Plan Sponsors. If your coverage is through an employer sponsored group health plan, we may share PHI with your plan sponsor.
• Facility Directories. Unless you object, we may use and disclose in our facility directory your name, the location at which you are receiving care, your condition (in general terms), and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name. Members of the clergy will be told your religious affiliation. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use of disclosure of the PHI, then your physician may, using professional judgement, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.
• Others Involved in Your Health Care. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgement. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
• Required by Law. We may use or disclose your PHI to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
• Public Health. We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
• Business Associates. We may disclose your PHI to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf or to provide consulting services for us. All of our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
• Communicable Diseases. We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
• Health Oversight. We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
• Food and Drug Administration. We may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance, as required by law.
• Coroners, Funeral Directors, and Organ Donation. We may disclose your PHI to a coroner or medical examiner for identification purposes, determining 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, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. PHI may be used and disclosed for cadaveric organ, eye, or tissue donation purposes.
• Research. We may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
• Criminal Activity. Consistent with applicable federal and state laws, we may disclose your PHI, if we believe that the use or disclosure is necessary to prevent or lessen 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.
• Military Activity and National Security. When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your PHI to authorized federal officials for conducting nation security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
• Workers’ Compensation. Your PHI may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.
• Inmates. We may use or disclose your PHI if you are an inmate of a correctional facility and your physician created or received your PHI in the course of providing care to you.
• For Data Breach Notification Purposes. We may use or disclose your PHI to provide legally required notices of unauthorized acquisitions, access, or disclosure of your health information. We may send notice directly to you or provide notice to the sponsor of your plan, if applicable, through which you receive coverage.

Special Protections for HIV, Alcohol and Substance Abuse, Mental Health and Genetic Information. Certain federal and state laws may require special privacy protections that restrict the use and disclosure of certain health information, including HIV-related information, alcohol and substance abuse information, mental health information, and genetic information. For example, a health plan is not permitted to use or disclose genetic information for underwriting purposes. Some parts of this HIPAA Notice of Privacy Practices may not apply to these types of information. If your treatment involves this information, you may contact our Compliance Officer for more information about these protections.

Uses and Disclosure of PHI Based Upon Your Written Authorization. Use and disclosures of your PHI that involve the release of psychotherapy notes (if any), marketing, sale or your PHI , or other uses or disclosures not described in this notice will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization at any time, in writing, except to the extent that this office has taken action in reliance on the use or disclosure indicated in the authorization. Additionally, if a use or disclosure of PHI described above in this notice is prohibited or materially limited by other laws that apply to use, it is our intent to meet the requirements of the more stringent law.

Your Rights Regarding Health Information About You. The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.

• You have the right to inspect and copy your PHI. This means you may inspect and obtain a copy of your PHI that is contained in your designated file for as long as we maintain the PHI. A “designated file” contains medical and billing records and any other records that your physician and the office use for making decisions about you. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI. You must make a written request to inspect and copy your designated file. Additionally, if we maintain an electronic health record of your designated file, you have the right to request that we send a copy of your PHI in an electronic format to you or to a third party that you identify. We have up to thirty (30) days to make your PHI available to you and we may charge you a reasonable fee for any copies. Depending on the circumstances, we may deny your request to inspect and/or copy your PHI. A decision to deny access may be reviewable. Please contact our Compliance Officer if you have questions about access to your medical record.
• You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this HIPAA Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. This office is not required to agree to a restriction unless you are asking us to restrict the use and disclosure of your PHI to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you paid us out-of-pocket in full. If this office believes it is in your best interest to permit the use and disclosure of PHI, your PHI will not be restricted. If this office does agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with you physician. You may request a restriction by contacting our Compliance Officer.
• You have the right to restrict information given to your third-party payer if you fully pay for the services out of your pocket. If you pay in full for services out of your own pocket, you can request that the information regarding the services not be disclosed to your third-party payer because no claim is being made against the third-party payer. • You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Compliance Officer.
• You may have the right to have your physician amend your PHI. This means you may request an amendment of PHI about you in your designated file for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Compliance Officer if you have questions about amending your medical record. Your request must be in writing and provide the reasons for the requested amendment.
• You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this HIPAA Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members, or friends involved in your care, or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations. Additionally, limitations are different for electronic heath records.
• You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
• You have the right to receive notice of a security breach. We are required to notify you if your PHI has been breached. The notification will occur by first-class mail within 60 days of the event. A breach occurs when there has been an unauthorized use or disclosure under HIPAA that compromises the privacy or security of your PHI. The notice will contain the following information: (1) a brief description of what happened, including the date of the breach and the date of the discovery of the breach; (2) the steps you should take to protect yourself from potential harm resulting from the breach; and (3) a brief description of what we are doing to investigate the breach, mitigate losses, and to protect against further breaches.

Complaints. If you have any questions or complaints about this notice, please contact our Compliance Officer at 617-588-3057 or in writing to Boston Orthopaedic and Spine, LLC, Attn: Compliance Officer, 20 Guest Street, Suite 225, Brighton, MA 02135. If you think we may have violated your privacy rights, please contact our Compliance Officer. You may also file a complaint with the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Revised date: 01/01/2026