This
notice describes how medical information about you may be used
and disclosed and how you can get access to this information.
Please read it carefully.
This
Privacy Notice is being provided to you as a requirement of
a federal law, the Health Insurance Portability and Accountability
Act (HIPAA). This Privacy Notice describes how we may use and
disclose your protected health information to carry out treatment,
payment or health care operations and for other purposes that
are permitted to required by law. It also describes your rights
to access and control your protected health information in some
cases. Your "protected health information" means any
written and oral health information about you, including demographic
data that can be used to identify you. This is health information
that is created or received by your health care provider, and
that relates to your past, present or future physical or mental
health or condition.
I.
Uses and Disclosures of Protected Health Information
The Regional Ambulatory Surgery Center, L.L.C. (R.A.S.C.) may
use your protected health information for purposes of providing
treatment, obtaining, payment for treatment, and conducting
health care operations. Your protected health information may
be used or disclosed only for these purposes unless the facility
has obtained your authorization or the HIPAA privacy regulations
or state law otherwise permits the use or disclosure. Disclosures
of your protected health information for the purposes described
in this Privacy Notice may be make in writing, orally, or by
facsimile.
A.
Treatment We will use and disclose your protected health
information to provide, coordinate, or manage your health care
and any related services. this includes the coordination or management
of your health care with a third party for treatment purposes.
For example, we may disclose your protected health information
to a pharmacy to fill a prescription or to a laboratory to order
a blood test. We may also disclose protected health information
to physicians who may be treating you or consulting with the facility
with respect to your care. In some cases, we may also disclose
your protected health information to an outside treatment provider
for purposes of the treatment activities of the other provider.
B. Payment Your protected health information
will be used, as needed, to obtain payment for the services that
we provide. This may include certain communications to your health
insurance company to get approval for the procedure that we have
scheduled. For example, we may need to disclose information to
your health insurance company to get prior approval for the surgery.
We may also disclose protected health information to your health
insurance company to determine whether you are eligible for benefits
or whether a particular service is covered under your health plan.
In order to get payment for the services we provide to you, we
may also need to disclose your protected health information to
your health insurance company to demonstrate the medical necessity
of the services or, as required by your insurance company, for
utilization review. We may also disclose patient information to
another provider involved in your care for the other provider's
payment activities. This may include disclosure of demographic
information to anesthesia care providers for payment of their
services.
C. Operations We may use or disclose your protected
health information, as necessary, for our own health care operations
to facilitate the function of R.A.S.C. and to provide quality
care to all patients. Health care operations include such activities
as: quality assessment and improvement activities, employee review
activities, training programs including those in which students,
trainees, or practitioners in health care learn under supervision,
accreditation, certification, licensing or credentialing activities,
review and auditing, including compliance reviews, medical reviews,
legal services and maintaining compliance programs, and business
management and general administrative activities.
In certain situations, we may also disclose patient information
to another provider or health plan for their health care operations.
D. Other Uses and Disclosures As part of treatment,
payment and health care operations, we may also use or disclose
your protected health information for the following purposes:
to remind you of your surgery date, to inform you of potential
treatment alternatives or options, to inform you of health-related
benefits or services that may be of interest to you, or to contact
you to raise funds for the facility or an institutional foundation
related to the facility. If you do not wish to be contacted regarding
fundraising, please contact our Privacy Officer.
II. Uses and Disclosures Beyond Treatment, Payment, and
Health Care Operations, Permitted Without Authorization or Opportunity
to Object
Federal privacy rules allow us to use or disclose your protected
health information without your permission or authorization for
a number of reasons including the following:
A. When Legally Required We will disclose your
protected health information when we are required to do so by
any federal, state or local law.
B. When There Are Risks to Public Health We may
disclose your protected health information for the following public
activities and purposes
- To prevent, control, or report disease, injury or disability
as permitted by law.
- To report vital events such as birth or death as permitted
or required by law.
- To conduct public health surveillance, investigations and
interventions as permitted or required by law.
- To collect or report adverse events and product defects,
track FDA regulated products, enable product recalls, repairs
or replacements to the FDA and to conduct post marketing surveillance.
- To notify a person who has been exposed to a communicable
disease or who may be at risk of contracting or spreading
a disease as authorized by law.
- To report a employer information about an individual who
is a member of the workforce as legally permitted or required.
C. To Report Suspended Abuse, Neglect Or Domestic
Violence We may notify government authorities if
we believe that a patient is the victim of abuse, neglect
or domestic violence. We will make this disclosure only when
specifically required or authorized by law or when the patient
agrees to the disclosure.
D. To Conduct Health Oversight Activities
We may disclose your protected health information to a health
oversight agency for activities including audits; civil, administrative,
or criminal investigations, proceedings, or actions; inspections;
licensure or disciplinary actions; or other activities necessary
for appropriate oversight as authorized by law. We will not
disclose your health information under this authority if you
are the subject of an investigation and your health information
is not directly related to your receipt of health care of
public benefits.
E. In Connection With Judicial And Administrative
Proceedings We may disclose your protected health
information in the course of any judicial or administrative
proceeding in response to an order of a court or administrative
tribunal as expressly authorized by such order. In certain
circumstances, we may disclose your protected health information
in response to a subpoena to the extent authorized by state
law if we receive satisfactory assurances that you have been
notified of the request or that an effort was made to secure
a protective order.
F. For Law Enforcement Purposes We may disclose
your protected health information to a law enforcement official
for law enforcement purposes as follows:
- As required by law for reporting of certain types of
wounds or other physical injuries.
- Pursuant to court order, court ordered warrant, subpoena,
summons or similar process.
- For the purpose of identifying or locating a suspect,
fugitive, material witness or missing person.
- Under certain limited circumstances, when you are a
vicim of a crime.
- To a law enforcement official if the facility has a
suspicion that your health condition was the result of
criminal conduct.
- In an emergency to report a crime.
G. To Coroners, Funeral Directors, and for Organ Donation
We may disclose protected health information 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 protected health information 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. Protected health information
may be used and disclosed for cadaveric organ, eye or tissue
donation purposes.
H. For Research Purposes We may use or disclose
your protected health information for research when the use
or disclosure for research has been approved by an institutional
review board that has reviewed the research proposal and research
protocols to address the privacy of your protected health
information.
I. In The Event of a Serious Threat to Health or Safety
We may, consistent with the applicable law and ethical standards
of conduct, use or disclose your protected health information
if we believe, in good faith, that such use or disclosure
is necessary to prevent or lessen a serious and imminent threat
to your health or safety or to the health and safety of the
public.
J. For Specified Government Functions In certain
circumstances, federal regulations authorize the facility
to use or disclose your protected health information to facilitate
specified government functions relating to military and veterans
activities, national security and intelligence activities,
protective services for the President and others, medical
suitability determinations, correctional institutions, and
law enforcement custodial situations.
K. For Worker's Compensation The facility
may release your health information to comply with worker's
compensation laws or similar programs.
III. Uses and Disclosures Which You Authorize
We may disclose your protected health information to your
family member or a close personal friend if it is directly
relevant to the person's involvement in your surgery or payment
related to your surgery. We can also disclose your information
in connection with trying to locate or notify family members
or others involved in your care concerning your location,
condition or death.
You may object to these disclosures. If you do not object
to these disclosures or we can infer from the circumstances
that you do not object or we determine, in the exercise of
our professional judgment, that it is in your best interests
for us to make disclosure of information that is directly
relevant to the person's involvement with your care, we may
disclose your protected health information as described.
IV. Uses and Disclosures Which You Authorize
Other than as stated above, we will not disclose your health
information other that with your written authorization. You
may revoke your authorization in writing at any time except
to the extent that we have taken action in reliance upon the
authorization.
V. Your Rights
You have the following rights regarding your health information:
A. The Right to Inspect and Copy Your Protected Health Information
You may inspect and obtain a copy of your protected health
information that is contained in a designated record set for
as long as we maintain the protected health information. A
"designated record set" contains medical and billing
records and any other records that your surgeon and the facility
uses 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 for use in, a civil criminal,
or administrative action or proceeding; and protected health
information that is subject to a law that prohibits access
to protected health information. Depending on the circumstances,
you may have the right to have a decision to deny access reviewed.
We may deny your request to inspect or copy your protected
health information if, in our professional judgment, we determine
that the access requested is likely to endanger your life
or safety or that of another person, or that it is likely
to cause substantial harm to another person referenced within
the information. You have the right to request a review of
this decision.
To inspect and copy your medical information, you must submit
a written request to the Privacy Officer whose contact information
is listed at the end of this Privacy Notice. If you request
a copy of your information, we may charge you a fee for the
costs of copying, mailing or other costs incurred by us in
complying with your request.
Please contact the Privacy Officer if you have questions about
access to you medical records.
B. The Right to Request a Restriction on Uses and
Disclosures of Your Protected Health Information
You may ask us not to use or disclose certain parts of your
protected health information for the purposes of treatment,
payment or health care operations. You may also request that
we not disclose your health information to family members
or friends who may be involved in your care or for notification
purposes as described in this Privacy Notice. Your request
must state the specific restriction requested and to whom
you want the restriction to apply.
The facility is not required to agree to a restriction that
you may request. We will notify you if we deny your request
to a restriction. If the facility does agree to the requested
restriction, we may not use or disclose your protected health
information in violation of that restriction unless it is
needed to provide emergency treatment. Under certain circumstances,
we may terminate our agreement to a restriction. You may request
a restriction by contacting the Privacy Officer.
C. The Right to Request to Receive Confidential Communications
From US by Alternative Means or at an Alternative
Location
You
have the right to request that we communicate with you in certain
ways. We will accommodate reasonable requests. We may 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 require you to provide
an explanation for your request. Requests must be made in writing
to our Privacy Officer.
D. The Right to Request Amendments to Your Protected
Health Information You may request an amendment of
protected health information about you in a designated record
set 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 an 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. Requests for amendment must be in writing and must
be directed to our Privacy Officer. In this written request,
you must also provide a reason to support the requested amendments.
E. The Right to Receive An Accounting You have the
right to request an accounting of certain disclosures of your
protected health information made by the facility. This right
applies to disclosures for purposes other than treatment, payment
or health care operations as described in this Privacy Notice.
We are also not required to account for disclosures that you
requested, disclosures that you agreed to by signing an authorization
form, disclosures for a facility directory, to friends or family
members involved in your care, or certain other disclosures
we are permitted to make without your authorization. The request
for an accounting must be made in writing to our Privacy Officer.
The request should specify the time period sought for the accounting.
We are not required to provide an accounting for disclosures
that take place prior to April 14, 2003. Accounting requests
may not be made for periods of time in excess of six years.
We will provide the first accounting you request during any
12 month period without charge. Subsequent accounting requests
may be subject to reasonable cost-based fee.
F. The Right to Obtain a Paper Copy of this Notice
Upon request, we will provide a separate paper copy of this
notice even if you have already received a copy of the notice
or have agreed to accept this notice electronically.
VI. Complaints
The facility is required by law to maintain the privacy of your
health information and to provide you with this Privacy Notice
of our duties and privacy practices. We are required to abide
by terms of this Notice as may be amended from time to time.
We reserve the right to change the terms of this Notice and
to make the new Notice provisions effective for all future protected
health information that we maintain. If the facility changes
its Notice, we will provide a copy of the revised Notice by
sending a copy of the revised Notice via regular mail or through
in-person contact.
VII. Complaints
You have the right to express complaints to the facility and
to the Secretary of Health and Human Services if you believe
that your privacy rights have been violated. You may complain
to the facility by contacting the facility's Privacy Officer
verbally or in writing, using the contact information below.
We encourage you to express any concerns you may have regarding
the privacy of your information. You will not be retaliated
against in any way for filing a complaint.
VIII. Contact Person
The facility's contact person for all issues regarding patient
privacy and your rights under the federal privacy standards
is the Privacy Officer. Information regarding matters covered
by this Notice can be requested by contacting the Privacy Officer.
If you feel that your privacy rights have been violated by this
facility you may submit a complaint to our Privacy Officer by
sending it to:
Regional Ambulatory Surgery Center, L.L.C.
1376 Bucktail Road
St. Marys, PA 15857
ATTN. Privacy Officer
The Privacy Officer can be contacted by telephone at 814-781-6565
IX. Effective Date
This Notice is effective April 14, 2003
