Patient Privacy
SURGICAL ASSOCIATES OF
NOTICE OF PRIVACY PRACTICES
EFFECTIVE DATE APRIL 14, 2003
As required by the Privacy regulations created as a result of the Health Insurance Portability and Accountability act of 1996.
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUAL HEALTH INFORMATION.
A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to maintaining the privacy of your individually identifiable Health Information (IIHI). In conducting our business, we will create records regarding you and the treatment and services we provide you. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning you IIHI. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time. We realize that these laws are complicated, but we must provide you with the following important information:
· How we may use and disclose your health information
· Your privacy rights in regard to your health information
· Our obligations concerning the use and disclosure of your health information
The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend the Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices and you may request a copy of our most current Notice at any time.
B. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT: Privacy officer, 3004 2nd St. SE, Moultrie, GA 31768, 229-985-1080
C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION IN THE FOLLOW WAYS:
1. Treatment. Our practice may use your IIHI to treat you. For example, we may ask you to have a laboratory tests (such as blood or urine tests), and we may use results to help us reach a diagnosis. We might use your IIHI in order to write a prescription for you, or we might disclose you IIHI to a pharmacy when we order a prescription for you. Many of the people who work for our practice-including but not limited to, our doctors and nurses-may use or disclose you IIHI on order to treat or assist others in your treatment. Finally, we may also disclose you IIHI to other health care providers for purposes related to your treatment or any legally-appointed personal representative who is responsible for your care.
2. Payment. Our practice may use and disclose your IIHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your IIHI to obtain payment for third parties that may be responsible for cost, such as a legally-appointed personal representative. Also, we may use your IIHI to bill you directly for services and items. We may disclose your IIHI to other health care providers and entities to assist in their billing and collection efforts.
3. Health care options. Our practice may use and disclose your IIHI to operate our business. For example, our practice may use your IIHI to evaluate the quality of care you receive from us, or to conduct cost-management and business planning activities for our practice.
4. Appointment Reminders. Our practice may use and disclose your IIHI to contact you and remind you of an appointment. Only minimal information will be revealed if a message is left.
5. Disclosure Required by Law. Our practice will use and disclose your IIHI when we are required to do so by federal, state or local law.
D. USE AND DISCLOSE OF YOUR IIHI IN CERTAIN SPECIAL CIRCUMSTANCES
1. Public Health Risks. Our practices may disclose your IIHI to public health authorities by law to collect information for the purpose of:
v Maintaining vital records, such as births and deaths
v Reporting child abuse or neglect
v Preventing or controlling disease, injury or disability
v Notifying a person regarding potential exposure to a communicable disease
v Notifying a person regarding a potential risk for spreading or contracting a disease or condition
v Reporting reactions to drugs or problem with products or devices
v Notifying individuals if a product or device they may be using has been recalled
2. Health Oversight Activities. Our practice may disclose your health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions, or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings. Our practice may use and disclose your health information in response to a court or administrative order, if you are involved on a lawsuit or similar proceeding. We also may disclose your health information in response to discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
4. Law Enforcement. We may release IIHI if asked to do so by a law enforcement official:
v Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
v Concerning a death we believe has resulted from criminal conduct
v Regarding criminal conduct at our offices
v In response to a warrant, summons, court order, subpoena or similar legal process
5. Deceased Patients. Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to indentify the cause of death
6. Serious Threats to Health and Safety. Our practice may use and disclose your heath information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
7. Military. Our practice may disclose your IIHI if you are a member of U.S. or foreign military forces and if required by the appropriate authorities.
8. National Services. Our practice may disclose your IIHI to federal officials for intelligence and national security activities authorized by law. We may also disclose your health information to federal officials in order to protect the President, or other officials or foreign heads of state, or to conduct investigations
E. YOUR RIGHTS REGARDING YOUR IIHI
1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Privacy Officer specifying the need to give a reason for your request.
2. Requesting Restrictions. You have the right to request a restriction in our disclosure of you IIHI or treatment, payment or health care operations. Additionally, you have the right the request that we restrict our disclosure of your IIHI to only certain individuals involved in your care or the payment for your care, such as family member and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use of disclosure of your IIHI, you must complete a “Request for limitations and Restrictions of Protected Health Information” and return to the Privacy officer. You request must describe in a clear and concise fashion:
v The information you wish restricted
v Whether you are requesting to limit our practice’s use and disclosure or both; and
v To whom you want the limits to apply.
3. Inspection and copies. You have the right to inspect and obtain a copy of the health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must send a written request to the Privacy Officer in order to inspect and/or obtain a copy of your health information. Our practice may deny your request to inspect and/or copy certain limited circumstances; however, you may request a review of your denial. Another licensed health care professional chosen by us will conduct reviews.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion (A) accurate and complete; (B) not part of the IIHI kept by of for the practice; (C) not part of the IIHI which you would be permitted to inspect or copy; (D) not created by our practice, unless the individual or entity that created the information is not available to amend the information.
5. Accounting of Disclosures. All of our patients have the right to request an “Accounting of Disclosures.” An“ Accounting of Disclosures” is a list of certain non-routine disclosures our practice has made of your IIHI for non-treatment, non-payment or non-operations purposes and for which prior authorization was not required. Use of your IIHI as part of the routine patient care in our practice is not required to be documented. For example, the doctor sharing the information with the nurse; or the billing department using your information to file your insurance claim. In order to obtain an accounting of disclosures, you must send a written request to Privacy Officer, 3004 2nd Street SE, Moultrie, GA 31768. All requests for an accounting of disclosures must state a time period, which may not be longer than six years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a twelve month period is free of charge, but our practice may charge you for an additional list within the same twelve month period. Our practice will notify you of the costs involved with the additional requests, and you may withdraw our request before you incur any costs.
6. Right to Paper Copy of this Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice contact the Privacy Officer at 229-985-1080.
7. Right to File a Complaint. If you believe your privacy rights have been violated you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the Privacy Officer at 229-985-1080 to obtain a patient complaint form. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization. Please note, we are required to retain records of your care.
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