Any health care
professional at the Surgery Center authorized to enter
information into your medical chart.
Any member of a
volunteer group that we allow to help you while you are our
patient.
All employees, staff
and other therapeutic personnel of the Surgery Center.
All employees, staff
and other therapeutic personnel of the Anesthesia Group when at
the Surgery Center.
These entities may
share medical information about you with each other for
treatment, payment or health care operations purposes described
in this Notice.
I. YOUR RIGHTS
REGARDING MEDICAL INFORMATION ABOUT YOU
Your health record is
the physical property of Specialty Surgery Center of CNY. The
information contained in the record, however, belongs to you.
You have the right to:
A. Request a
restriction or limitation on the medical information we use or
disclose about you for your treatment, payment or health care
operations. For example, you may request that a particular
procedure be kept confidential and not shared with other
providers. You also have the right to request a limit on the
medical information we disclose about you to someone who is
involved in your care or the payment for your care, like a
family member or friend or when we notify a family member,
personal representative or other person responsible for your
care to inform them of your location and general condition. We
are not required to agree to your requested restrictions. If we
do agree, we will comply with your request unless the
information is needed to provide you emergency treatment.
B. Obtain a copy of
this Notice by requesting one from the administrator of the
surgery center.
C. Inspect and obtain
a copy of your health care record by submitting a request in
writing to the administrator of the surgery center.
Amend your healthcare
record if you feel that medical information that we have about
you is incorrect or incomplete by requesting, in writing, that
an amendment be made. You must provide a reason that supports
your request.
E. Obtain a report of
all of the disclosures of your health information that we have
made.
F. Request that we
communicate with you about your medical information in a certain
way or at a certain location within reasonable limits.
G. Revoke your
authorization to use and disclose medical information about you,
except to the extent that we have already used or disclosed your
medical information.
II. OUR
RESPONSIBILITIES REGARDING YOUR MEDICAL INFORMATION
We are required by law
to:
A. Maintain the
privacy of your health information.
B. Provide you with
this Notice, which describes our legal duties and privacy
practices with respect to information we collect about you and a
revised copy of the Notice if it is amended or otherwise
changes.
C. Abide by the terms
of this Notice.
D. Notify you if we
are unable to agree to a requested restriction.
E. Accommodate
reasonable requests that you have made to have us communicate
your health information to you in a certain way or at a certain
location.
WE RESERVE THE RIGHT
TO CHANGE THIS NOTICE. We reserve the right to make the revised
and changed notice effective for medical information that we
already have about you, as well as any information we receive in
the future. We will post a copy of the current notice in the
surgery center. The notice will contain the effective date on
the first page. Each time you register at the surgery center for
health care services, we will offer you a copy of the current
notice in effect.
III. HOW WE MAY USE
AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
Each time you visit
us, a record of your visit is made. We may use or disclose the
health information contained in this record to certain employees
and staff members of the surgery center or certain persons or
entities outside the surgery center in certain situations
without first obtaining your authorization. The following
categories describe the different ways that we may use and
disclose your medical information. We must obtain your prior
written authorization before using or disclosing your medical
information in all other situations which are not listed below.
A. Treatment.
We may use medical information about you to provide you with
medical treatment and services. We may disclose medical
information about you to doctors, nurses, technicians, or other
surgery center personnel who are involved in taking care of you
at the surgery center.
For example,
information obtained by a nurse, physician, or other member of
your health care team will be recorded in your medical record
and used to determine the course of treatment that should work
best for you. Your physician will document in your record his or
her expectations of the members of your health team. Members of
your health care team will then record the actions that they
took and their observations. By reading your medical record, the
physician will know how you are responding to treatment.
B. Payment. We
may use and disclose medical information about you so that the
treatment and services you receive at the surgery center may be
billed to and payment may be collected from you, an insurance
company, or third party.
For example, we may
need to give your insurance company information about surgery
you received at the surgery center so that the insurance company
will pay us or reimburse you for the surgery.
C. Health Care
Operations. We may use and disclose medical information
about you for the operations of the surgery center.
For example, members
of the medical staff, the risk manager or quality improvement
manager, or members of the quality improvement team may use
information in your health record to assess the care and
outcomes in your case and others like it. This information will
be used in a way to improve the quality and effectiveness of the
healthcare and services that we provide.
D. Appointment
Reminders. We may use and disclose medical information to
contact you as a reminder that you have an appointment for
treatment or medical care at the surgery center.
E. Treatment
Alternatives. We may use and disclose medical information
about you to contact you about or recommend possible treatment
options or alternatives that may be of interest to you.
F. Health-Related
Benefits and Services. We may use and disclose your medical
information to inform you about health-related benefits or
services that may be of interest to you.
G. Individuals
Involved in Your Care or Payment for Your Care. We may
release medical information about you to a friend or family
member who is involved in your medical care or who helps pay for
your care. We must inform you that we are going to use or
disclose your information for this purpose and provide you with
an opportunity to agree to, restrict or object to the disclosure
or use.
H. Notification.
We may use or disclose your medical information to notify or
assist in notifying a family member, personal representative, or
other person responsible for your care of your location and
general condition. We must inform you that we are going to use
or disclose your information for this purpose and provide you
with an opportunity to agree to, restrict or object to the
disclosure or use.
I. As Required by
Law. We will disclose medical information about you when
required to do so by federal, state or local law.
J. Avert Serious
Threat to Health or Safety. We may use and disclose medical
information about you when necessary to prevent a serious threat
to your health or safety or the health or safety of the public
or another person. The surgery center, however, will only
disclose the information to someone able to help prevent the
threat.
K. Organ and Tissue
Donation. Consistent with applicable law, we may disclose
health information to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation
of organs for the purpose of tissue donation and transplant.
L. Business
Associates. Some of the services provided at the surgery
center are provided by business associates. For example, we
contract with certain laboratories to perform lab tests. When we
contract for these services, we may disclose your health
information to our business associates so that they can perform
the job we have hired them to do. To protect your health
information, we require our business associates to appropriately
safeguard your information.
M. Workers’
Compensation. We may release medical information about you
to the extent authorized by and to the extent necessary to
comply with the laws relating to workers’ compensation or other
similar programs established by law.
N. Public Health
Risks. As required by law, we may disclose your health
information to public health or legal authorities charged with
preventing or controlling disease, injury, or disability.
O. Health Oversight
Activities. We may disclose medical information to a health
oversight agency for activities authorized by law. These
oversight activities include, for example, audits,
investigations, inspections, and licensure and disciplinary
action that are necessary for the government to monitor the
health care system, government programs, and compliance with
civil rights laws.
Q. Lawsuits and
Disputes. If you are involved in a lawsuit or a dispute, we
may disclose medical information about you in response to a
court or administrative order. We may also disclose medical
information about you in response to a subpoena, discovery
request, or other lawful process by someone else involved in a
dispute, but only if efforts have been made to tell you about
the request or to obtain an order protecting the information
requested.
R. Law Enforcement.
We may disclose health information for law enforcement purposes
as required by law or in response to a valid subpoena.
S. Coroners,
Medical Examiners and Funeral Directors. We may release
medical information to a coroner or medical examiner for
purposes of identifying a deceased, determining a cause of
death, or other duties authorized by law. We may also disclose
health information to funeral directors consistent with
applicable law to carry out their duties.
T. Food and Drug
Administration. We may disclose to the FDA health
information related to adverse events with respect to food,
supplements, products and product defects, or post marketing
surveillance information or to enable product recalls, repairs,
or replacement.
U. Inmates. If
you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release medical
information about you to the correctional institution or law
enforcement official.
V. Victims of
Abuse, Neglect or Domestic Violence. We may release medical
information to a government authority if we reasonably believe
that you are a victim of abuse, neglect or domestic violence, to
the extent authorized or required by law. We must inform you or
your personal representative that we have disclosed information
for this purpose unless we believe that telling you or your
personal representative would place you in risk of serious harm
or otherwise not be in your best interest.
W. Child Abuse.
We may release medical information to a government authority
authorized by law to receive reports of child abuse or neglect.
IV. OTHER USES OF
MEDICAL INFORMATION
Other uses and
disclosures of medical information not covered by this Notice or
the laws that apply to us will be made only upon a specific
written authorization that you provide to us. If you provide us
authorization to use or disclose medical information about you,
you may revoke that authorization, in writing, at any time. If
you revoke your authorization, we will no longer use or disclose
medical information about you for the reasons covered by your
written authorization. The revocation, however, will not have
any effect on any action the surgery center took before it
received the revocation.
V. QUESTIONS OR
COMPLAINTS
If you have questions
and would like additional information, you may contact Carol S.
Slagle, Administrator, Privacy Officer at (315) 451-6911 at the
Surgery Center or Bill Schellinger, Privacy Officer at (315)
345-8109 at the Anesthesia Group offices.
If you believe your
privacy rights have been violated, you can submit a written
complaint describing the circumstances surrounding the violation
to Carol S. Slagle, Administrator, (315) 451-6911, 225
Greenfield Parkway, Suite 105, Liverpool, New York, 13088 at the
Surgery Center or to the Secretary of Health and Human Services
in Washington, D.C. You will not be penalized for filing any
complaint.
