HIPPA
Privacy Notice This
notice describes how medical information about you may be used and disclosed and
how you can get access to this information. Please review 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 or 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 condition. Uses
and Disclosures of Protected Health Information
The ASC 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 Winter Haven ambulatory
Surgical Center has obtained your authorization or the use or disclosure is otherwise
permitted by the IHPAA privacy regulations or state law. Disclosures of your protected
health information for the purposes described in this Privacy Notice may be made
in writing, orally, or by facsimile. 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 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.
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 insurance
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 service 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.
Operations
We may use or disclose your protected
health information, as necessary, for our own health care operations to facilitate
the function of the ASC and to provide quality care to all patients. Health care
operations include such activities as: Quality Improvement/Assessment activities,
employee review activities, training programs including those 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. 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 procedure date, to inform you of potential treatment alternatives or options,
or to inform you of health-related benefits or services that may be of interest
to you.
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: When
Legally Required
We will disclose your protected health information when
we are required to do so by any federal, state or local law.
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 intervention 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 to an employer information about an individual who is a member of th3 workforce
as legally permitted or required.
- To
Report Suspected 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.
- 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 or public benefits.
In
connections With Judicial and Administrative Proceedings. W 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 e3tnt authorized by state law if
we receive satisfactory assurances that you have been notified of the request
of that an effort was made to secure a protective order.
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 a 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 your are the victim of a crime. - To
a law enforcement official if the facility has a suspicion that your health condition
was the result of a criminal conduct.
- In
an emergency to report a crime.
- 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.
- For
Research Purposes. We may use and disclose your protected health information for
research when the use or disclosure for research as 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.
- In
the Event of a Serious Threat to Health or Safety. We may, consistent with 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.
- 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
an others, medical suitability determinations, correctional institutes, and law
enforcement custodial situations.
- For
Worker’s compensations. The facility may release your health information
to comply with worker’s compensation laws or similar programs
Uses and
Disclosures Permitted without Authorization but with Opportunity to Object.
- 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 procedure or payment related to your procedure. 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 disclosure 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. Uses
and Disclosure which you Authorize
Other than as stated above, we will
not disclose your health information other than 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. Your
Rights
You have the following rights regarding your health information: 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 physician and the facility uses for decisions about you.
Under federal
law, however, you may not inspect or copy the following records: psychotherapy
notes; information complied 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. 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 o 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 o for notification purposes a described
in the Privacy Notice. You 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. The
right to request to receive confidential communications from us by alternative
means or at an alternative location. You have the right to request 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.
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 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.
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 that 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 requests 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 fore 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 a reasonable cost-based fee.
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.
Our Duties
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 re 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. 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. 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: Winter
Haven Ambulatory Surgical Center
325 Ave. B, NW
Winter Have, FL 33881
ATTN:
Privacy Officer
The Privacy Officer can be contacted by telephone at 863-291-4000. Effective
Date
This Notice is effective April 14, 2003.
|
