NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED
AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
OUR COMMITMENT: when you receive services at East Norriton Surgical Center,
we will create a medical record, in order to provide you with quality care and
comply with legal requirements. This record is the property of our center. We
understand that the information in your medical record is personal and are
committed to protecting it in accordance with state and federal law.
WHO WILL FOLLOW THESE PRACTICES: this notice is provided o you as
required by the Health Insurance Portability and Accountability Act of 1996, and
related privacy and security laws and regulations (collectively known as
“HIPPA”). All of center’s health care professionals and all members of our staff
have agreed to follow the practices described in this notice in using, maintaining
and disclosing information about your that is protected health information under
HIPPA.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION: the following categories describe different ways we may use
and disclose protected health information. Not every use and disclosure within a
category is listed, but all of the ways we are permitted to use and disclosed
protected health information fall within one of these categories.
For Treatment: Our physician’s and other personnel involved in your care will
have access to information about you in order to provide you with medical
treatment and services. For example, our physicians need to know your health
history in order to determine what procedure may be appropriate for your care.
We may also disclose your protected health information to physicians and other
health professionals providing care to you, such as your primary care physician,
or a specialist treating you.
For Payment: We may use and disclose protected health information about you in
order to obtain payment for the services we provide to you. For example, we may
provide information about your diagnosis and the procedure to be done to your
insurance company or health plan in order to obtain pre-authorization for the
procedure, if required, and to obtain payment for the services we provide to you.
For Health Care Operations: We may use and disclose your protected health
information for the Center’s operations. For example, we may use and disclose
such information for the purpose of evaluating the quality of the services you
received, or the performance of the health care professionals involved in your
care.
Appointment Reminders; Benefits and Services: We may use your protected
health information to provide appointment reminders, or to inform you about
treatment alternatives, or other health-related benefits or services that may be of
interest to you.
Research Studies: We may use or disclose your protected health information for
research purposes, when the research proposal and protocols established to
ensure the privacy of your protected health information have been reviewed and
approved by an institutional review board or privacy board.
Business Associates: We may disclose protected health information to individuals
and entities we engage to perform specific functions for the center, such as
billing or transcription services. We require that our business associates
implement appropriate safeguards for such information.
Family and Friends; Disaster Relief: We may disclose your protected health
information to a family member or friend who is involved in your care, or to
someone who helps pay for your care. We may also disclose protected health
information to entities authorized to assist in disaster relief efforts. Except in
certain limited situations, such as an emergency or when you are unable to
communicate, we will first give you an opportunity to object to such disclosures.
Threat to Health or Safety: We may use and disclose protected health information
about you when necessary to prevent a serious threat to your health or safety, or
to the health or safety of the public or another individual.
Workers Compensation: We may release protected health information as
required by laws relating to workers’ compensation or similar programs.
Public Health Activities: We may disclose protected health information doe
public health activities, such as preventing or controlling disease, injury or
disability; reporting reactions to medications or problems with products;
notifying a person who may be at risk for contracting or spreading a disease; or
reporting workplace injury or illness.
Domestic Violence, Abuse of Neglect: We may disclose protected information in
notifying a government authority of suspected domestic violence, abuse or
neglect, when required or authorized by law.
Health Oversight Activities: We may disclose protected health information to a
health oversight agency for activities authorized by law. These activities might
include, for example, audits, investigations and inspections conducted to monitor
the health care system and government programs.
Lawsuits and Disputes: If you are involved in a lawsuit or other dispute or legal
action, we may disclose your protected health information in response to a court
or administrative order and, under some circumstances, in response to a
subpoena, discovery request, or other lawful process by someone else involved
in the dispute.
Law Enforcement: Under certain circumstances we may release protected health
information to assist law enforcement officials in their law enforcement duties.
Coroners, Medical Examiners, Procurement Organizations and Funeral
Directors: We may release protected health information to a coroner or medical
examiner as necessary to identify a deceased person, or determine the cause of
death, to organizations involved in procurement, banking or transplantation of
organs or tissues, and to funeral directors as necessary to fulfillment of their
duties.
Specialized Government Functions: We may release protected health information
certain specialized government functions. For example:
Military Personnel: If you are a member of the armed forces, we may release
protected health information as required by military authorities.
Inmates: In the case of an inmate of a correctional facility or the law enforcement
official, as necessary (1) to provide the inmate with the health care; (2) to protect
the health and safety of the inmate or others; or (3) for the safety and security of
the correctional facility or law enforcement official.
National Security and Intelligence Activities; Security Clearances: We may
disclose your protected health information to authorized federal officials for
purposes of intelligence, counterintelligence, security clearances, and other
national security activities, as authorized by law.
As Required by Law: We will disclose protected health information about you
when required to do so by federal, state or local law.
USES OR DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION:
We are required to obtain your written authorization for the following uses or
disclosures of your Protected Health Information, unless otherwise permitted or
required by law:
- Most uses and disclosures of psychotherapy notes and/or mental health
information; - Uses and disclosures of HIV status;
- Uses and disclosures related to alcohol and substance abuse;
- Uses and disclosures for marketing purposes such as providing your
protected health information to a pharmaceutical company or placing you
on a mailing list. - Uses and disclosures that constitute a sale of your protected health
information; or - A request by you to provide your health information to an attorney for use
in a civil litigation claim
You have the right to revoke a written authorization at any time as long as your
revocation is provided in writing to our Privacy Officer at the office address at
the end of this notice. If you revoke your written authorization, we will no longer
use or disclose your protected
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION: You have
the following rights regarding the protected health information we maintain
about you: - Right to Inspect and Copy: You have the right to inspect and copy medical
information that may be used to make decisions about your care. To
inspect or copy medical information that may be used in making decisions
about your care, submit a request in writing to our Privacy Officer. If you
request a copy of the information, we may charge a fee to cover our costs
associated with the request. In very limited circumstances, we may deny a
request to inspect and copy medical information. In most but not all
circumstances, if you are denied access to medical information, you may be
able to request that denial be reviewed. In that case, a licensed health care
professional other than the individual who denied your request will be
chosen by the center to review your request and the denial. - Right to Amend: If you feel that medical information we have about you is
incorrect or incomplete, you may ask us to amend our information. A
request to amend your medical information must be submitted to our
Privacy Officer in writing, with a reason supporting your request. We may
deny your request if it is not in writing or does not include a reason
supporting your request. In addition, we may deny a request if you ask us
to amend information that was not created by us, unless the person or
entity that created the information is no longer available to make the
amendment, or is not part of the information you would be permitted to
inspect or copy, or is accurate and complete. If we deny your request for an
amendment, we will notify you of the reason for the denial. You may then
submit a statement of disagreement, or ask that your request become part
of your medical record. These documents, and any rebuttal we prepare,
will become part of your medical record. - Right to an Accounting of Disclosures: You have the right to request a list of
the instances in which we have disclosed your protected health
information. Your request must be in writing, directed to our Privacy
Officer, and must state a time period not longer than six years. The first list
you request within a twelve month period will be free of charge. We may
charge you the costs of providing any additional lists within the same
twelve month period. The list will not include disclosures for treatment,
payment or Center operations, disclosures to family members or friends
involved in your care, or disclosures that you have authorized in writing. - Right to Request Restrictions: You have the right to request a restriction or
limitation on the protected health information we use or disclose about
your for treatment, payment or operations. You also have the right to
request a limitation on the protected health information we disclose to
someone involved in your care or the payment for your care, such as a
family member or friend. You must make your request in writing, directed
to our Privacy Officer. Your request must tell us (1) what information you
want to limit; (2) whether you want to limit our use or disclosure, or both;
and (3) to whom you want the limits to apply. We are not required to agree
to your request. If we do agree we will comply with your request unless
the information is needed to provide emergency treatment to you. - Right to Request Confidential Communications: You have the right to
request that we communicate with you about medical information in a
certain way, or at a specific location. For example, you can request that we
contact you at work. Your request for confidential communications must
be made in writing, directed to our Privacy Officer. You need not specify a
reason for your request. We will accommodate reasonable requests, when
possible. - Right to Restrict Disclosure to a Health Plan for Out-of-Pocket-Payments:
You have the right to request that we not disclose to your health plan or
other insurer protected health information with respect to an item or
service for which you pay out-of-pocket in full. You must make your
request in writing, and we are required to honor it. - Right to Paper Copy of this Notice: You have a right to a paper copy of this
notice at any time.
OUR RESPONSIBILITIES REGARDING YOUR PROTECTED HEALTH
INFORMATION: We are required to (1) keep protected health information that
identifies your private; (2) give you this notice of our legal duties and privacy
practices with respect to protected health information; (3) follow the terms of
the notice that is currently in effect; and (4) notify you of a breach of your
secured protected health information, in accordance with applicable
requirements of HIPPA.
Changes to this Notice: we reserve the right to change this notice, and to make
the changed notice effective for protected health information we already have
about you as well as any information we receive in the future. We will post a copy
of our current notice in our office, and on our website (www.eastnorritonsc.com)
and give you a copy upon request.
Complaints: If you believe your privacy rights have been violated, you may file a
complaint with our Privacy Officer at the address below. In addition, you may file
a complaint with the Secretary of the Department of Health and Human Services.
You will not be penalized for filing a complaint.
Contact our Privacy Officer, Taylor Fox, at:
East Norriton Surgical Center
317 W Germantown Pike Ste 102
East Norriton, PA 19403
(267) 392-2402