Our Privacy Pledge
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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 or condition.
I. 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 the facility has obtained your authorization or the
use or disclosure is otherwise permitted by the HIPAA 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. 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 the ASC 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:
While this does not apply to you at ASC,
we are required by law to inform you,
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 to an 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
or 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.
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 the victim
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 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 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 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 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.
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 on
the last page 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 our Privacy
Officer if you have questions about access to your medical record.
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 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 a 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. 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 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:
ASC Durango
1 Mercado Street, Suite 210
Durango, CO 81301
Attn: Privacy Officer
The Privacy Officer can be contacted by telephone at
970-508-0500.
IX. Effective Date
This Notice is effective December 5, 2005.
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