ZANESVILLE
SURGERY CENTER’S 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 Zanesville
Surgery Center 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.
The
Zanesville Surgery Center is operating as a clinically integrated
health care organization with Genesis Healthcare System.
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, time and to give specific instructions.
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:
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:
Zanesville
Surgery Center
2907 Bell Street
Zanesville, Ohio 43701
ATTN: Privacy Officer
The
Privacy Officer can be contacted by telephone at 740-455-6300.
IX.
Effective Date
This
Notice is effective April 14, 2003.
