Notice of Privacy Practices
Effective April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.
If you have any questions about this Notice, please contact our Privacy Officer at 814-943-7040.
This Notice of Privacy Practices 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. "Protected health information" is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
We are required to abide by the law, terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices by accessing our web site at alleghenyregionalsurgical.com and/or lexingtonsurgicalassoc.com, calling the office and requesting that a revised copy be sent to you in the mail or requesting one at the time of your next appointment.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
You will be asked by our staff to sign an acknowledgement form. Your protected health information may be used and disclosed by your physician, our office staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care service to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the physician's practice.
Following are examples of the types of uses and disclosures of your protected health care information that the physician's office is permitted to make once you have signed our consent form. These examples are not meant to be inclusive, but to describe types of uses and disclosures made by our office once you have provided acknowledgement
Treatment
We will use and disclose your protected health information to provide, coordinate, and manage your health care and any related services. This includes the coordination and management of your health care with a third party that has already obtained your permission to have access to your protected health information. For example, we may disclose some of your protected health information to a home nursing agency that provides care to you. We may also disclose your protected health information to other physicians whom we refer you to. In addition, from time to time, we may release this information to another physician or health care provider (specialist or laboratory) who, at the request of our physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.
Payment
Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, we may need to disclose relevant protected health information to obtain approval for your surgery or admission to the Hospital.
Healthcare Operations
We may use or disclose, as-needed, your protected health information in order to support the business activities of Lexington Surgical Associates. These may include, but are not limited to, quality assessment activities, training of medical students, licensing, and other business activities.
For example, we may call you by name in the waiting room when the physician is ready to see you. We may use or disclose your protected health information, as necessary, to call and remind you of your appointment.
Uses and Disclosures of Protected Health Information
Others Involved in Your Healthcare
Unless you object, we may disclose to a member of your family, a relative, or close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object, we may disclose such information as necessary if we determine that is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care, general condition, or death.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization at any time, in writing, except to the extent that your physician or the physician's practice has taken an action in reliance on the use or disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization, or Opportunity to Object
We may use or disclose your protected health information in the following situations without your authorization:
Required by Law - We may use or disclose your protected health information to the extent that the use or disclosure is required by law. This will be made in compliance with the law and will be limited to relevant requirements of the law. Your will be notified, as required by law, of any such uses or disclosures.
Public Health - We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. This disclosure may be made for the purpose of controlling disease, injury, or disability.
Communicable Diseases - We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight - We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information may include government agencies that oversee the health care system, government benefit programs, and other government regulatory programs and civil rights laws.
Abuse or Neglect - We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim or abuse, neglect, or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration - We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, tract products, to enable product recalls, make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings - We may disclose protected health information in the course of any judicial or administrative proceeding, in response to a court order or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request, or other lawful purpose.
Law Enforcement - We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These may include: Legal processes as otherwise required by law; limited information requests for identification and location purposes; pertaining to victims of a crime; suspicion that death has occurred as a result of criminal conduct; in the event that a crime occurs on the premises of the practice; and medical emergency, and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation - We may disclose protected health information to a coroner or medical examiner for identification purposes, determining the 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.
Criminal Activity - Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose this information to law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security - When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military command authorities, for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or to disclose protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to those legally authorized.
Worker's Compensation - Your protected health information may be disclosed by us as authorized to comply with workers' compensation laws and other similar legally established programs.
Inmates - We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.
Required Uses and Disclosures - Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. Seq.
Your Rights
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights:
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you 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 practice 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 use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny accesses may be reviewable. In some circumstances, you may have a right to have this decision reviewed.
You have the right to request a restriction of your protected health information. This means you may request in writing that we not to use or disclose any part of your protected health information for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who are involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state specific restriction requested and to whom you want the restrictions to apply.
Your physician is not required to agree to a restriction that you may request. If the physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your physician does agree to the requested restriction, release would be in violation of that request, unless in a case of emergency treatment. You must discuss any restriction request with your physician.
You have a right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate all reasonable requests and will not request an explanation from you on the basis of such request. Please make this request in writing to our Privacy Officer.
You have the right to request that your physician make amendments your protected health information. You may request in writing, that an amendment of your protected health information be made, as long as we maintain this information. In certain cases, we may deny your request. If we deny your request for amendment, you have the right to file a statement disagreement with us and we may prepare a rebuttal to your statement and will provide you a copy of such rebuttal.
You have the right to receive an accounting of certain disclosures we have made. This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Notice of Privacy Practice. The right to receive this is subject to certain exceptions, restrictions, and limitations.
Complaints
You may complain to us or to the Secretary of Health and Human Services if you believe your rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer. We will not retaliate against you for filing a complaint.
You may contact our Privacy Officer at 814-943-7040 for further information about the complaint process.