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Northeast
Missouri Ambulatory Surgery Center, LLC
Notice of Privacy Practices
This
notice describes how medical information about you may be used
and disclosed, and how you can get access to this information.
PLEASE REVIEW THIS
NOTICE CAREFULLY. If you have any questions about this notice,
please contact the Privacy Officer at (573) 406-1301.
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.
HOW WE MAY USE AND DISCLOSE
MEDICAL INFORMATION
ABOUT YOU
The following categories describe different ways that we use and
disclose medical information. For each category of uses or
disclosures, we will explain what is meant and give examples.
Not every use or disclosure in a category will be listed.
However, all of the ways we are permitted to use and disclose
information will fall within one of the categories.
For Treatment:
We may use medical information about you to provide you with
medical treatment or services.
We may
disclose medical information about you to the Medical Staff,
doctors, nurses, technicians, medical students, anesthesia, or
other Center personnel who are involved in taking care of you at
the Center. For example, a doctor treating you for a broken leg
may need to know if you have diabetes because diabetes may slow
the healing process. The Center may share medical information
about you with other providers such as Pharmacy, Lab, and X-Ray.
We also may
disclose medical information about you to people outside the
Center who may be involved in your medical care after you leave
the Center, such as family members, clergy, a hospital or others
we use to provide services that are part of your care.
For Payment:
We may use and disclose medical information about you so that
the treatment and services you receive at the Center may be
billed to and payment may be collected from you, an insurance
company or a third party. For example, we may need to give your
health plan information about surgery you received at the Center
so your health plan will pay us or reimburse you for the
surgery.
We may also tell your health plan about a treatment you are
going to receive to obtain prior approval or to determine
whether your plan will cover the treatment.
For Health Care Operations:
We may use and disclose medical information about you for Center
operations. These uses and disclosures are necessary to run the
Center and make sure that all of our patients receive quality
care. For example, we may use medical information to review our
treatment and services and to evaluate the performance of our
staff in caring for you.
We may also combine medical information about many surgical
patients to decide what additional services the Center should
offer, what services are not needed, and whether certain new
treatments are effective.
We may also disclose information to doctors, nurses,
technicians, medical students, and other personnel for review
and learning purposes.
We may also combine the medical information we have with medical
information from other Centers to compare how we are doing and
see where we can make improvements in the care and services we
offer.
We may remove information that identifies you from this set of
medical information so others may use it to study health care
and health care delivery without learning who the specific
patients are.
Treatment Alternatives:
We may use and
disclose medical information to tell you about or recommend
possible treatment operations or alternatives that may be of
interest to you.
Health-Related Benefits and
Services:
We may use and
disclose medical information to tell you about or recommend
possible treatment options or alternatives that may be of
interest to you.
Individuals Involved In Your Care
Or Payment For Your Care:
We may release medical information about you to a friend or
family member who is involved in your medical care or payment
for care. 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, we may disclose your protected health
information as described.
As Required By
Law:
We will disclose medical information about you when required to do so
by federal, state, or local law.
To Avert A Serious Threat To
Health Or Safety:
We may use and disclose medical information about you when necessary to
prevent a serious threat to your health and safety or the health
and safety of the public or another person. Any disclosure,
however, would only be to someone able to help prevent the
threat.
SPECIAL
SITUATIONS
(Federal privacy rules allow us to
use or disclose your protected health information without your
permission or authorization when situations as below arise.)
Military And Veterans:
If you are
member of the armed forces, we may release medical information
about you as required by military command authorities. We may
also release medical information about foreign military
personnel to the appropriate foreign military authority.
Workers Compensation:
We may release
medical information about you
for workers compensation or similar programs. These programs
provide benefits for work-related injuries or illness.
Public Health Risks:
We may disclose medical information about you for public health
activities. These activities generally include the following:
to prevent or control disease, injury, or disability; to report
births and deaths; to report child abuse or neglect; to report
reactions to medications or problems with products; to notify
people of recalls of products they may be using; to notify a
person who may have been exposed to a disease or may be at risk
for contracting or spreading a disease or condition; to notify
the appropriate government authority if we believe a patient has
been the victim of abuse, neglect or domestic violence (we will
only make this disclosure if you agree or when required or
authorized by law).
Health Oversight Activities:
We may disclose medical information to a health oversight agency for
activities authorized by law. These oversight activities
include, for example, audits, investigations, inspections, and
licensure. These activities are necessary for the government to
monitor the health care system, government programs, and
compliance with civil rights laws.
Lawsuits And Disputes:
If you are involved in a lawsuit or a dispute, we may disclose medical
information about you in response to a court or administrative
order.
We may also disclose medical information about you in response to a
subpoena, discovery request, or other lawful process by someone
else involved in the dispute, but only if efforts have been made
to tell you about the request or to obtain an order protecting
the information requested.
Law Enforcement:
We may release medical information if asked to do so by a law
enforcement official:
In response to a court order, subpoena, warrant, summons, or
similar process;
To identify or locate a suspect, fugitive, material witness, or
missing person;
About the victim of a crime, if, under certain limited
circumstances, we are unable to obtain the personal agreement;
About criminal conduct at the Center; and
In emergency circumstances to report a crime; the location of
the crime or victims; or the identity, description or location
of the person who committed the crime.
Coroners, Medical Examiners, And
Funeral Directors:
We may release medical information to a coroner or medical examine, for
example to identify a deceased person or determine the cause of
death.
We may also release information about patients of the Center to funeral
directors as necessary to carry out their duties.
National Security And Intelligence
Activities:
We may release medical information about you to authorized federal
officials for intelligence, counterintelligence, and other
national security activities authorized by law.
Protective Services For The
President And Others:
We may disclose medical information about you to authorized federal
officials so they may provide protection to the President, other
authorized persons or foreign heads of state or conduct special
investigations.
Inmates:
If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release medical
information about you to the correctional institution or law
enforcement official. This release would be necessary (1) for
the institution to provide you with health care; (2) to protect
your health and safety or the health and safety of others; or
(3) for the safety and security of the correctional institution.
Other Uses of Medical Information:
Other uses and
disclosures of medical information not covered by this notice or
the laws that apply to us will be made only with your written
permission. If you provide us permission to use or disclose
medical information about you, you may revoke that permission,
in writing, at any time. If you revoke your permission, we will
no longer use or disclose medical information about you for the
reasons covered by your written authorization. You understand
that we are unable to take back any disclosures we have already
made with your permission, and that we are required to retain
records of the care that we provided to you.
YOUR RIGHTS REGARDING MEDICAL
INFORMATION ABOUT YOU
Right To Inspect And Copy:
You have the right to inspect and copy medical information that may be
used to made decisions about your care. Usually, this includes
medical and billing records, but does not include psychotherapy
notes.
To inspect and copy medical information that may be used to make
decisions about you, submit your request in writing to the
Center. We may charge a fee for the costs of copying, mailing
or other supplies associated with your request. We may deny
your request to inspect and copy in certain very limited
circumstances. If you are denied access to medical information,
you may request that the denial be reviewed. Another licensed
health care professional chosen by the Center will review your
request and the denial. The person conducting the review will
not be the person who denied your request. We will comply with
the outcome of the review.
Right To Request Restrictions:
You have the right to request a restriction or limitation on the
medical information we use or disclose about you for treatment,
payment, or health care operations. You also have the right to
request a limit on the medical information we disclose about you
to someone who is involved in your care or the payment for your
care, like a family member or friend. For example, you could
ask that we not use or disclose information about a surgery you
had.
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 you emergency treatment.
To request
restrictions, you must make your request in writing. In your
request, you must tell us (1) what information you want to
limit; (2) whether you want to limit our use, disclosure or
both; and (3) to whom you want the limits to apply, for example,
disclosures to your spouse.
Right To Request Confidential
Communications:
You have the right to request that we communicate with you about
medical matters in a certain way or at a certain location. For
example, you can ask that we only contact you at work or by
mail. To request confidential communications, you must make
your request in writing. We will not ask you the reason for
your request. We will accommodate all reasonable requests.
Your request must specify how or where you wish to be contacted.
Right To Amend:
If you feel that medical information we have about you is incorrect or
incomplete, you may ask us to amend the information. You have
the right to request an amendment for as long as the information
is kept by or for the Center. To request an amendment, your
request must be made in writing and submitted to the Center. In
addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in
writing or does not include a reason to support the request. In
addition, we may deny your 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;
Is not part of the medical information kept by or for the
Center;
Is not part of the information which you would be permitted to
inspect and copy; or
Is
accurate and complete.
Right To An Accounting Of
Disclosures:
You have the right to request an accounting of disclosures. This is a
list of the disclosures we made of medical information about
you. To request this list or accounting of disclosures, you
must submit your request in writing to the Center. Your request
must state a time period which may not be longer than six years
and may not include dates before April 14, 2003. The first list
you request within a 12-month period will be free. For
additional lists, we may charge you for the costs of providing
the list. We will notify you of the cost involved. You may
choose to withdraw or modify your request at that time before
any costs are incurred.
CHANGES TO
THIS NOTICE
We reserve the right to change
this notice. We reserve the right to make the revised or
changed notice effective for medical information we already have
about you as well as any information we receive in the future.
We will post a copy of the current notice (including an
effective date) in the facility. In addition, each time you
register for treatment for health care services, a copy of the
current notice will be offered.
COMPLAINTS
If you believe
your privacy rights have been violated, you may file a complaint
with the Privacy Officer, or with the Secretary of the
Department of Health and Human Services. Submit complaints in
writing to the below address and contact. You will not be
penalized or retaliated against for filing a complaint.
Northeast Missouri Ambulatory Surgery Center
Attn: Privacy Officer
98 Medical Drive
Hannibal, MO 63401
(573) 406-1301 |
