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Effective Date: April
14, 2003
Notice of Privacy Practices of UNITED SURGICAL ASSOCIATES, P.S.C.
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.
CONTACT PERSON: If you have any questions about this notice,
please contact the Privacy Officer in our Administrative Offices of United Surgical
Associates at 701 Bob-O-Link Drive, Suite 120, Lexington, KY 40504. The phone
number of the Privacy Officer is (859) 277-5934.
This notice describes our organizations practices as they relate to the use
and disclosure of your medical information.
WHO WILL FOLLOW THIS NOTICE.
• Any health care professional authorized to enter information into your
medical chart.
• Any member of a volunteer group we allow to help you while you are our
patient.
• All employees, staff and other professional personnel of our organization.
• The persons listed above may share your medical information with each
other for the treatment, payment or heath care operation purposes described
in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal.
We are committed to protecting medical information about you. We create a record
of the care and services you receive at our organization. We need this record
to provide you with quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care generated or maintained
by us, whether made by our personnel or other health care providers.
This notice will tell you about the ways in which we may use and disclose medical
information about you. We also describe your rights and certain obligations
we have regarding the use and disclosure of medical information.
We are required by law to: (1) make sure that medical information that identifies
you is kept private; (2) give you this notice of our legal duties and privacy
practices with respect to medical information about you; and (3) follow the
terms of the notice that is currently in effect.
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 we
mean and try to give some 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 doctors, nurses, technicians, medical students, or other health care
personnel who are involved in taking care of you at our organization. For example,
a physician who is treating you for a broken leg may need to know if you have
diabetes because diabetes may slow the healing process. We also may disclose
medical information about you to people outside our organization who may be
involved in your medical care such as family members, clergy 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 from us 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 treatment information about any treatment
you receive so your health plan will pay us or reimburse you for the treatment.
We may also tell your health plan about a treatment you are going to receive
to obtain prior approval, authorization, or to determine whether your health
plan will cover the treatment.
• For Health Care Operations. We may use and disclose medical information
about you for our administrative operations. These uses and disclosures are
necessary to run our organization 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 of our patients to decide
what additional services our organization should offer, what services are not
needed, and whether certain new treatments are effective. We may also disclose
information to doctors, nurses, technicians, and other health care personnel
for review and learning purposes. We may also combine the medical information
we have with medical information from other organizations 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.
• Appointment Reminders. We may use and disclose medical information to
contact you as a reminder that you have an appointment for treatment or medical
care.
• Treatment Alternatives. We may use and disclose medical information
to recommend or tell you about possible treatment options 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 health-related benefits or services 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. We may also give information to someone who helps pay for
your care. We may also tell your family or friends your condition if you are
hospitalized. In addition, we may disclose medical information about you to
an entity assisting in a disaster relief effort so that your family can be notified
about your condition, status and location.
• 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
• Military and Veterans. If you are a 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.
• 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.
• Coroners, Medical Examiners and Funeral Directors. We may release medical
information to a coroner or medical examiner. This may be necessary, for example,
to identify a deceased person or determine the cause of death. We may also release
medical information about patients of the hospital 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.
YOU HAVE CERTAIN RIGHTS REGARDING MEDICAL 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. 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, you must submit your request in writing to the contact person listed on
page one of this notice. If you request a copy of the information, 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 organization
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 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 our organization.
To request an amendment, your request must be made in writing and submitted
to the contact person listed on page one of this notice. 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 our organization;
• 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 make of medical
information about you without your authorization or unrelated to your treatment,
payment for your treatment, or our organizations health care operations.
To request this list or accounting of disclosures, you must submit your request
in writing to the contact person listed on page one of this notice. Your request
must state a time period that may not be longer than six years and may not include
dates before April 14, 2003. Your request should indicate in what form you want
the list (for example, on paper or electronically). 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
and you may choose to withdraw or modify your request at that time before any
costs are incurred.
• 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 to the contact
person listed on page one of this notice. 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
to the contact person listed on page one of this notice. 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 a Paper Copy of This Notice. You have the right to a paper
copy of this notice. You may ask us to give you a copy of this notice at any
time. Even if you have agreed to receive this notice electronically, you are
still entitled to a paper copy of this notice.
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 prominently
post a copy of the current notice in our organization. The notice will contain
on the first page, in the top right-hand corner, the effective date. In addition,
each time you register at our offices, we will offer you a copy of the current
notice in effect.
COMPLAINTS (You will not be penalized for filing a complaint.)
If you believe your privacy rights have been violated, you may file a complaint
with the address below or with our organization. All complaints must be
submitted in writing.
Region IV, Office for Civil Rights
U.S. Dept. of Health and Human Services
Atlanta Federal Center, Suite 3B70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
Voice Phone: 404-562-7886
Fax: 404-562-7881
Our Organization
Janie M. Ratliff, Esq.
Hemmer Spoor Pangburn DeFrank PLLC
250 Grandview Drive, Suite 200
Ft. Mitchell, KY 41017
859-344-1188 (general)
859-578-3869 (fax)
859-578-3867 ext. 234 (direct dial)
JRatliff@HemmerLaw.Com
OTHER USES OF MEDICAL INFORMATION AND WRITTEN AUTHORIZATION.
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 authorization.
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 acknowledge and understand
that we are unable to take back any disclosures we have already made with your
permission, and that we are required to retain our records of the care that
we provided to you.
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