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. Your "protected health information", or PHI means any written and oral health information about you, including demographic data that can be used to identify you.
SDC may use your PHI 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. In addition, the physicians and/or nurse anesthetists of Associated Anesthesiologists, S.C., working in association with the Peoria Ambulatory Surgery Center, may also use your PHI for purposes of providing treatment, obtaining payment for treatment, and conducting health care operations.
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
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.
C. Operations. We may use or disclose your protected health information, as necessary, for our own health care operations to facilitate the function of SDC and to provide quality care to all patients. Health care operations include such activities as: quality assessment and improvement activities, employee review activities, training, 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 appointment, 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.
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 by any federal, state or local law.
B. When There Are Risks to Public Health as required by law.
D. To Conduct Health Oversight 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.
E. In Connection With Judicial And Administrative Proceedings in response to an order of a court or administrative tribunal as expressly authorized by such order.
F. For Law Enforcement Purposes or as the law requires.
G. To Coroners, Funeral Directors, and for Organ Donation as authorized by law.
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 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.
A. The right to look at or get a copy of medical information. In most cases, you may review or obtain a copy of your protected health information that we use to make decisions on your care, when you make a written request to the Privacy Officer. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision. 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.
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. The request to restrict disclosure of authorized health information must be in writing, include the specific restriction requested, to who the restrictions apply, and presented to the privacy officer. Revocation will not apply to information that has already been released. 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.
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. 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 PHI 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 may appeal, in writing, a decision by us not to amend a record.
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. The request for an accounting must be made in writing to our Privacy Officer and 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, but 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.
V. 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/revises its Notice, we will provide a copy of the revised Notice at your next visit as well as posting our current Notice in the lobby and on our website.
VI. 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. You will not be retaliated against in any way for filing a complaint.
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:
Soderstrom Dermatology Center, S.C. The Privacy Officer can be contacted by telephone at 309-674-7546.
4909 N. Glen Park Place
Peoria, IL 61614
ATTN: Privacy Officer
© Soderstrom Dermatology Center, S.C. 2006, All Rights Reserved