THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED, 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 healthcare 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 healthcare 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 Peninsula Surgery Center may use your protected health information for purposes of providing treatment, obtaining payment for treatment, and conducting healthcare operations. Your protected health information may be used or disclosed only for these purposes unless the facility has obtained your authorization or to 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.
- Treatment. We will use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare 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.
- Payment. Your protected health information will be used, as needed, to obtain payment for the services that we provide. This may 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.
- Operations. We may use or disclose your protected health information, as necessary, for our own healthcare operations to facilitate the function of the ASC and to provide quality care to all patients. Healthcare operations include such activities as: Quality assessment and improvement activities, employee review activities, trainees, practitioners in healthcare learn under supervision, accreditation, certification, licensing or credentialing activities, review and auditing, including compliance reviews, medical reviews, legal services, maintaining compliance programs, business management and general administrative activities.In certain situations, we may also disclose patient information to another provider or health plan for their healthcare operations.
- Other Uses and Disclosures. As part of treatment, payment and healthcare operations, we may also use or disclose your protected health information for the following purposes: To remind you of your surgery date, to inform you of potential treatment alternatives or options, to inform you of health-related benefits for services that may be of interest to you, or to contact you to raise funds for the facility or an institutional foundation related to the facility. If you do not wish to be contacted regarding fundraising, please contact our Privacy Officer.
II. Uses and Disclosures Beyond Treatment, Payment, and Healthcare Operations Permitted without Authorization or Opportunity to Object
Federal privacy rules allow us to use or disclose of 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:
- To prevent, control, or report disease, injury or disability as permitted by law
- To report vital events such as birth or death as permitted or required by law
- To conduct public health surveillance, investigations and interventions as permitted or required by law
- To collect or report adverse events in product defect, Track FDA regulated products, enable product recalls, repairs or replacements to the FTA and to conduct post marketing surveillance
- To notify a person who has been exposed to communicable disease or who may be at risk of contracting or spreading a disease as authorized by law
- To report to an employer information about an individual who is a member of the workforce as legally permitted or required
C. To Report Suspected Abuse, Neglect or Domestic Violence
We may notify government authorities if we believe that a patient is the victim of abuse, neglect or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.
D. To Conduct Health Oversight Activities
We may disclose your protected health information to a health oversight agency for 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. We will not disclose your health information under this authority if you are the subject of an investigation and your health information is not directly related to your receipt of healthcare or public benefits.
E. In Connection with the Judicial and Administrative Proceedings
We may disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order. In certain circumstances, we may disclose your protected health information in response to a subpoena to the extent authorized by state law if we receive a satisfactory assurance that you have been notified of the request or that an effort was made to secure a protective order.
F. For Law Enforcement Purposes
We may disclose your protected health information to a law-enforcement official for law enforcement purposes as follows:
- As required by law for reporting of certain types of wounds for or other Physical injuries
- Pursuant to court order, court ordered warrant, subpoena, summons or similar process
- For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
- Under certain limited circumstances, when you are the victim of a crime
- To a law-enforcement official if the facility has a suspicion that your health condition was the result of criminal conduct
- In an emergency to report a crime
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 lesson a serious and imminent threat to your health or safety or to the health and safety of the public.
J. For a Specified Government Functions. In certain circumstances, federal regulations authorize the facility to use or disclose you are 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 determination, 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 persons 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 interest 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 note 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 protect and 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 determined 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 with 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 cost 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 healthcare 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 not 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 request. We may condition this accommodation by asking you for information as to how payment will be handled or specification of an alternate address or other method of contact. We will not require you to provide an explanation for your request. Request 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. Request for amendments 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 healthcare 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 request may not be made for periods of time to 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 except this notice.
This information is also available on MyChart as well as Peninsula Surgery Center Website
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.
You have the right to express complaints to the facility add 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 facilities 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.
The facilities 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 the privacy rights have been violated by this facility you may submit a complaint to our Privacy Officer by sending it to:
Peninsula Surgery Center • 350 Marine Parkway • Redwood City, CA 94065
ATTN: Lisa Harvey RN, Privacy Officer
The Privacy Officer can be contacted by telephone at (650) 865-6400