HIPPA NOTICE OF PRIVACY PRACTICES


THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YO CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

Pacific Ambulatory Surgery Center, (the “Center”), is required to maintain the privacy of your health information and to provide you with a notice of its legal duties and privacy practices.  The Center will not use or disclose your protected health information except as described in this notice.  “Protected Health Information” is information about you which was created or received by the Center and that relates to your past, present or future physical or mental health or condition, or the provision of, or payment for, your health care and which could be used to identify you.  All uses and disclosures of protected health information (PHI) will follow HIPAA standards or policies.

EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH OPERATIONS:  The following categories describe the ways that the Center may use and disclose your protected health information without your written authorization.

Treatment:  The Center will use your health information in the provision and coordination of your healthcare.  We may disclose all or any portion of your protected health information to your attending physician, anesthesiologist, consulting physician(s), nurses, technicians, and other health care providers, including any hospital or emergency room personnel to whom you need to be transferred in the event of an emergency who have a legitimate need for such information in the care and continued treatment of the patient.  The Center also may disclose your health information to people outside the Center who may be involved in your private health care after you leave the Center, such as family members, clergy, and others used to provide services that are part of your care. 

Treatment Alternatives:  The Center may use and disclose your protected health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Family/Friends:  The Center may release private health record information about you to a friend or family member who is involved in your private health care.  We may also give information to someone who helps pay for your care.  We may also tell your family or friends your condition and that you are in the Center.  In addition, we may disclose protected health 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.

Payment:  The Center may release protected health information about you for the purposes of determining coverage, billing, claims management, private health data processing, and reimbursement.  The information may be released to an insurance company, third party payer or other entity (or their authorized representatives) involved in the payment of your medical bill and may include copies or excerpts of your private health record which are necessary for payment of your account.  For example, a bill sent to a third party payer may include information that identifies you, your diagnosis, and the procedures and supplies used.

Routine Healthcare Operations:  The Center may use and disclose your protected health information during routine healthcare operations, including quality assurance, utilization review, private health review, internal auditing, accreditation, certification, licensing or credentialing activities of the Center, private health research and educational purposes.

Appointment Reminders:  The Center may use and disclose protected health information to contact you as a reminder that you have an appointment for treatment or private health care at the Center.

Health Related Business and Services:  The Center may use and disclose your protected health information to tell you of health-related benefits or services that may be of interest to you.

Business Associates:  The Center may use and disclose certain protected health information about you to business associates.  A business associate is an individual or entity under contract with the Center to perform or assist the Center in a function or activity which necessitates the use or disclosure of protected health information.  Examples of business associates, include, but are not limited to, organizations, private health transcriptionists and third-party billing companies.  The Center requires the business associate to protect the confidentiality of your protected health information. 

Regulatory Agencies: The Center may disclose your protected health information to a health oversight agency for activities authorized by law, including, but not limited to, licensure, certification, audits, investigations and inspections.  These activities are necessary for the government and certain private health oversight agencies, e.g. Accreditation Association of Ambulatory Health Care (“AAAHC”) to monitor the healthcare system, government programs, and compliance with civil rights.

Law Enforcement / Litigation: The Center may disclose your protected health information for law enforcement purposes as required by law or in response to a valid subpoena or court order.

Public Health: As required by law, the Center may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.  For example, the Center may be required to report the existence of a communicable disease, such as acquired immune deficiency syndrome (“AIDS”), to the Department of Health to protect the health and well-being of the general public. 

Workers Compensation: The Center may release protected health information about you for workers’ compensation or similar programs.  These programs provide benefits for work-related injuries or illnesses. 

Military / Veterans:  The Center may disclose your protected health information as required by military command authorities, if you are a member of the armed forces.

Required by Law:  The Center will disclose protected health information about you when required to do so by law.  For example, the Center may disclose certain protected health information to those persons who have a risk exposure related to a communicable disease if required by law. 

Coroners, Medical Examiners, Funeral Directors:  The Center may disclose your protected health information to a coroner or private health examiner.  This may be necessary, for example, to identify a deceased person or to determine a cause of death.  The Center may also release your protected health information to funeral directors as necessary to carry out their duties.

Other Uses:  Any other uses and disclosures will be made only with your written authorization.

PATIENT HEALTH INFORMATION RIGHTS:  Although all records concerning your treatment obtained at the Center are the property of the Center, you have the following rights concerning your protected health information.  (“CFR” below stands for the Code of Federal Regulations).  To exercise any of these rights, please contact the Center in writing.

Right to Confidential Communications:  You have the right to receive confidential communications of your protected health information by alternative means or at alternative locations.  For example, you may request that the Center only contact you at work or by mail.

Right to Inspect and Copy:  You have the right to inspect and copy your protected health information as provided by 45 CFR § 164.524.

Right to Amend:  You have the right to amend your protected health information as provided by 45 CFR § 164.528.

Right to Accounting:  You have the right to obtain a statement of the disclosures of your protected health information as provided by 45 CFR § 164.528.

Right to Request Restrictions:  You have the right to request restrictions on certain uses and disclosures of your protected health information 45 CFR § 164.522.

Right to Receive Copy of this Notice:  You have the right to receive a paper copy of this Notice, upon request.

Right to Revoke Authorization:  You have the right to revoke your authorization to use or disclose your protected health information except to the extent that action has already been taken in reliance on your authorization.

FOR MORE INFORMATION OR TO REPORT A PROBLEM:  If you have questions and would like additional information, you may contact Pacific Ambulatory Surgery Center.  If you believe your privacy rights have been violated, you may file a complaint with the Center or with the Secretary of the U.S. Department of Health and Human Services.  To file a complaint with the Center, please call (626) 656-1285 or submit in writing to the following address:  707 S. Garfield Avenue, Suite 101, Alhambra, CA 91801.  There will be no retaliation for filing a complaint.

 

CHANGES TO THIS NOTICE:  The Center will abide by the terms of the notice currently in effect.  The Center reserves the right to change the terms of its notice and to make the new notice provisions effective for all protected health information that it maintains.  Center will distribute and post any revised Notice. 

 

NOTICE EFFECTIVE DATE:  The effective date of this notice is September 6, 2005.