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Effective Date: 04/14/03
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.
If you have any questions about this notice,
please contact our
Privacy Officer at (503) 221-1870
WHO WILL FOLLOW THIS NOTICE.
This notice describes our surgicenter's practices and that of:
Any health care professional authorized to enter information into
your chart.
All departments and units of the surgicenter.
Any member of a volunteer group we allow to help you while you
are in the surgicenter.
All employees, staff and other surgicenter personnel.
All these entities will follow the terms of this notice. In addition,
these entities, may share medical information with each other
for treatment, payment or hospital operations 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 the surgicenter. 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 by the surgicenter,
whether made by surgicenter personnel or your personal doctor
or other practitioners involved in your care.
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:
make sure that medical information that identifies you is kept
private;
give you this notice of our legal duties and privacy practices
with respect to medical information about you; and 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 personnel who are involved in your
care. For example, our physicians will need to know of your past
medical history in order to evaluate your condition and health
care needs. Different departments of the surgicenter also may
share medical information about you in order to coordinate the
different things you need, such as prescriptions, lab work and
ultrasounds. We also may disclose medical information about you
to people outside the surgicenter who may be involved in your
medical care after you leave the surgicenter, such as pharmacies.
For Payment. We may use and disclose medical information
about you so that the treatment and services you receive at the
surgicenter 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
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 surgicenter operations. These uses and
disclosures are necessary to run the surgicenter 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 surgicenter
patients to decide what additional services the surgicenter should
offer, what services are not needed, and whether certain new treatments
are effective. We may also disclose information to doctors, nurses,
technicians, health care students, and other personnel for review
and learning purposes. We may also combine the medical information
we have with medical information from other clinics 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.
Research. All research is strictly on a volunteer basis
at the surgicenter. Under certain circumstances, we may use and
disclose medical information about you for research purposes.
For example, a research project may involve comparing the results
of all patients who received one medication to those who received
another, for the same condition. All research projects, however,
are subject to a special approval process. We will ask for your
specific permission.
As Required By Law. We will disclose medical information
about you when required to do so by federal, state or local law.
SPECIAL SITUATIONS
Military. 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.
Business Associates. We may contract with business associates
to perform activities on our behalf, such as payment and health
care operations. These business associates are also under contract
to safeguard your PHI.
Public Health Risks (Health and Safety to you and/or others).
We may disclose medical information about you for public health
activities. We may use and disclose medical information about
you to agencies when necessary to prevent a serious threat to
your health and safety or the health and safety of the public
or another person. These activities generally include the following:
to prevent or control disease, injury or disability;
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 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.
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 person s agreement;
About a death we believe may be the result of criminal conduct;
About criminal conduct at the hospital; 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.
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
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 (I)
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.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following 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, contact the Medical Records Department at
(503) 221-1870. 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 surgicenter 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 the surgicenter.
To request an amendment, your request must be made in writing
and submitted to the Medical Records Department. 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 hospital;
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 others
except for purposes of treatment, payment and operations identified
above.
To request this list or accounting of disclosures, you must submit
your request in writing to the Medical Records Department. Your
request must state a time period which 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, 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.
Please note that it is not the practice of Lovejoy Surgicenter
to disclose information to friends or family members without your
prior consent. But we must, by law, let you know how you can request
restrictions. We automatically assume that your healthcare information
is confidential unless you inform us otherwise.
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 Medical Records Department. 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 about medical matters in a certain way or at a
certain location. For example, you can ask that we only contact
you at work.
To request confidential communications you can let us know verbally.
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 privacy notice. You may ask us to give
you a copy of this privacy notice at any time by requesting a
copy from any member of our personnel.
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
in the hospital. The notice will contain on the first page, in
the top right-hand corner, the effective date. In addition, each
time you are admitted to the surgicenter for treatment or health
care services, we will offer you a copy of the current notice
in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you
may contact or submit your complaint in writing to the Privacy
Officer in the Medical Records Department at the surgicenter.
If we cannot resolve your concern, you also have the right to
file a written complaint with the Secretary of the Department
of Health and Human Services.
The quality of your care will not be jeopardized nor will you
be penalized for filing a complaint.
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
our records of the care that we provided to you.
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