The Surgery Center Privacy Notice
This Notice is being posted on The Surgery Center web site and/or given to you on behalf of the following people and organizations located or operating in Genesee County and the immediately surrounding area.
• The Surgery Center and the members of its workforce, including its employees, volunteers, and trainees,
• The members of The Surgery Center Medical Staff, and physicians holding temporary privileges at The Surgery Center
• Persons who have been granted clinical practice privileges by the Surgery Center
• Appropriate Surgery Center subsidiaries and related health care affiliates.
We are all covered entities subject to the same federal privacy law. When we are working together in the Surgery Center, we are also all part of an organized health care arrangement or OHCA in the sense that we follow the same privacy policies and procedures.
Our purpose in giving you this notice is to tell you how we will use and disclose health information about you within the OHCA. The term health information includes all health information we produce about you, such as information contained in your medical record or a designated record set, information used in invoices or payment forms, and information maintained as a hard copy, in electronic form, as photographs or videotapes or in any other medium. The term also includes health information about you we received from hospitals, health care providers, and health plans or health insurers.
Understanding Your Health Record/Information
Understanding what is in your record and how your health information is used helps you to:
• Ensure its accuracy
• Better understand who, what, when, where, and why others may access your health information
• Make more informed decisions when authorizing disclosure to others
Accordingly, we want you to know that each time you visit TSC; a record of your visit is made. This information, often referred to as your health or medical record, serves as a:
• Basis for planning your care and treatment
• Means of communication among the various health professionals who contribute to your care
• Official document describing the care you received
• Means by which you or a third-party payer can verify services billed
• Tool in educating heath professionals
• Tool used to assess and work to improve the care we render and the outcomes we achieve. Source of data for medical research
• Source of information for public health officials who regulate health care facilities and providers
• Source of data for facility planning and marketing
• In this Notice, activities like these are called treatment, payment and operations.
Examples of Disclosures for Treatment, Payment and Health Operations
What follows are some specific examples of how we may use your health information for Treatment, Payment and Health Operations purposes.
Uses for treatment purposes. A nurse from this facility may contact you prior to your surgery to obtain information about your medical history in order to perform a surgical pre-assessment. Your medical history and/or condition may be discussed with an anesthesiologist, your surgeon, your primary care physician and/or a specialist involved in your care. We may also provide your physician or a subsequent healthcare provider with copies of various reports that should assist them in treating you once you are discharged from this facility.
Uses for payment: We may send a bill to you or your insurance company or health plan. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. We may also tell your health plan about your scheduled surgery to obtain prior approval or to determine whether your plan will cover the treatment.
For regular health care operations: We may use medical information to review our treatment and services and to educate or evaluate the performance of our staff and to assess the care and outcomes in your case and others like it. We may also combine the medical information we have with medical information from other health care providers to compare how we are doing and see whether we can make improvements in the care and services we offer.
Uses and Disclosures We May Make Unless You Object
Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for or about you by name. There are exceptions.
Communication with family: Unless you notify us that you object, our health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that persons involvement in your care or payment related to your care.
Required Disclosures
We are required to make various disclosures of your protected health information (phi) by the final privacy rules. These required disclosures include:
• As authorized by law in connection with workers compensation programs
• When required by state or federal law. These include:
1. For judicial and administrative proceedings pursuant to legal authority;
2. To report information related to victims of abuse, neglect or domestic violence; and
3. To assist law enforcement officials in their law enforcement duties.
• To state and federal public health authorities, including state medical officers, the Food and Drug Administration (FDA), and other agencies charged with preventing or controlling disease.
• To government authorities, including protective service agencies, authorized to receive reports of abuse, neglect, or domestic violence.
• To government health oversight agencies, such as the state and federal Departments of Health and Human Services, Medicare/Medicaid Peer Review Organizations, state Boards of Medicine, Nursing, and Pharmacy, and other licensing authorities.
• To medical examiners, or funeral directors for purposes of identifying a deceased person or carrying out their duties as required by law.
• To organ procurement organizations for purposes of organ or tissue donation and transplantation, consistent with applicable law.
• For research approved by an Institutional Review Board or Privacy Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
• When required to avert a serious threat to health or safety.
• When requested for certain specialized government functions authorized by law, including military and similar situations.
Your Health Information Rights
Although your health record maintained by TSC is the physical property of TSC, the information belongs to you. Under the Federal Privacy Rules, 45 CFR Part 164, you have the right to:
• Obtain a paper copy of this Notice of Privacy Practices upon request,
• Inspect and obtain a copy of your health record, except:
1. Psychotherapy notes, if any,
2. Information compiled in anticipation of or for use in civil, criminal or administrative proceedings.
3. Certain formation governed by a federal law called the Clinical Laboratory Improvement Act.
There are several circumstances in addition to those just stated when your right to access your health information may be denied. They include the following: If you are an inmate in a correctional institution or are participating in a research study related to treatment, your right to access your PHI may be denied or suspended. Your right to access may also be denied pursuant to the Federal Privacy Act, if applicable. Your right to access may also be denied, if the information was obtained from a confidential source other than a health care provider under a promise of confidentiality.
Denials in any of the circumstances described in either of the preceding two paragraphs are not subject to review.
Access may be denied, subject to review, if (i) access is reasonably likely to endanger the life and physical safety of you or someone else, (ii) the information refers to another person and granting you access would be reasonably likely to cause harm to that person, or (iii) you are the personal representative of another person and a licensed health care professional determines that giving you access would cause substantial harm to the patient or another individual. If access is denied for any reason in this paragraph, you have the right to have the decision reviewed by a health care professional who was not involved in the original decision to deny. If access is ultimately denied, the reasons will be given to you in writing. To request review of a decision, in writing you should contact the Privacy Officer identified on the last page of this notice.
Request an amendment to your health information. The request may be denied (i) if we did not create the information, unless the creator is no longer available to receive your request to amend, or (ii) if the information or record is not part of a designated record set, or (iii) the information is accurate and complete or (iv) if you have no right of access in any of the circumstances discussed above, with or without review.
Obtain an accounting of disclosures of your health information made by us or our business associates during the six years preceding your request, except that you have no right to receive an accounting of:
• Disclosures made for treatment, payment, or health care operations
• Disclosures made before April 14, 2003,
• Disclosures made to you,
• Disclosures of information maintained in our facility directory, or to persons involved in your care or for the purpose of notifying your family or friends about your location and general condition or death,
• Disclosures for national security or intelligence purposes,
• For persons in custody at the time of the disclosure, disclosures to correctional institutions or law enforcement
• Disclosures made pursuant to an authorization signed by you,
• Disclosures that are part of a limited data set,
• Disclosures that are incidental to another permissible use or disclosures,
• Disclosure made to a health oversight agency or law enforcement, if the agency or official asks us not to account to you for such disclosures and only for the limited period of time covered by the request not to disclose.
The accounting will include the date of each disclosure, the name of the entity or person to whom disclosure was made, the address of the person or entity, if known, and a brief description of the information disclosure and the purpose of the disclosure.
Request a restriction on certain uses and disclosures of your information as provided by law. You may request a restriction for disclosures to a health plan where payment is made out of pocket for service. You may also request other restrictions. We are not required to agree, but if we do, we are bound by our agreement, unless you are in need of emergency treatment and the restricted information is needed to provide that treatment.
Revoke your authorization to use or disclose health information, except where disclosures have already been made in reliance on your prior consent.
Finally, you also have the right to request us to communicate your health information by alternative means or at alternative locations. You may, for example, ask us to contact you at your office instead of at home or to contact you by e-mail instead of by regular mail or the telephone.
All requests to exercise your rights or to complain if you believe they have been violated should be directed to The Privacy Officer identified on the last page of this notice.
Our Responsibilities:
This organization is required to:
• Maintain the privacy of your health information
• Provide you with a hard copy of this Notice of Privacy Practices
• Notify the affected individuals following a breach of unsecured PHI.
• Abide by the terms of this notice
We reserve the right to change our practices and to make the new provisions effective for all PHI we maintain. Should our information practices change, we will post a revised notice prominently in the facility as well as on our website: www.surgerycenter-flint.com. We will also provide the revised notice to our patients upon request.
Uses and Disclosures Specifically Authorized By You
We will not use or disclose your health information without your authorization, except as described in this notice. We will make other uses and disclosures of your health information, including those for marketing, psychotherapy notes and disclosures that constitute a sale of PHI only on the basis of specific written authorization forms signed by you. You have the right to revoke any such authorization at any time, except to the extent we have already relied on it in making an authorized use or disclosure.
For More Information, to Report a Problem or ask a question, or to send a request or revocation, you may contact our Privacy Officer. If you believe your privacy rights have been violated, you may file a complaint either verbally or in writing with The Surgery Center by contacting our Privacy Officer.
You may contact the privacy officer in person, by mail, or by telephone as follows:
Privacy Officer
5202 Miller Rd
Flint, MI 48507
(810) 732-7700.
If you believe your privacy rights have been violated, you may file a complaint in writing with the Privacy Officer. Only written complains will be valid. You may also file a complaint or if you believe your privacy rights have been violated with the Secretary of Department of Health and Human Services. In either case, there will be no retaliation for filing a complaint.
Effective Date: April 14, 2003
Revision Date: September 23, 2013
The Surgery Center w 5202 Miller Road w Flint, MI 48507
Phone: (810) 732-7700 www.surgerycenter-flint.com
5202 MILLER ROAD
FLINT MI 48507