| NOTICE
OF PRIVACY PRACTICES FOR
SURGICAL ASSOCIATES OF WEST FLORIDA, PA
This notice describes how protected health information
may be used and disclosed and how you can access this information.
Please review this notice.
Visit our web site at
www.WestFloridaSurgery.com
Issue Date: April 2003
Introduction
At Surgical Associates of West Florida, PA we are committed to
treating and using protected health information about you responsibly.
This Notice of Privacy Practices describes the personal information
we collect, and how and when we use or disclose that information.
It also describes your rights as they relate to your protected
health information. This Notice is effective April 2003, and applies
to all Protected Health Information (information) as defined by
federal regulations.
Understanding
Your Medical Record Information
Each time you visit Surgical Associates of West Florida, PA, a
record of your visit is made. Typically, this record contains
your symptoms, examination and test results, diagnoses, treatment,
and a plan for future care or treatment. This information, often
referred to as your health or medical record, serves as a:
- Basis for planning your care and treatment, and the outcomes
we achieve,
- Means of communication among the many health professionals
who contribute to your care,
- Legal document describing the care you received,
- Means by which you or a third-party payer can verify that
services billed were actually provided,
- A source of data for medical research,
- A source of information for public health officials charged
with improving the health of this state and the nation.
Understanding what is in your record and how your medical information
is used helps you to: ensure its accuracy, better understand who,
what, when, where, and why others may access your medical information,
and make more informed decisions when authorizing disclosures
to others.
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Your Medical
Record Information Rights
Although your medical record is the physical property of Surgical
Associates of West Florida, PA, the information belongs to you.
You have the right to:
- Obtain a paper copy of this Notice of Privacy Practices upon
request,
- Review or amend your medical records in accordance with Federal
Regulations,
- Obtain an accounting of disclosures of your protected health
information,
- Request a restriction on certain uses and disclosures of your
medical information, and
- Revoke your authorization to use or disclose medical information
except to the extent that action has already been taken.
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Our
Responsibilities
Surgical Associates of West Florida, PA is required by law to:
- Maintain the privacy of your medical information,
- Provide you with this notice as to our legal duties and privacy
practices with respect to
- medical information that we collect and maintain about you,
- Abide by the terms of this notice,
- Notify you if we are unable to agree to a requested restriction,
and
- Accommodate reasonable requests you may have to communicate
medical information by alternative means or at alternative locations.
We reserve the right to change our practices and this notice
and to make the revised notice effective for protected health
information we maintain as required by changes in Federal or State
regulations.
We will not use or disclose your medical information without
your authorization, except as described in this notice. We will
also discontinue to use or disclose your health information after
we have received a written revocation of the authorization according
to the procedures included in the authorization.
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Examples of Allowable
Disclosures for:
Treatment, Payment and Healthcare Operations
We will use your health information for treatment.
For example: Information obtained by a nurse,
physician, or other member of our health care team will be recorded
in your medical record and used to determine a diagnosis or
course of treatment .
We will also provide your primary, referring or specialist
physician or a subsequent health care provider with copies of
various medical records and reports that should assist him or
her in treating you.
We will use your health information for payment.
For example: A claim may be sent to you or
a third-party payer. The information on or accompanying the
bill may include information that identifies you, as well as
your diagnosis, procedures, and supplies used.
We will use your health information for our health
care operations.
For example: Members of the practice may use
information in your health record to assess the care and outcomes
in your case and others like it. This information will then
be used in an effort to continually improve the quality and
effectiveness of healthcare and service we provide.
Business Associates:
There are some services provided in our organization through contacts
with business associates. Examples include physician billing,
answering and transcription services. When these services are
contracted, we may disclose your health information to our business
associate so that they can perform the job we've asked them to
do. To protect your health information, however, we require the
business associate to appropriately safeguard your information.
Communication with Family:
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
person's involvement in your care or payment related to your care.
Worker's Compensation:
We will use and disclose your protected health information about
you for workers' compensation or similar programs which provide
benefits for work-related injuries or illness.
Research: We may
disclose information to researchers when their research has been
approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy
of your health information.
Public Health: As required by law, we may disclose your health
information to public health or legal authorities charged with
preventing or controlling disease, injury, or disability.
Law Enforcement: We may disclose information for law enforcement
purposes as required by law or in response to a valid subpoena.
Federal law makes provisions for your health information to be
released to an appropriate health oversight agency, public health
authority or attorney, provided that a work force member or business
associate believes in good faith that we have engaged in unlawful
conduct or have otherwise violated professional or clinical standards
and are potentially endangering one or more patients, workers,
or the public.
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Acknowledgement
of Receipt of This Notice
You will be asked to provide a signed acknowledgment of receipt
of this notice. Our intent is to make you aware of the possible
uses and disclosures of your protected health information and
your privacy rights. The delivery of your health care services
will in no way be conditioned upon your signed acknowledgment.
If you decline to provide a signed acknowledgment, we will continue
to provide your treatment, and will use and disclose your protected
health information for treatment, payment and health care operations
when necessary.
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For More Information
or to Report a Problem
If you have questions and would like additional information you
may contact any of our Office Managers or the practice's Privacy
Officer at (727) 446-5681.
If you believe your privacy rights have been violated, you can
file a complaint with the practice's Privacy Officer, or with
the Office for Civil Rights, U.S. Department of Health and Human
Services. There will be no retaliation for filing a complaint
with either the Privacy Officer or the Office for Civil Rights.
The address for the OCR is listed below:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
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