Privacy Policy

Uses and Disclosures: The reasons listed in this section do NOT require your authorization as indicated in the Health Insurance Portability Accountability Act of 1996 (HIPPA) Treatment. Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment. Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.

Health Care Operations. Your health information may be used as necessary to support the day-to- day activities and management of Plastic Surgery of Southern Maryland. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

Law Enforcement. Your health information may be disclosed to law enforcement agencies, with your permission, to support government audits and inspections, to facilitate law enforcement investigations, and to comply with government mandated reporting.

Public Health Reporting. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to state’s public health department.

Other Uses and Disclosures Require Your Authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.

Additional Uses of Information

Appointment Reminders. Your health information will be used by our staff to notify you about upcoming appointments.

Information About Treatments. Your health information may be used to send you information on the treatment and management of your medical condition that you may find to be of interest. We may also send you information describing other health-related goods and service that we believe may interest you. We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We are also required to abide by the privacy policies and practices that are outlined in this notice.

Individual Rights

You have certain rights under the federal privacy standards. These include:

·         The right to request restrictions on the use and disclosure of your protected health information

·         The right to receive confidential communications concerning your medical condition and treatment

·         The right to inspect and copy your protected health information

·         The right to amend or submit corrections to your protected health information

·         The right to receive an accounting of how and to whom your protected health information has been disclosed

·         The right to receive a printed copy of the notice

Right to Revise Privacy Practice. As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice on your next office visit. The revised policies and practices will be applied to all protected health information that we maintain.

Requests to Inspect Protected Health Information. As permitted by federal regulation, we require that requests to inspect, copy or disclose protected health information to yourself or another person, be submitted in writing. You may obtain a form to request access to your records by contacting our Medical Records Department.

Complaints. If you would like to submit a comment or complaint about our privacy practice, you can do so by sending a letter outlining your concerns to the contact person listed below. If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern to the contact person listed below. You will not be penalized or otherwise retaliated against for filing a complaint.

PRIVACY POLICY

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.

This notice is intended to inform you about our practices related to the protection of the privacy of your medical records. Generally, we are required by law to ensure that medical information that identifies you is kept private. Further, we must give you this information related to our legal duties and privacy practices with respect to any medical information we create or receive about you. We are required by law to follow the terms of the notice that is currently in effect. This notice will explain how we may use and disclose your medical information, our obligations related to the use and disclosure of your medical information and your rights related to any medical information that we have about you. This notice applies to the medical records that are generated in or by this Practice.

With a few exceptions, we are required to obtain your authorization for the use or disclosure of information for reasons other than for treatment, payment or health care operations. We have listed some of the reasons why we might use or disclose your medical information and some examples of the types of uses or disclosures below. Not every use or disclosure is covered, but all of the ways that we are allowed to use and disclose information will fall into one of the categories.

In addition to Practice departments, employees, staff and other Practice personnel, the following persons will also follow the practices described in this Notice of Privacy Practices:

Any health care professional who is authorized to enter information in your medical record; Any member of a volunteer group that we allow to help you while you are receiving care at the Practice’s Office & Surgery center.

In addition, this entity may share medical information for treatment, payment or health care operations as they are described in this Notice of Privacy Practices. This entity is hereinafter referred to collectively with the Practice as Practice.

Use and Disclosure of Medical Information for Treatment, Payment or

Health Care Operations:

We can use or disclose medical information about you regarding your treatment, payment for services or for certain Practice operations.

For Treatment: To provide you with medical treatment or services, we may need to use or disclose information about you to doctors, nurses, technicians, students or other Practice personnel who are involved in your treatment. For example, a doctor may need to know what drugs you are allergic to before prescribing medications. Other doctors may share this medical information about you to coordinate your care. For instance, the laboratory may request information to complete lab work. We may also disclose medical information about you to people who may be involved in your medical care after you leave the Practice, such as home health agencies, your family and clergy members. We may also disclose information to other covered entities that are not affiliated with the Practice for your treatment (e.g. pharmacists, emergency medical providers, and unaffiliated physicians).

For Payment: We may use and disclose your medical information for the Practice to bill and receive payment for the treatment that you received here.

For example, we may use or disclose your medical information to your insurance company about a service you received at the Practice so that your insurance company can pay us or reimburse you for the service. We may also ask your insurance company for prior authorization for a service to determine whether the insurance company will cover it. We may also disclose your information so that other covered entities may obtain payment for treatment that they have provided (e.g. ambulance service providers).

For Health Care Operations: We can use and disclose medical information about you for Practice operations. These include uses and disclosures that are necessary to run the Practice and make sure that our patients receive quality care. For example, we may use or disclose medical information about you to evaluate our staffs performance in caring for you. Medical information about you and other Practice patients may also be combined to allow us to evaluate whether the Practice should offer additional services or discontinue other services and whether certain treatments are effective. We may also compare this information with other Practices to evaluate whether we can make improvements in the care and services that we offer.

Uses and Disclosures of Medical Information that do not Require Your Authorization:
We can use or disclose health information about you without your authorization when there is an emergency or when we are required by law to treat you, when we are required by law to use or disclose certain information, or when there are substantial communication barriers to obtaining consent from you.

Further, we may use or disclose your health information without your consent or authorization in any of the following circumstances:

When it is required by law;
When it involves use and disclosure for public health activities, such as mandated disease reporting, etc.;
When reporting information about victims of abuse, neglect or domestic violence as required by law;
When disclosing information for the purpose of health oversight activities, such as audits, investigations, licensure or disciplinary actions or legal proceedings or actions; When disclosing information for judicial and administrative proceedings in accordance with state and/or federal law, for instance, in response to a court order, such as a court-ordered subpoena;

When disclosing information for law enforcement purposes, for instance, to locate or identify a suspect, fugitive, witness or missing person or regarding a victim of a crime who can not give consent or authorization because of incapacity; When we believe in good faith that the disclosure is necessary to avert a serious health or safety threat to you or to the publics safety; In the case of a prison inmate, information can be released to the correctional facility in which he or she resides for the following purposes: (1) for the institution to provide the inmate with health care; (2) to protect the health and safety of the inmate or the health and safety of others; or (3) for the safety and security of the correctional facility; and When disclosure is necessary to comply with workers compensation laws or purposes.

Planned Uses or Disclosures to Which You May Object

We will use or disclose your health information for any of the purposes described in this section unless you affirmatively and object to or otherwise restrict a particular release. You must direct your written objections or restrictions to our office. We may use or disclose your health information to contact you and remind that you have an appointment for treatment or medical care. We may use or disclose your health information to provide you with information about or recommendations of possible treatment options or alternatives that may interest you.

We may use and disclose your health information to inform you about health benefits or services that may interest you.
We may use health information about you to contact you in an effort to raise money for the Practice. A Foundation related to the Practice may receive contact information, which includes your name, address and phone number and the dates that you received services from the Practice.

Other Uses or Disclosures Uses or disclosures not covered in this Notice of Privacy Practices will not be made without your written authorization. If you provide us written authorization to use or disclose information, you can change your mind and revoke your authorization at any time, as long as it is in writing. If you revoke your authorization, we will no longer use or disclose the information.

However, we will not be able to take back any disclosures that we have made pursuant to your previous authorization.

Your Rights with Respect to Health Information Right to Receive Information in Certain Form and Location: You have the right to receive information about your health in a certain form and location.

For instance, you can request that we not contact you at work. To request confidential communications, you must make your request in writing to: Privacy Officer. The request must tell us how and/or where you want to receive information. We will accommodate reasonable requests. Right to Inspect and Copy PHI: You have the right to inspect and copy your health information that may be used to make decisions about your care, with the exception of any psychotherapy notes that we might have created. If you want to see or copy your medical information, you must submit your request in writing to: Privacy Officer. If you request copies of information, we may charge a fee for any costs associated with your request, including the cost of copies, mailing or other supplies.

Right to Request Amendment to PHI: You have a right to request that your health information be changed if you believe that it is incorrect or incomplete. You have a right to request changes for as long as the information is kept by the Practice. To request a change in your information, you must submit it in writing to Privacy Officer. In addition, you must give the reason that you want the information changed, including why you think the information is incorrect or incomplete.

We can deny your request if it is not in writing and if it does not include a reason why the information should be changed. We can also deny your request for the following reasons: (1) the information was not created by the Practice, unless the person or entity that did create the information is no longer available; (2) the information is not part of the medical record kept by or for the Practice; (3) the information is not part of the information that you would be permitted to inspect and copy; or (4) we believe the information is accurate and complete.

Right to an Accounting of Disclosures: You have the right to receive an accounting of disclosures of medical information that we have made, with some exceptions. You must submit your request in writing to: Privacy Officer. Your request must state the time period that may not be longer than six (5) years and may not include dates before April 1, 2005. You should include how you want the information reported to you, i.e., by paper, electronically, etc. You have the right to a paper copy of this Notice of Privacy Practices. Even if you have agreed to receive this notice in another form, you can still have a paper copy of this notice. To obtain a paper copy of this notice, contact the

Privacy Officer.

(UNDER TRICOUNTY BILL OF RIGHTS & NEED TO ADD THIS STATEMENT below) keep tri-county bill of rights already on website

If you believe that your rights have been violated you may contact

Michele Falcon, Facility Director, at 724-226- 3900, the Civil Rights Regional Office at 1-800- 368-1019, or the Medicare Ombudsman at 1-800-MEDICARE

(UNDER PATIENT RESOURCES)

WHERE WE OPERATE

Allegheny Valley Hospital
Forbes Regional Hospital
Tri-County Outpatient Surgical Facility
UPMC East
UPMC Harmar Outpatient Center
UPMC St. Margaret