Our pledge regarding health information:
We understand that health information about you and your healthcare is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. 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 this healthcare practice, whether made by your personal doctor or others working in this office. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you and describe certain obligations we have regarding the use and disclosure of your health information. We are required by law to:
- Make sure that health information that identifies you is kept private;
- Give you this notice of our legal duties and privacy practices with respect to health information about you; and
- Follow the terms of the notice that is currently in effect.
How we may use and disclose health information about you:
The following categories describe different ways that we use and disclose health information. By coming for care, you give us the right to use your information for treatment, to get reimbursed for your care, and to operate our organization.
There are also various other ways in which we may use or disclose your information:
- To allow oversight of the quality of the healthcare we provide
- In a medical appeal process with your insurance carrier to obtain payment
- As required by subpoena in lawsuits and disputes
- Various uses as required by law or to avert a serious threat to health or safety
Your rights regarding health information about you:
You have the following rights regarding health information we maintain about you:
- Right to Inspect and Copy
- Right to Amend
- Right to an Accounting of Disclosures
- Right to Request Restrictions
- Right to Request Confidential Communications
- Right to a Paper Copy of this Notice
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 health 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 our facility. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register for treatment or healthcare services, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact the Administrator listed above. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Other uses of health information:
Other uses and disclosures of health 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 health 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 health 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 care that we provided to you.
Protecting your medical identity:
Most people are aware of the risk of identity theft related to their financial records, social security number, etc. Medical Identity Theft happens when a person seeks healthcare using someone else’s name or insurance information. Victims may find that their benefits have been exhausted or that their medical record has been compromised by the person receiving treatment for illnesses that could be contradictory to their own health history.
Due to these risks, we at the Montvale Surgical Center take precautions to help protect your medical identity. This includes requiring our admissions staff to request that you provide a photo ID (such as current driver’s license, passport, visa, etc.) at the time of admission.
In addition, we will obtain and verify complete registration and insurance information. You should also be proactive in guarding and protecting your insurance card information. We encourage you to contact the Federal Trade Commission at 1-877-FTC-HELP (1-877-382-4357) if you become aware of or have concerns about Medical Identity Theft.
Full notice of privacy practices:
If you have any questions about this notice, please contact the Privacy Officer. A full notice of our privacy practices is available on request.