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.
Weston Outpatient Surgery Center is required by law to maintain the privacy
of your health information and to provide you with notice of its legal duties
and privacy practices with respect to your health information. If you have
questions about any part of this notice or if you want more information
about the privacy practices at Weston Outpatient Surgery Center please contact:
Privacy Officer
Weston Outpatient Surgery Center
2229 N. Commerce Pkwy.
Weston, FL 33326
954-389-2446
Effective Date of This Notice: April 14, 2003
I. How Weston Outpatient Surgery Center may Use or Disclose Your Health
Information
Weston Outpatient Surgery Center collects health information from
you and stores it in a chart and on a computer. This is your medical
record. The medical record is the property of Weston Outpatient Surgery
Center,
but the information in the medical record belongs to you. Weston
Outpatient Surgery Center protects the privacy of your health information.
The law
permits Weston Outpatient Surgery Center to use or disclose your
health information for the following purposes:
- Treatment. We will use and disclose your Protected Health Information
to provide, coordinate, or manage your health care and any related
services. This includes the coordination or management of your health care
with a
third party for treatment purposes. For example, we may disclose
your protected health information to a pharmacy to fill a prescription
or to a laboratory
to order blood tests.
- Payment. Your protected health information will be used, as needed,
to obtain payment for the services that we provide. This may include
certain communications to your health insurance company to get approval
for the
procedure that we have scheduled. For example, we may need to disclose
information to your health insurance company to get prior approval for
the surgery.
- Operations. We may use or disclose your protected health information,
as necessary, for our own health care operations to facilitate the
function of Weston Outpatient Surgery Center and to provide quality care
to all our
patients. Health care operations include such activities as: quality
assessment and improvement activities, employee review activities and training
programs.
- Other Uses and Disclosures. As part of your treatment, payment
and health care operations, we may also use or disclose your protected
health information for the following purposes: to remind you of your surgery
date,
to inform you of potential treatment alternatives or options, to
inform you of health-related benefits or services that may be of interest
to you.
- Notification and communication with family. We may disclose your
health information to notify or assist in notifying a family member,
your personal representative or another person responsible for your care.
If
you are able and available to agree or object, we will give you the
opportunity to object prior to making this notification. If you are unable
or unavailable
to agree or object, our health professionals will use their best
judgment in communication with your family and others.
- Required by law. As required by federal, state or local law, we
may use and disclose your health information.
- Public health. As required by law, we may disclose your health
information to public health authorities for purposes related to:
preventing or controlling disease, injury or disability; reporting child
abuse or neglect;
reporting domestic violence; reporting to the Food and Drug Administration
problems with products and reactions to medications; and reporting
disease or infection exposure.
- Health oversight activities. We may disclose your health information
to health agencies during the course of audits, investigations, inspections,
licensure and other proceedings.
- Judicial and administrative proceedings. We may disclose your
health information in the course of any administrative or judicial
proceeding.
- Law enforcement. We may disclose your health information to a
law enforcement official for purposes such as identifying of locating
a suspect, fugitive, material witness or missing person, complying with
a
court order or subpoena and other law enforcement purposes.
- Deceased person information. We may disclose your health information
to coroners, medical examiners and funeral directors.
- Organ donation. We may disclose your health information to organizations
involved in procuring, banking or transplanting organs and tissues.
- Research. We may disclose your health information to researchers
conducting research that has been approved by an Institutional Review
Board or Weston Surgery Center’s privacy board.
- Public safety. We may disclose your health information to appropriate
persons in order to prevent or lessen a serious and imminent threat
to the health or safety of a particular person or the general public.
- Specialized government functions. We may disclose your health
information for military and veterans activities, national security
and intelligence activities, correctional institutions and law enforcement
custodial
situations.
- Worker’s compensation. We may disclose your health information
as necessary to comply with worker’s compensation laws.
- Marketing. We may contact you to provide appointment reminders
or to give you information about other treatments or health-related
benefits and services that may be of interest to you.
- Fund-raising. We may contact you to participate in fund-raising
activities for this organization.
- Change of Ownership. In the event that Weston Outpatient Surgery
Center is sold or merged with another organization, your protected
health information will become the property of the new owner.
II. When Weston Outpatient Surgery Center May Not Use or Disclose Your
Health Information
Except as described in this Notice of Privacy Practices, Weston Outpatient
Surgery Center will not use or disclose your health information without
your written authorization. If you do authorize Weston Outpatient Surgery
Center to use or disclose your health information for another purpose, you
may revoke your authorization in writing at any time.
III. Your Health Information Rights
- You have the right to request restrictions on certain uses and
disclosures of your health information. Weston Outpatient Surgery
Center is not required to agree to the restriction that you requested.
We will
notify you if we deny your request to a restriction.
- You have the right to receive your health information through
a reasonable alternative means or at an alternative location. We
will accommodate reasonable requests. We may condition this accommodation
by asking you for
information as to how payment will be handled.
- You have the right to inspect and copy your health information.
Under federal law, however, you may not inspect or copy the following
records: psychotherapy notes; information compiled in anticipation of a
civil, criminal,
or administrative action or proceeding.
- You have a right to request that Weston Outpatient Surgery Center
amend your health information that is incorrect or incomplete. Weston
Outpatient Surgery Center is not required to change your health information
and will
provide you with information about our denial and how you can disagree
with the denial.
- You have a right to receive an accounting of disclosures of your
health information made by Weston Outpatient Surgery Center, except
that we do not have to account for the disclosures described in parts 1
(treatment),
2 (payment), 3 (Operations), 4 (other uses and disclosures), information
provided to you, and 15 (certain government functions) of section
I of this Notice of Privacy Practices.
- You have a right to a paper copy of this Notice of Privacy Practices.
If you would like to have a more detailed explanation of these rights
or if you would like to exercise one or more of these rights, contact the
Privacy Officer at Weston Outpatient Surgery Center.
IV. Changes to this Notice of Privacy Practices
Weston Outpatient Surgery Center reserves the right to amend this
Notice of Privacy Practices at any time in the future, and to make the
new provisions effective for all information that it maintains, including
information that was created or received prior to the date of such amendment.
Until such amendment is made, Weston Outpatient Surgery Center is required
by law to comply with this Notice.
V. Complaints
Complaints about this Notice of Privacy Practices or how Weston Outpatient
Surgery Center handles your health information should be directed to:
Privacy Officer
Weston Outpatient Surgery Center
2229 N. Commerce Pkwy.
Weston, FL 33326
954-389-2446
If you are not satisfied with the manner in which this office handles
a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your compliant to one of the regional Offices for
Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.
View this document in pdf format
Acknowledgment of Receipt Notice (pdf)
