Englewood Surgery Center LLC
Notice of Privacy Practices for the Protected Health Information
Effective: September 23, 2013
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Englewood Surgery Center, LLC (ESC) understands how important your personal medical information is to you. We know that you are concerned with how that information might be used, the way in which it is disclosed and how you can access the information. That is why we have put this document in your hands. It is why the “Privacy Practices” outlined here is so important and why we want to pledge our commitment, at the onset, to respect your personal medical information.
ESC is permitted by federal privacy laws to make uses and disclosures of your health information for purposes of treatment, payment and health care operations. Protected health information is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination, test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for these services.
In summary, the law requires us to:
- Keep your medical information private
- Notify you of our legal duties and privacy practices with respect to your medical information
- Follow the terms of the most current notice and regulations
The US Department of Health and Human Services sponsored the Health Insurance Portability and Accountability Act (HIPAA). HIPAA dictates the medical information privacy practices that health care organizations and their partners are obligated to follow. CCSI provides health care to our patients in partnership with many physicians, other medical professionals and organizations.
This notice outlines ESC practices and that of:
- Any health care professionals who treat you
- All department and units of our organization
- All employed associates or staff of our organization. This includes staff at our sponsor organizations with which we may share information.
ESC is responsible for ensure that these individuals and organizations understand the importance of medical information and are trained following HIPAA guidelines to ensure that your information is used only as it is intended.
How your personal medical information can be used and disclosed
The following is a list of ways in which your personal medical information can be used and disclosed as allowed by HIPAA provisions. Be assured that we will use your information in the most discreet manner.
- Disclosure for health related purposes
- Treatment; sending your medication information to a specialist as part of a referral or order
- Obtaining payment for treatment; billing information to your insurance company, lab or collection agency
- Supporting health care operations; compiling patient data to improve treatment methods internally
- Business partners. Business Associates (BA) are partners that we work with to complete the process of healthcare and healthcare operations. All business partners are required by law to comply with the provisions of HIPAA and protect your rights as we do. All business associates can be held liable for breaches related to HIPAA violations. They are required to report these breaches when they occur to all covered entities that may be affected in a timely manner.
Subject to certain requirements, we may give out your personal medical information to other organizations without prior authorization:
- Public health resources
- Research studies
- Abuse or neglect reporting
- Workers Compensation purposes
- Health oversight audits and inspections
We are also required to disclose medical information when required by law in response to:
- Valid judicial or administrative orders
- The government, if you are in the military or a veteran
- NSA/intelligence activities
- Protective services for the local government, congress or President
- Disaster relief authorities to notify your family of your location and condition
We are required to obtain authorization from you before using or disclosing your medical information for the purpose of the following activities:
- Disclosure of psychotherapy/counseling notes
- Marketing activities from which the provider would receive financial remuneration
- Sale of protected health information
- Fundraising activities
Communication with family, friends and others will only be provided through written authorization from our patients. Upon initial treatment and annually thereafter, we will request your permission to speak with your family, friends and others. If you have provided permission to our office to communicate this information and wish to rescind this information; you will need to complete an updated acknowledgement with our office. This authorization will allow us to speak with individuals who are involved with your care, someone who helps pay for services or advocates on your behalf.
In any other situation not covered by this notice, we will ask for your written authorization before disclosing your medical information. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing.
- You have the right to review and obtain a copy of the medical information we use to make decisions about your care by submitting a written request. The request must be a HIPAA compliant standard medical release form for disclosure to be processed. We may use a third party HIPAA compliant contractor to complete your records request. We will respond to all requests timely and pursuant to regulations dictated by state or federal guidelines.
- If you believe information in your record is incorrect or if important information is missing, you have the right to request correction of the records by submitting a request in writing along with your reason for requesting the amendment. We could deny your request to amend the record formally. We will add to your medical record a copy of your request and details of what you define are missing or incorrect in your medical file.
- You have the right to a list of those instances where we have disclosed your medical information, other than for treatment, payment or health operations where you specifically authorized a disclosure by submitting a written request. The request must state the time period you are requesting. You may receive the list in paper or electronic form.
- You have the right to request that your medical information be provided to you in a confidential manner. You can specify how or where you wish to be contacted. We will attempt to honor all requests.
- You may request in writing that we do not disclose your medical information for treatment, payment and healthcare operations, or to persons involved in your care except when specifically authorized by you, or when required by law or in an emergency. All written requests must tell us (1) what information you want to limit; (2) whether you want to limit our use or disclosure; and (3) to whom you want the limits to apply. (4)Unless your request is to restrict disclosing your medical information for health care services for which you pay for out of pocket in full to your health plan.
You have a right to receive a paper copy of this notice. You may view or print a copy of the notice at our website www.englewoodsurgerycenter.com. Our staff can also provide an email version to you as well for convenience.
We may change our policies at any time. Changes will apply to medical information we already hold, as well as new information after the change occurs. When we make a significant change to our policies, we will change this notice and post the current notice in our facility on our website. This notice will contain the effective date. In addition, you will be offered a copy of the current notice each time you register for a new visit.
If you are concerned that your privacy rights may have been violated or disagree with a decision we made about access to your records, you may contact our company privacy officer at 720-274-0341.
Colorado State Agency:
Colorado Department of Public Health and Environment; 4300 Cherry Creek Drive South; Denver, CO 80222; ph.: 303-692-2800
Office of Medicare Beneficiary Ombudsman, www.Medicare.gov or call 1-800-MEDICARE (1-800-633-4227)