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HIPAA
regulations in effect now
NEW Surgical Associates
is
required by law to maintain the privacy of your
protected health information. This information consists
of all records related to your health, including
demographic information, either created by
NEW
Surgical Associates
or
received by NEW Surgical Associates from other
health care providers.
We
are required to provide you with notice of our legal
duties and privacy practices with respect to your
protected health information. These legal duties and
privacy practices are described in this Notice.
NEW Surgical Associates
will
abide by the terms of this Notice, or the Notice
currently in effect at the time of the use or disclosure
of your protected health information.
NEW
Surgical Associates
reserves the right to change the terms of this Notice
and to make any new provisions effective for all
protected health information that we maintain. Patients
will be provided a copy of any revised Notices upon
request. An individual may obtain a copy of the current
Notice from our office at any time.
Uses and Disclosures of Your Protected Health
Information not Requiring Your Consent
NEW
Surgical Associates
may
use and disclose your protected health information,
without your written consent or authorization, for
certain treatment, payment and healthcare operations.
There are certain restrictions on uses and disclosures
of treatment records, which include registration and all
other records concerning individuals who are receiving,
or who at any time have received services for mental
illness, developmental disabilities, alcoholism, or drug
dependence. There are also restrictions on disclosing
HIV test results.
Treatment
may include:
·
Providing, coordinating, or managing health care and
related services by one or more health care providers;
·
Consultations between health care providers concerning a
patient;
·
Referrals to other providers for treatment;
·
Referrals to nursing homes, foster care homes, or home
health agencies.
For
example, NEW Surgical Associates may determine
that you require the services of a specialist. In
referring you to another doctor, NEW Surgical
Associates may share or transfer your healthcare
information to that doctor.
Payment activities
may include:
·
Activities undertaken by NEW Surgical Associates
to obtain reimbursement for services provided to you;
·
Determining your eligibility for benefits or health
insurance coverage;
·
Managing claims and contacting your insurance company
regarding payment;
·
Collection activities to obtain payment for services
provided to you;
·
Reviewing health care services and discussing with your
insurance company the medical necessity of certain
services or procedures, coverage under your health plan,
appropriateness of care, or justification of charges;
·
Obtaining pre-certification and pre-authorization of
services to be provided to you.
For
example, NEW Surgical Associates will submit
claims to your insurance company on your behalf. This
claim identifies you, your diagnosis, and the services
provided to you.
Healthcare operations
may include
·
Contacting health care providers and patients with
information about treatment alternatives;
·
Conducting quality assessment and improvement
activities;
·
Conducting outcomes evaluation and development of
clinical guidelines;
·
Protocol development, case management, or care
coordination;
·
Conducting or arranging for medical review, legal
services, and auditing functions.
For
example, NEW Surgical Associates may use your
diagnosis, treatment, and outcome information to measure
the quality of the services that we provide, or assess
the effectiveness of your treatment when compared to
patients in similar situations.
NEW
Surgical Associates
may contact you, by telephone or mail, to provide
appointment reminders. You must notify us if you do not
wish to receive appointment reminders.
We may not disclose
your protected health information to family members or
friends who may be involved with your treatment or care
without your written permission. Health information may
be released without written permission to a parent,
guardian, or legal custodian of a child; the guardian of
an incompetent adult; the healthcare agent designated in
an incapacitated patient’s healthcare power of attorney;
or the personal representative or spouse of a deceased
patient.
There
are additional
situations when
NEW Surgical Associates
is permitted or required to use or disclose your
protected health information without your consent or
authorization. Examples include the following:
·
As
permitted or required by law
In
certain circumstances we may be required to report
individual health information to legal authorities, such
as law enforcement officials, court officials, or
government agencies. For example, we may have to report
abuse, neglect, domestic violence or certain physical
injuries. We are required to report gunshot wounds or
any other wound to law enforcement officials if there is
reasonable cause to believe that the wound occurred as a
result of a crime.
Mental health records may be disclosed to law
enforcement authorities for the purpose of reporting an
apparent crime on the provider’s/facility’s preminses.
-
For public health activities
We
may release healthcare records, with the exception of
treatment records, to certain government agencies or
public health authority authorized by law, upon receipt
of written request from that agency. We are required to
report positive HIV test results to the state
epidemiologist. We may also disclose HIV test results to
other providers or persons when there has been or will
be risk of exposure. We may report to the state
epidemiologist the name of any person known to have been
significantly exposed to a patient who tests positive
for HIV. We are required by law to report suspected
child abuse and neglect and suspected abuse of an unborn
child, but cannot disclose HIV test results in
connection with the reporting or prosecution of alleged
abuse or neglect. We may release healthcare records,
including treatment records and HIV test results, to the
Food and Drug Admnistration when required by federal
law. We may disclose healthcare records, except for HIV
test results, for the purpose of reporting elder abuse
or neglect, provided the subject of the abuse or neglect
agrees, or if necessary to prevent serious harm.
Records may be released for the reporting of domestic
violence if necessary to protect the patient or
community from imminent and substantial danger.
-
For health oversight activities.
We
may disclose healthcare records, including treatment
records, in response to a written request by any federal
or state governmental agency to perform legally
authorized functions, such as management audits,
financial audits, program monitoring and evaluation, and
facility or individual licensure or certification. HIV
test results may not be released to federal or state
governmental agencies, without written permission,
except to the state epidemiologist for surveillance,
investigation, or to control communicable diseases.
-
Judicial and Administrative Proceedings
Patient healthcare records, including treatment records
and HIV test results, may be disclosed pursuant to a
lawful court order. A subpoena signed by a judge is
sufficient to permit disclosure of all healthcare
records except for HIV test results.
-
For activities related to death.
We
may disclose patient healthcare records, except for
treatment records, to a coroner or medical examiner for
the purpose of completing a medical certificate or
investigating a death. HIV test results may be disclosed
under certain circumstances.
Under certain circumstances, and only after a special
approval process, we may use and disclose your health
information to help conduct research.
-
To avoid a serious threat to health or safety.
We
may report a patient’s name and other relevant data to
the Department of Transportation if it is believed the
patient’s vision or physical or mental condition affects
the patient’s ability to exercise reasonable or ordinary
control over a motor vehicle. Healthcare information,
including treatment records and HIV test results, may be
disclosed where disclosure is necessary to protect the
patient or community from imminent and substantial
danger.
-
For workers’ compensation.
We
may disclose your health information to the extent such
records are reasonably related to any injury for which
workers compensation is claimed.
NEW
Surgical Associates
will not make any other use or disclosure of your
protected health information without your written
authorization. You may revoke such authorization at any
time, except to the extent that
NEW
Surgical Associates
has taken action in reliance thereon. Any revocation
must in writing.
Your Rights Regarding Your Protected Health Information
You are permitted to
request that restrictions be placed on certain uses or
disclosures of your protected health information by
NEW
Surgical Associates
to carry out treatment,
payment, or healthcare operations. You must request such
a restriction in writing. We are not required to agree
to your request, but if we do agree, we must adhere to
the restriction, except when your protected health
information is needed in an emergency treatment
situation. In this event, information may be disclosed
only to healthcare providers treating you. Also, a
restriction would not apply when we are required by law
to disclose certain healthcare information.
You
have the right to review and/or obtain a copy of your
healthcare records, with the exception of psychotherapy
notes, or information compiled for use (or in
anticipation for use) in a civil, criminal, or
administrative action or proceeding.
NEW
Surgical Associates
may
deny an access under other circumstances, in which case
you have the right to have such a denial reviewed. We
may charge a reasonable fee for copying your records.
You
may request that NEW Surgical Associates send
protected health information, including billing
information, to you by alternative means or to
alternative locations. You may also request that
NEW Surgical Associates
not
send information to a particular address or location or
contact you at a specific location, perhaps your place
of employment. This request must be submitted in
writing. We will accommodate reasonable requests by you.
You
have the right to request that
NEW
Surgical Associates
amend portions of your healthcare records, as long as
such information is maintained by us. You must
submit this request in writing, and under certain
circumstances the request may be denied.
You
may request to receive an accounting of the disclosures
of your protected health information made by
NEW
Surgical Associates
for
the six years prior to the date of the request,
beginning with disclosures made after April 14, 2003. We
are not required, however, to record disclosures made
pursuant to a signed consent or authorization.
You
may request and receive a paper copy of this Notice, if
you had previously received or agreed to receive the
Notice electronically.
Any person or patient may file a complaint with
NEW
Surgical Associates
and/or the Secretary of Health and Human Services if
they believe their privacy rights have been violated. To
file a complaint with
NEW
Surgical Associates,
please contact the Privacy Officer at the
following:
Privacy Officer
NEW Surgical Associates
670 Cormier Road
Green Bay, WI 54304
(920) 494-9685
It is the policy of
NEW
Surgical Associates
that no retaliatory action will be made against any
individual who submits or conveys a complaint of
suspected or actual non‑compliance or violation of the
privacy standards.
This
Notice of Privacy Practices is effective April 14, 2003.
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