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.
The OBGYN Pavilion understands that your medical information is private and
confidential. Further, we are required by law to maintain the privacy of
“protected health information”. “Protected health information” includes any
individually identifiable information that we obtain from you or others that
relate to your past, present or future physical or mental health, and the
health care you have received, or payment for your health care.
As required by law, this notice provides you with information about your rights and our legal duties and privacy practices with respect to the privacy of protected health information. This notice also discusses the uses and disclosures we will make of your protected health information. We must comply with the provisions of this notice as currently in effect, although we reserve the right to change the terms of this notice from time to time and to make the revised notice effective for all protected health information we maintain. You can always request a written copy of our most current privacy notice from The OBGYN Pavilion at the Ambulatory Surgery Center of Brooklyn Privacy Officer.
PERMITTED USES AND DISCLOSURES
We can use or disclose your protected health information for purposes of
treatment, payment and health care operations. For each of these categories of
uses and disclosures, we have provided a description and an example below.
However, not every particular use or disclosure in every category will be
Treatment means the provision, coordination or management of your health care, including consultations between health care providers regarding your care and referrals for health care from one health care provider to another. For example, a doctor treating your for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to contact a physical therapist to create the exercise regimen appropriate to your care.
Payment means the activities we undertake to obtain reimbursement for the health care provided to you, including billing, collections, claims management, determinations of eligibility and coverage and utilization review activities. For example, prior to providing health care services, we may need to provide information to your Third Party Payer about your medical condition to determine whether the proposed course of treatment will be covered. When we subsequently bill the Third Party Payer for the services rendered to you, we can provide the Third Party Payer with information regarding your care if necessary to obtain payment. Federal or State law may require us to obtain a written release from you prior to disclosing certain protected health information for payment purposes, and we will ask you to sign a release when necessary under applicable law.
Health care operations means the support functions of our practice related to treatment and payment, such as quality assurance activities, case management, receiving and responding to patient comments and complaints, physician reviews, compliance programs, audits, business planning, development, management and administrative activities. For example, we may use your protected health information to evaluate the performance of our staff when caring for you. We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. In addition, we may remove information that identifies you from your patient information so that others can use the de-identified information to study health care and health care delivery without learning who you are.
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OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
In addition to using and disclosing your information for treatment, payment
and health care operations, we may use your protected health information in the
We may contact you to provide appointment reminders for treatment or medical care.
We may contact you to tell you about or recommend possible treatment alternatives or other health-related benefits and services that may be of interest to you.
We may disclose to your family or friends or any other individual identified by you protected health information directly relevant to such person’s involvement with your care or payment for your care. We may use or disclose your protected health information to notify, or assist in the notification of, a family member, a personal representative, or another person responsible for your care of your location, general condition or death. If you are present or otherwise available, we will give you an opportunity to object to these disclosures, and we will not make these disclosures if you object. If you are not present or otherwise available, we will determine whether a disclosure to your family or friends is in your best interest, taking into account the circumstances and based upon our professional judgment.
When permitted by law, we may coordinate our uses and disclosures of protected health information with public or private entities authorized by law or by charter to assist in disaster relief efforts.
We will allow your family and friends to act on your behalf to pick-up filled prescriptions, medical supplies, X-rays, and similar forms of protected health information, when we determine, in our professional judgment that it is in your best interest to make such disclosures.
| We may contact you as part of our efforts to market our practice’s services as permitted by applicable law.
Subject to applicable law, we may make incidental uses and disclosures of protected health information. Incidental uses and disclosures are by-products of otherwise permitted uses or disclosures which are limited in nature and cannot be reasonably prevented.
We may use or disclose your protected health information for research purposes, subject to the requirements of applicable law. For example, a research project may involve comparisons of the health and recovery of all patients who received a particular medication. All research projects are subject to a special approval process which balances research needs with a patient’s need for privacy. When required, we will obtain a written authorization from you prior to using your health information for research.
We will use or disclose protected health information about you when required to do so by applicable law.
(Note: In accordance with applicable law, we may disclose your protected health information to your employer if we are retained to conduct an evaluation relating to medical surveillance of your workplace or to evaluate whether you have a work-related illness or injury. You will be notified of these disclosures by your employer or the Center as required by applicable law.
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Subject to the requirements of applicable law, we will make the following uses and disclosures of your protected health information:
NOTE: HIV-related information, genetic information, alcohol
and/or substance abuse records, mental health records and other specially
protected health information may enjoy certain special confidentiality
protections under applicable State and Federal law. Any disclosures of these
types of records will be subject to these protections.
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OTHER USES OF YOUR HEALTH INFORMATION
Other uses and disclosures of protected health information not covered by
this notice or the laws that apply to us will be made only with your permission
in a written authorization. You have the right to revoke that authorization at
any time, provided that the revocation is in writing, except to the extent that
we already have taken action in reliance to your authorization.
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1. You have the right to request restrictions on our uses and disclosures of protected health information for treatment, payment and health care operations. However, we are not required to agree to your request. To request a restriction, you must make your request in writing to the Clinic's Privacy Officer.
2. You have the right to reasonably request to receive confidential communications of protected health information by alternative means or at alternative locations. To make such a request, you must submit your request in writing to the Clinic's Privacy Officer.
3. You have the right to inspect and copy protected health information contained in your medical and billing records and in any other Clinic records used by us to make decisions about you, except:
In order to inspect and copy your health information, you must submit your request in writing to the Clinic's Privacy Officer. If you request a copy of your health information, we may charge a fee for the costs of copying and mailing your records, as well as other costs associated with your request.
We may also deny a request for access to protected health information if:
If we deny a request for access for any of the three reasons described above, then you have the right to have our denial reviewed in accordance with the requirements of applicable law.
4. You have the right to request an amendment to your protected health information, but we may deny your request for amendment, if we determine that the protected health information or record that is the subject of the request:
In any event, any agreed amendment will be included as an addition to, and not a replacement of, already existing records. In order to request an amendment to your health information, you must submit your request in writing to the Clinic's Privacy Officer, along with a description of the reason for your request.
5. You have the right to receive an accounting of disclosures of protected health information made by us to individuals or entities other than to you for the six years prior to your request, except for disclosures:
To request an accounting of disclosure of your health information, you must submit your request in writing to the Clinic's Privacy Officer. Your request must state a specific time period for the accounting (e.g. the three months). The first accounting you request within a twelve (12) month period will be free. For additional accountings, we may charge you for the costs of providing the list. We will notify you of the costs involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
If you believe that your privacy rights have been violated, you should immediately contact the Clinic's Privacy Officer. We will not take action against you for filing a complaint. You also may file a complaint with the Secretary of Health and Human Services.