Short Hills Surgical Center

SHORT HILLS SURGERY CENTER

NOTICE OF PRIVACY

PURPOSE

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 Center uses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of the Center.

HOW THE CENTER MAY USE OR DISCLOSE YOUR HEALTH INFORMATION

For Treatment. The Center may use your health information to provide you with medical treatment or services. For example, information obtained by a health care provider such as a physician, nurse, or other persons providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.

For Payment. The Center may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third party-payer, such as an insurance company or health plan. This information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

For Health Care Operations. The Center may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:

Evaluate the performance of the staff;
Assess the quality of care and outcomes in your case and similar cases;
Learn how to improve our facilities and services; and
Determine how to continually improve the quality and effectiveness of the health care we provide.

Appointment. The Center may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual.

Fundraising. The Center may use your information to contact you to raise funds for the Center.

Required by Law. The Center may use or disclose information about you as required by law. For example, the Center may disclose information for the following purposes:

For judicial and administrative proceedings pursuant to legal authority;
To report information related to victims of abuse, neglect or domestic violence; and
To assist law enforcement officials in their law enforcement duties.

Public Health. Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury or disability, or for health oversight activities.

Decedents. Health information may be disclosed to funeral directors or coroners to enable them to carry out lawful duties.

Organ/Tissue Donation. Your health information may be used or disclosed for cadaver organ, eye or tissue donation purposes.

Research. The Center may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.

Health and Safety. Your health information may be disclosed to avert a serious threat to the health and safety of you and any other person pursuant to applicable law.

Government Functions. Your health information may be disclosed for specialized government functions such as protection of public health officials or reporting to various branches of the armed services.

Workers’ Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Workers’ Compensation.

Other Uses. Other uses and disclosures will be made only with written authorization and you may revoke the authorization except to the extent the Center has taken in reliance on such.

YOUR HEALTH INFORMATION RIGHTS

You have the right to:

Request a restriction on certain uses and disclosure of your information provided by 45 CFR § 164.522; however, the Center is not required to agree to a requested restriction;
Obtain a copy of the notice of information practices upon request;
Request communication of your health information by alternative means or at alternative locations;
Revoke your authorization to use or disclose health information except to the extent action has already been taken; and
Receive an accounting of disclosures made of your health information as provided by 45 CFR § 164.528.

COMPLAINTS

You may complain to the Center and to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.

OBLIGATIONS OF THE CENTER

The Center is required by law to:

Maintain privacy of protected health information;
Provide to you with this notice of its legal duties and privacy practices with respect to your health information;
Abide by the terms of this notice;
Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
Accommodate reasonable requests you may make to communicate health information by alternative means or alternative locations; and
Obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law.

The Center reserves the right to change its information practices and to make the new provisions affective for all protected health information it maintains. Revised notices will be posted in the waiting area within the Center. You also may obtain any new notice by contacting the Chief Privacy Officer.

CONTACT INFORMATION

If you have any questions or complaints, please contact:

Linda Kenworthy
Chief Corporate Compliance Officer
Salus Surgical Group
132 S Rodeo Drive
Beverly Hills, CA 90212
(310) 285-0070