PATIENT NOTICE OF PRIVACY PRACTICES
WILLIAMS PLASTIC SURGERY CENTER
Effective April 14th, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
I. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
Your health record is the physical property of Williams Plastic Surgery Center. The information contained in the record, however, belongs to you. You have the right to:
A. Request a restriction or limitation on the medical information we use or disclose about you for your treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your requested restrictions. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
B. Obtain a written copy of this Notice by requesting one from Williams Plastic Surgery Center.
C. Inspect and obtain a copy of your health care record by submitting a request in writing to Williams Plastic Surgery Center amend your healthcare record if you feel that medical information that we have about you is incorrect or incomplete by requesting, in writing, that an amendment be made. You must provide a reason that supports your request.
D. Obtain a report of all of the disclosures of your health information that we have made.
E. Request that we communicate with you about your medical information in a certain way or at a certain location within reasonable limits.
F. Revoke your authorization to use and disclose medical information about you, except to the extent that we have already used or disclosed your medical information.
II. OUR RESPONSIBILITIES REGARDING YOUR MEDICAL INFORMATION
We are required by law to:
A. Maintain the privacy of your health information.
B. Provide you with this Notice, which describes our legal duties and privacy practices with respect to information we collect about you.
C. Abide by the terms of this Notice.
D. Notify you if we are unable to agree to a requested restriction.
E. Accommodate reasonable requests that you have made to have us communicate your health information to you in a certain way or at a certain location.
WE RESERVE THE RIGHT TO CHANGE THIS NOTICE. We reserve the right to make the revised and changed notice effective for medical information that we already have about you, as well as any information we receive in the future. We will post a copy of the current notice at the receptionist desk and on our website which is www.williamsfacialsurgery.com. The notice will contain the effective date of the revised notice. Each time you register at Williams Plastic Surgery Center for health care services, we will offer you a copy of the current notice in effect.
III. HOW WE CAN USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
Each time you are a patient at Williams Plastic Surgery Center, a record of your visit is made. We may use or disclose the health information contained in this record if you have signed a consent allowing us to do so. The following categories describe the different ways that we may use and disclose your medical information upon your signing consent.
A. Treatment. We may use medical information about you to provide you with medical treatment and services. We may disclose medical information about you to doctors, nurses, technicians, or other personnel who are involved in taking care of you. For example, information obtained by a nurse, physician, or other member of your health care team will be recorded in your medical record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health team. Members of your healthcare team will then record the actions that they took and their observations. By reading your medical record, the physician will know how you are responding to treatment.
B. Payment. We may use and disclose medical information about you so that the treatment and services you receive at Williams Plastic Surgery Center may be billed to and payment may be collected from you, an insurance company, or third party. For example, we may need to give your insurance company information about surgery you received at Williams Plastic Surgery Center so that the insurance company will pay us or reimburse you for the surgery.
C. Health Care Operations. We may use and disclose medical information about you for the operations of Williams Plastic Surgery Center. For example, members of the medical staff, the risk management or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will be used in a way to improve the quality and effectiveness of the healthcare and services that we provide.
D. Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at Williams Plastic Surgery Center.
E. Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
F. Health-Related Benefits and Services. We may use and disclose medical information to inform you about health-related benefits or services that may be of interest to you.
G. Individuals Involved in Your Care of Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care or who helps pay for your care.
The following categories describe the different ways that we may use and disclose your medical information without your consent or authorization.
A. As Required by Law. We will disclose medical information about you when required to do so by federal, state or local law.
B. Emergency. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Williams Plastic Surgery Center, however, will only disclose the information to someone able to help prevent the threat.
C. Organ and Tissue Donation. Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
D. Business Associates. Some of the services provided at Williams Plastic Surgery Center are provided by business associates. For example, we contract with certain laboratories to perform lab tests. When we contract for these services, we may disclose your health information to our business associates so that they can perform the job we have hired them to do. To protect your health information, we require our business associates to appropriately safeguard your information.
E. Workers' Compensation. We may release medical information about you to the extent authorized by and to the extent necessary to comply with the laws relating to workers' compensation or other similar programs established by law.
F. Public Oversight Activities. As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
G. Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
H. Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in a dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
I. Law Enforcement. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
J. Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. We may also disclose health information to funeral directors consistent with applicable law to carry out their duties.
K. Food and Drug Administration. We may disclose to the FDA health information related to adverse events with respect to food, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
L. Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.
M. Victims of Abuse, Neglect or Domestic Violence. We may release medical information to a government authority if we reasonably believe that you are a victim of abuse, neglect or domestic violence, to the extent authorized or required by law.
IV. OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only upon a specific written authorization you provide to us that is different from the consent you have signed which allows Williams Plastic Surgery Center to use your medical information for the purpose listed in A-M above. If you provide us authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. The revocation, however, will not have any effect on any action Williams Plastic Surgery Center took before it received the revocation.
V. QUESTIONS OR COMPLAINTS
If you have questions and would like additional information, you may contact Susan Sullivan, R.N., CNOR, - Director of Operations at (518) 786-7000 at Williams Plastic Surgery Center. If you believe your privacy rights have been violated, you can submit a written complaint describing the circumstances surrounding the violation to Susan Sullivan, R.N., CNOR, - Director of Operations at 1072 Troy-Schenectady Road, Latham, NY 12110 Williams Plastic Surgery Center or to the Secretary of Health and Human Services in Washington, D.C. You will not be retaliated against for filing any complaint.