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.

We may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations.  We have established policies to guard against unnecessary disclosure of your health information.  

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:

To Provide Treatment.  We may use your health information to coordinate care with others involved in your care.  For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications.  We also may disclose your health care information to individuals outside of our office involved in your care including family members, pharmacists, suppliers of medical equipment, or other healthcare professionals.

To Obtain Payment.  We may include your health information in invoices to collect payment from third parties for the care you receive from us.  

To Conduct Health Care Operations.  We may use and disclose health information for its own operations in order to facilitate our services and as necessary to provide quality care to all patients.  Health care operations include such activities as:

1. Quality assessment and improvement activities.  
2. Activities designed to improve health or reduce health care costs.
3. Protocol development, case management and care coordination.
4. Contacting patients with information about treatment alternatives and other related functions that do not include treatment.
5. Professional review and performance evaluation.
6. Training programs including those in which students, trainees or practitioners in health care learn under supervision.
7. Training of non-health care professionals.
8. Accreditation, certification, licensing or credentialing activities.
9. Review and auditing, including compliance reviews, medical reviews, legal services, and compliance programs.
10. Business planning and development including cost management and planning related analyses and formulary development.
11. Business management and general administrative activities 

For example, we may use your health information to evaluate our staff performance, combine your health information with other patients in evaluating how to more effectively serve all patients, disclose your health information to our staff and contracted personnel for training purposes.

We may use your contact information/phone number to contact you as a reminder regarding a visit to you, or contact you as part of general marketing and community information mailings (unless you tell us you do not want to be contacted).

For Appointment Reminders.  We may use and disclose your health information to contact you as a reminder that you have an appointment for a doctor’s office visit. 

For Treatment Alternatives.  We may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.  

 

In accordance with health and safety codes, we have adopted the following list of PATIENT RIGHTS:

1. Exercise these rights without regard to sex or culture, economic, educational, or religious background, or the source of payment for his/her care.
2. Considerate and respectful care.
3. Knowledge of the name of the physician who has primary responsibility for coordinating his/her care and the names and professional relationships of other physicians who will see this patient.
4. Receive information from his/her physician about his/her illness, his/her course of treatment and his/her prospects for recovery in easy-to-understand terminology.
5. Receive as much information about any proposed treatment or procedure as he/she may need in order to give informed consent or to refuse this course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved, and knowledge of the name of the person who will carry out the procedure or treatment.
6. Participate actively in decisions regarding his/her medical care. To the extent permitted by law, including the right to refuse treatment.
7. Full consideration of privacy concerning his/her medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discreetly. The patient has the right to know the reason for the presence of any individual.
8. Confidential treatment of all communications and records pertaining to his/her care. His/her written permission shall be obtained before his/her medical records can be made available to anyone not directly concerned with his/her care.
9. Reasonable responses to reasonable requests he/she may make for services.
10. He/she may leave the facility even against the advice of his/her physicians.
11. Reasonable continuity of care and to know in advance the time and location of the appointment, as well as the physician providing the care.
12. Be informed by his/her physician or a delegate of his/her physician of his/her continuing healthcare requirement following his/her discharge from the center.
13. Examine and receive an explanation of the bill regardless of the source of payment.
14. Know which rules and policies apply to the patient’s conduct while a patient.
15. Have all patient’s rights apply to the person who may have a legal responsibility to make decisions regarding medical care on behalf of the patient.
16. Patients shall be advised if their treating physician or nurse does not carry current liability insurance.

 

In order for medical staff to provide each individual with the best possible care, we have adopted the following patient RESPONSIBILITIES for the participation of his/her care. These responsibilities should be followed in the spirit of mutual trust and respect.

1. The patient has the responsibility to provide accurate and complete information concerning his/her present complaints, past illnesses, hospitalizations, and other matters related to his/her health.
2. The patient is responsible for making it known whether he/she clearly comprehends the course of medical treatment and what is expected of him/her. Cooperate with a physician or his designee and ask questions if not understanding instructions or information.
3. The patient is responsible for following the treatment plan established by his/her physician, including the instructions of nurses and other health professionals as they carry out the physician’s order.
4. The patient is responsible for keeping appointments and for notifying the office or physician when he/she is unable to do so.
5. The patient is responsible for his/her action should treatment be refused or not followed as prescribed. Fully participate in decisions involving own care.
6. The patient is responsible for assuring that the financial obligations for the care provided are fulfilled as promptly as possible.
7. The patient is responsible for following the office’s policies and procedures.
8. The patient is responsible for being considerate of the rights of other patients and surgery center personnel.
9. The patient is responsible for being respectful of his/her personal property and that of other patients.
10. The patient is responsible to notify the office if there is any problem or dissatisfaction with care or services.
11. The patient is responsible to notify the office if there is any change in contact information or if they no longer wish to receive communications via email or text message.