THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy describes how Newport Beach Surgery Center (NBSC) may use and disclose your Protected Health Information (PHI) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:
Newport Beach Surgery Center is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, NBSC will create records regarding you and the treatment and services provided to you. NBSC is required by law to maintain the confidentiality of health information that identifies you. NBSC is also required by law to provide you with this notice of our legal duties and privacy practices concerning your identifiable health information. By law, NBSC must follow the terms of the notice of privacy practices that NBSC has in effect at the time.
Treatment:
The Staff of Newport Beach Surgery Center may use your identifiable health information to treat you. For example, the Anesthesiologist may ask you to undergo laboratory tests (such as blood or urine tests), and use the results to help reach a diagnosis. The Anesthesiologist might use your identifiable health information in order to write a prescription for you, and the Staff subsequently might disclose your identifiable health information to a pharmacy when instructed to call and order the prescription for you. Additionally, the Staff may disclose your identifiable health information to others who may assist in your care, such as your spouse, children, or parents.
Payment:
Newport Beach Surgery Center may use and disclose your identifiable health information, as needed, in order to submit claims and collect payment for the services you received. For example, the Staff may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and the Staff may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. The Staff also may use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, NBSC may use your identifiable health information to bill you directly for services and items.
Health Care Operations:
Newport Beach Surgery Center may use and disclose your identifiable health information to operate our business. As examples of the ways in which NBSC may use and disclose your information for operations, NBSC may use your health information to evaluate the quality of care that you received or to conduct cost-management and business planning activities. NBSC may use your PHI, as necessary, to contact you in regards to a scheduled appointment.
NBSC may use or disclose your PHI in the following situations without your authorization. These situations (which may be required by law) include: Public Health Issues; Communicable Diseases; Health Oversight; Abuse or Neglect; Food and Drug Administration Requirements; Legal Proceedings; Law Enforcement; Coroners; Funeral Directors; Organ Donation; Research; Criminal Activity; Military Activity and National Security; and Workers Compensation. Under the law, NBSC must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine Newport Beach Surgery Center’s compliance with the requirement of Section 164.500.
Other Permitted and Required Uses and Disclosures will be made only with your consent, authorization of opportunity to object unless required by law.
You may revoke this authorization, at any time, in writing except to the extent that NBSC has taken an action in reliance on the use or disclosure indicated in the authorization.
YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION:
You have the following rights regarding the identifiable health information that Newport Beach Surgery Center maintains about you:
Confidential Communication: You have the right to request a restriction of NBSC use or disclosure of your identifiable health information for treatment, payment or health care operations. Additionally, you have the right to request that NBSC limit our disclosure of your identifiable health information to individuals involved in your case or the payment for your care, such as family members and friends. Newport Beach Surgery Center is not required to agree to your request; however, if NBSC does agree, NBSC will be bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.
Inspection and Copies: You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. NBSC will charge a fee for the costs of copying, mailing, labor and supplies associated with your request. NBSC may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted by another licensed health care professional chosen by NBSC.
Amendment: You may ask NBSC to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept. You must provide NBSC with a reason that supports your request for the amendment. NBSC will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, NBSC may deny your request if you ask to amend information that is: (a) accurate and complete; (b) not part of the identifiable health information kept by NBSC; (c) not part of the identifiable health information which you would be permitted to inspect and copy; or (d) not created by NBSC, unless the individual or entity that created the information is not available to amend the information.
Accounting of Disclosures: All of our patients have the right to request an “accounting of disclosure.” An “accounting of disclosure” is a list of certain disclosures NBSC has made of your identifiable health information. All requests for an “accounting of disclosures” must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12 month period is free of charge, but NBSC will charge you for additional lists within a 12 month period. NBSC will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
Right to a Paper Copy: You are entitled to receive a copy of the HIPAA Notice of Privacy Practices.
Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with NBSC or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Right to Provide an Authorization for Other Uses and Disclosures: Newport Beach Surgery Center will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to NBSC regarding the use and disclosure of your identifiable health information may be revoked at any time in writing. After you revoke your authorization, NBSC will no longer use or disclose your identifiable health information for the reasons described in the authorization. Please note that NBSC is required by law to retain records of your care.
If you have any questions, requests or complaints regarding this notice of our health information privacy policies please contact NBSC in writing.
