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PRIVACY PRACTICES

  SURGERY CENTER, Inc. ®

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY

When signing the "Authorization for Examination and Treatment" form you are authorizing the following:

TREATMENT

GulfCoast Surgery Center, Inc. and any physician examining or any medical facility treating you is authorized to release to any subsequent treating physician information and/or records concerning your diagnosis and treatment.

PAYMENT

Medical records and/or information will be shared with third party payers such as insurance companies or the Social Security Administration or its intermediaries or carriers, when requested for use in connection with determining a claim for payment.

HEALTHCARE OPERATIONS

Medical record information may be used in performing the following activities:

	Quality Improvement;
	Reviewing competence or qualifications of healthcare professionals;
	Underwriting, premium rating, and other insurance activities.
	Conducting or arranging for medical review, legal services, auditing functions, fraud and abuse detection, and compliance programs;
	Business planning and development;
	General administrative duties including but not limited to: Compliance management; Customer service; Resolution of internal grievances;

YOUR RIGHTS

	You have the right to request restrictions regarding usage/disclosure of information.
	You have the right to receive confidential communications.
	You have the right to inspect and copy protected health information.
	You have the right to amend incorrect or incomplete protected health information.
	You have the right to receive an accounting of disclosures.
	You have the right to receive a paper copy of this notice.

Each time you visit the hospital, surgery center, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination, test results, diagnoses, treatment, and a plan for future care/treatment. This notice applies to all of the care generated by GulfCoast Surgery Center, Inc.

OUR RESPONSIBILITIES

We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices.

USES AND DISCLOSURE(S) OF INFORMATION

How we may use and disclose medical information about you.

The following categories describe examples of the way we use and disclose medical information:

For Treatment: We may use medical information about you to provide you treatment or services. We may disclose medical information about you to doctors, nurses, technicians, or other personnel who are involved in taking care of you.

For Health Care Operations: Members of the staff may use information in your record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all patients we serve. We also may combine medical information about many patients to evaluate the need for new services or treatment. We may remove information that identifies you from this set of medical information to protect your privacy.

We may also use and disclose medical information:

	To remind you that you have an appointment for medical care;
	To assess your satisfaction with our services;
	To tell you about health related benefits or services;
	For population-based activities relating to improving health or reducing health care costs.

Individuals involved in Your Care or 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 to pay for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

Future Communications: We may communicate to you via newsletters, mail or other means regarding health related information, wellness programs, or other community based initiatives or activities in which the Surgery Center is participating.

As required by law, we may use and disclose health information to:

	Food and Drug Administration.
	Public health or legal agencies charged with preventing or controlling disease, injury or disability.

To exercise your rights, please obtain the required forms from the Privacy Officer and submit your request in writing.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Privacy Officer. All complaints must be submitted in writing. You will NOT be penalized for filing a complaint.

Other Uses of Medical Information

Other uses and disclosures of medical information not covered by this notice will be made only with your written permission. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are required to retain our records of the care that we provided to you.

 

If you have any questions about this notice, please contact our Privacy Officer at 941-924-9282.

Effective Date: October 2002.

 

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