N O T I C E  O F  
P R I V A C Y  P R A C T I C E S

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.

     This document being supplied to you represents our compliance with the Health Insurance Portability and Accountability Act (HIPAA) passed by Congress and enacted into law in August, 1996.  If you have any questions about this notice, please contact the ASCW Privacy Officer.

WHO WILL FOLLOW THIS NOTICE:

     This notice describes the privacy practices of every employee of the ASCW who is authorized to enter or see information in your paper chart or electronic medical record.

OUR PLEDGE REGARDING MEDICAL INFORMATION:

     Since it’s inception in 2002, the ASCW has worked to protect the privacy of the medical records of our patients.   We understand that medical information about you and your health is personal. We are committed to protecting your medical information.  This notice applies to all records of your medical care generated by any ASCW employee.

     This notice informs you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.  

We are required by law:

     1.    to make sure that your medical information is kept private.

     2.    to give you this notice of our legal duties and privacy practices with respect to medical   
            information about you, and

     3.    to follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE 
MEDICAL INFORMATION ABOUT YOU.

     For each category of uses or disclosures of your medical information, we will explain what we mean and try to give some examples.  Not every use or disclosure in a category will be listed.  However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

     For Treatment.  We may use medical information about you to provide you with medical treatment or services.  We may disclose medical information about you to doctors, nurses, technicians, or other individuals who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes, because diabetes may slow the healing process.  We also may disclose medical information about you to people outside ASCW who may be involved in your medical care such as physician consultants or family members.  We may use a transcription service to type your physician’s record of your care.  We may use a copying service to make copies of your records and send them to anyone that you request.  We may send your laboratory specimens to reference lab and forward demographic and insurance information necessary to track your laboratory results or for the lab to bill for its work.  The names of any of our contract service providers are available upon your request to the ASCW Privacy Officer.

     For Payment.  We may use and disclose medical information about you so that the treatment and services you receive may be billed and payment collected from you, an insurance company, or a third party.  We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

      For Health Care Operations.  We may use and disclose medical information about you for office operations.  These uses and disclosures are necessary to run the office and make sure that all of our patients receive quality care.  Fro example, we may use medical information to review the quality of patient care and to evaluate the performance of our staff in caring for you.  We may require a cleaning company to perform routine maintenance on our building interiors.  We may require an answering service to answer patient calls when our offices are closed and to give the message to our nurses or physicians.  The names of any of our contract service providers are available upon your request to the ASCW Privacy Officer.

     Appointment Reminders.  We may use and disclose medical information to contact you as a reminder that you have an appointment for a surgical procedure.

     Health-Related Benefits and Services.  We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

     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.  We may also give information to someone who helps pay for your care.

     Research.  Under certain circumstances, we may use and disclose medical information about you for research purposes.  We will always ask for your specific written permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care.

     As required By Law.  We will disclose medical information about you when required to do so by federal, state or local law.

     To Avert a Serious Threat to Health or Safety.  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.  Any disclosure, however, would only be to someone able to help prevent the threat.

SPECIAL SITUATIONS

     Organ and Tissue Donation.  If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

     Military and Veterans.  If you are a member of the armed forces, we may release medical information about you as required by military command authorities.

     Worker’s Compensation.  We may release medical information about you for worker’s compensation or similar programs.  These programs provide benefits for work-related injuries or illness.  

     Public Health Risks.  We may disclose medical information about you to public health authorities as required by law:

• to prevent or control disease, injury, or disability;

• to report births and deaths;

• to report reactions to medications or problems with products;

• to notify people of recalls of products they may be using;

• to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;

• to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or  domestic violence.

     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.

     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 the dispute, but only if efforts have been made to tell you about the request.

     Law Enforcement.  We may release medical information if required to do so by a law enforcement official: 

• In response to a court order, subpoena, warrant, summons or similar process;

• To identify or locate a suspect, fugitive, material witness, or missing person;

• About the victim of a crime if, under certain limited circumstances, we are unable to obtain person’s agreement; 

• About a death we believe may be the result of criminal conduct;

• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

     Coroners, Medical Examiners and Funeral Directors.  We release medical information to a coroner or medical examiner.  This may be necessary, for example, to identify a deceased person or determine the cause of death.  We may also release medical information about patients to funeral directors as necessary to carry out their duties.

     National Security and Intelligence Activities.  We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:

     You have the following rights regarding medical information we maintain about you:

     Right to Copy.  You have the right to a copy of any medical information in your chart.  To obtain a copy of any medical information, please obtain a request form from the ASCW Medical Records Department.  If you request a copy of the information, we charge a New York State authorized fee for the costs of copying and/or mailing.  By New York State Law, we will provide the records within 10 business days.  

     We may deny your request to a copy in certain very limited circumstances.  If you are denied access to medical information, you may request that the denial be reviewed.  A different licensed health care professional chosen by this office will review your request and the denial.  We will comply with the outcome of the review.

     Right to Amend.  If you feel that medical information we have about you is incorrect or incomplete, you have the right to request an amendment, however, by law, we cannot alter the original information.  To request an amendment, please obtain a request form from the ASCW Privacy Officer.  In addition, you must provide a reason that supports your request.

     We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.  In addition, we may deny your request if you ask us to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;

• Is not part of the medical information kept by the office; 

• Is not part of the information which you would be permitted to inspect and copy; or

• Is accurate and complete.

      Right to an Accounting of Disclosures.  You have the right to request an “accounting of disclosure.” This is a list of the disclosures we made of medical information about you.

     To request this list or accounting disclosures, please obtain a request form from the ASCW Privacy Officer.  Your request must state a time period that may not be longer than six years and may not include dates before 4/14/03.  The first list you request within a 12-month period will be free.  For additional lists, we may charge you for the costs of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any cost is incurred.

     Right to Request Restrictions.  You have the right to request a restriction or limitation on the disclosure of the medical information in your chart.  For example, you could ask that we not disclose the information about surgery that you had to a particular family member.

     We are not required to agree to your request.  If we do agree, we will comply with your request unless the information is needed to provide you emergency medical treatment.

     To request a restriction, please obtain a request form from the ASCW Privacy Officer.  In your request, you must tell us (1) what information you want to limit; and (2) to whom you want the limits to apply;  for example, disclosures to your spouse. 

     Right to Request Confidential Communications.  You may request to receive Protected Health Information by alternative means of communication or alternative locations.

     To request confidential communications, please obtain a request form from the ASCW Privacy Officer.  We will not ask you the reason for your request.  We will accommodate all reasonable requests.  Your request must specify how or where you wish to be contacted.  

     Right to a Paper Copy of This Notice.  You have the right to a paper copy of this notice.  You may ask us to give you another copy of this notice at any time.

     Right to Designate a Personal Representative.  You have the right to designate a Personal Representative who can act on your behalf in regard to medical records.  This person can make all decisions that you can make only in so far as to handling of your medical records, not your health care.  Please obtain a request form from the ASCW Privacy Officer to designate a personal representative for medical information.  This designation will remain in effect until you change or revoke it in writing.

CHANGES TO THIS NOTICE

     We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.  We will post a copy of the current notice in the office.  The notice will contain the effective date on the first page in the upper left-hand corner.  We will also post an up-to-date copy of this Notice on our web site:  www.westchestersurgery.com

COMPLAINTS

     If you believe your privacy rights have been violated, you may file a complaint with the ASCW or with the Secretary of the Department of Health and Human Services.  To file a complaint with the ASCW, please contact The Medical Director at (914) 244-6787or the Corporate Administrator at (914) 242-1579.  All complaints must be submitted in writing on a special form available from the ASCW.  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 or the laws that apply to us will be made only with your written permission.  If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time.  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 unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.  

      By no means does this Notice intend to supercede or waive your rights under the NYS Health Law.