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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 notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, or
healthcare 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 healthcare services.
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notices will
be effective for all protected health information that we maintain at that time. Upon you request, you can receive any revised Notice of Privacy Practices
by accessing our website, www.healthsouth.com, contacting MemphisSurgeryCenter,
or the Privacy Officer at privacyofficer@healthsouth.com. Just request that a revised copy be sent to
you in the mail or ask for one at your next appointment.
How we may use and disclose your protected Health Information:
Your healthcare provider will use or disclose your protected health information as described in Section 1. Your protected health information may be used
and disclosed by your healthcare provider, our office staff, and others outside of our facility that are involved in your care and treatment for the purpose
of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and to support the
operation of Memphis Surgery Center.
Following are examples of the types of uses and disclosures of your protected healthcare information that Memphis Surgery Center is permitted to make.
These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our facility.
TREATMENT:
We may use protected health information about you to provide you with medical treatment or services. We may disclose medical information
about you to doctors, nurses, technicians, medical students, or other personnel who are involved in your care. Different departments of our facility also
may share protected health information about you in order to coordinate your needs, such as prescriptions, lab work, and x-rays. We may also disclose protected
health information about you to individuals outside of the Memphis Surgery Center who may be involved in your medical care, such as family members or others we
use to provide services who are part of your care. When required, we will obtain your authorization before disclosing any of your information. Only the minimal
amount of information will be revealed during any disclosures.
PAYMENT
Your protected health information will be used, as needed, to obtain payment of your healthcare services. This may include certain activities that your health
insurance plan may undertake before it approves or pays for the healthcare services we recommend for you such as: making a determination of eligibility or
coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example,
obtaining approval for a hospital stay may require that your relevant approval for the hospital admission.
HEALTHCARE OPERATIONS:
We may use or disclose as-needed, your protected health information in order to support the business activities of your healthcare provider and
Memphis Surgery Center. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical
students, licensing, marketing, fund-raising activities, and conducting or arranging for other business activities.
For Example, your health information may be disclosed to a member of the medical staff, risk, or quality improvement personnel and others to:
- Evaluate the performance of our staff.
- Assess the quality of care and outcome in your case and similar cases.
- Learn how to improve our facilities and services.
- Determine how to continually improve the quality and effectiveness of the health care we provide.
In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician or therapist.
We may also call you by name in the waiting room when your healthcare provider is ready to see you. We may use or disclose your protected health information,
as necessary, to contact you to remind you of your appointment.
We will share your protected health information with third party “business associates” that may perform various activities (e.g., billing and transcription
services) for Memphis Surgery Center. When there is an arrangement between our facility and a business associate involving the use or disclosure of your
protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related
benefits and services that may be of interest to you.
OTHER PERMITTED AN REQUIRED USES AND DISCLOSURES THAT MAY BE MADE WITH YOUR AUTHORIZATION, OR OPPORTUNITY TO OBJECT
You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to
agree or object to the use or disclosure of the protected health information, then you healthcare provider may, using professional judgment, determine
whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your healthcare will be disclosed.
We may use and disclose your protected health information in the following instances:
FACILITY DIRECTORIES:
Unless you object, we will use and disclose in our facility directory your name, the location at which you are receiving care, your condition (in general terms)
, and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name.
OTHER INVOLVED IN YOUR HEALTHCARE:
Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your protected health information
that directly relates to the involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as
necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify
or assist in notifying a family member, personal representative, or any other person that is responsible for your care, information such as: general condition,
your location, or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster
relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare
WE MAY USE OR DISCLOSE YOUR PROTECTED HEATH INFORMATION WITHOUT YOUR AUTHORIZATION IN THE FOLLOWING SITUATIONS:
Required by law:
We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure
will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law,
of any such uses or disclosures.
Public Health:
We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted
by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury, or disability.
We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is
collaborating with the public health authority.
Communicable Diseases:
We may disclose your protected health information, if authorized by law, to a person who may have been
exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight:
We may disclose protected health information to a health oversight agency for activities authorized by law,
such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the
healthcare system, government benefit programs, other government regulatory programs, and civil rights laws.
Abuse or Neglect:
We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse
or neglect. In addition, we may disclose your protected health information to the governmental entity or agency authorized to receive such
information if we believe that you have been a victim of abuse, neglect, or domestic violence. In this case, the disclosure will be made
consistent with the requirements of applicable federal and state laws.
Food and Drug Administration:
We may disclose your protected health information to a person or company required by the Food and Drug Administration to: report adverse
events, product defects, or problems, biologic product deviations, track products, to enable product recalls, to make repairs or replacements,
or to conduct post marketing surveillance, as required.
Legal Proceedings:
We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a
court or administrative tribunal (to the extent such disclosure expressly authorized). In certain conditions, in response to a subpoena,
discovery request, or other lawful process.
Law Enforcement:
We may disclose protected health information so long as applicable legal requirements are met, for law enforcement purposes. These
law enforcement purposes include; (1) legal processes and those otherwise required by law (2) limited information requests for identification
and location purposes (3) pertaining to victims of a crime (4) suspicion that death has occurred as a result of criminal conduct (5) in the
event that a crime occurs on the premises of Memphis Surgery Center and (6) medical emergency (not on Memphis Surgery Center's premises) and
it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation:
We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death
or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a
funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information
in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye, or tissue donation
purposes.
Research:
We may disclose your protected health information to researchers when their research has been approved by an institutional review board
that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Criminal Activity:
Consistent with applicable federal and state laws, we may disclose your protected health information if we believe that the use or disclosure
is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose
protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security:
When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces Personnel (1)
for activities deemed necessary by appropriate military authority (2) for the purpose of a determination by the Department of Veterans Affairs
of your eligibility for benefits or (3) to foreign military authority if you are a member of that foreign military services. We may also
disclose your protected health information to authorized federal officials for conducting nation security and intelligence activities,
including for the provision of protective services to the president or others legally authorized.
Workers Compensation:
Your protected health information may be disclosed by us as authorized to comply with worker's compensation
laws and other similar legally established programs.
Required Uses and Disclosures:
Under the law, we must make disclosures to you, and when required by the Secretary of the Department of Health and Human Services to
investigate or determine our compliance with the requirements of Section 164.500 et.seq.; Privacy of Individuality Identifiable Health
Information.
Your Rights:
Following is a statement of you rights with respect to your protected health information and a brief description of how you may exercise
these rights.
You have the right to inspect and copy your protected health information:
This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as
long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records
that your healthcare provider and Memphis SurgeryCenter use for making decisions about you.
Under federal law; however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable
anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to
law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable.
Please contact our Medical Records Department if you have questions about access to your medical record. If you request a copy of the
information, we may charge a fee for the costs of retrieving, copying, mailing, and any other supplies associated with your request.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part
of your protected health information for the purposes of treatment, payment, or healthcare operations. You may also request that any part of
your protected not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in
the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Your healthcare provider is not required to agree to restrictions you may request. If the healthcare provider believes it is in your best
interest to permit use and disclosure of your protected health information, your protected health information will not be restricted.
If your healthcare provider dies and agreed to the requested restriction, we may not use or disclose your protected health information in
violation of that restriction unless it is needed to proved emergency treatment. With this in mind please discuss any restriction you wish
to request with your healthcare provider.
You have the right to request to receive confidential communication from us by alternative means or at an alternative location.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will
accommodate reasonable requests. We may also condition this accommodation by asking you for information as to ho payment will be handled
or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the
request. Please make this request in writing to our Medical Records Department.
You may have the right to have your healthcare provider amend your protected health information. This means you may request an
amendment of protected health information about you in a designated record set for as long as we maintain this information.
In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file
a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
Please contact our Medical Records Department to determine if you have a question about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right
applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Notice of Privacy Practices.
It excludes disclosures we may have made to you, for a facility directory, to a family member, or friends involved in your care, or for
notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003.
You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions, and limitations.
You have the right to obtain a paper copy of this notice from us. You have the right to a copy of this notice. You may ask us to give you a
copy of this notice at any time. To request a copy of this notice, you must make your request in writing to the Privacy Officer.
Complaints:
You may file a complaint with us or with the Secretary of Health and Human Services if you believe your privacy rights have been violated
by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing
a complaint.
You may contact our Privacy Officer at 901-682-1516 for further information about the compliant process.
This notice was published on and becomes effective on April 14, 2003
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patient rights.pdf
patient privacy.pdf
receipt.pdf
registaratation.pdf
authoriztion.pdf
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