Your privacy is important to us. Our Notice of Privacy Practices describes how our medical practice uses and discloses your medical information. We ask that you please read this document carefully. If there are questions about the practices described in this Notice, please do not hesitate to contact our office. We are required by law to maintain the privacy of protected health information, and we have adopted this Privacy Policy to meet these legal requirements. This Notice describes our privacy practices with respect to medical information, including a description of the types of information we collect, when we collect it, and how we use it; an explanation of who may access information; and descriptions of certain rights that you have regarding our use of your medical information.

Hourglass Surgery Center is committed to protecting the privacy of your protected health information (PHI). We will use or disclose your PHI only with your written authorization. By being a patient of Hourglass Surgery Center, you are giving us permission to use, share and disclose your PHI with others under certain circumstances. These purposes include treatment, payment, and health care operations. We also may use and disclose your protected health information to bill and collect payment from you or a third party on your behalf for the services we provide.

Privacy Obligations
The law requires us to maintain the privacy and security of your health information (“Protected Health Information” or “PHI”). Hourglass Surgery Center is required to provide you with this Notice of privacy practices that describes how your PHI is protected and our legal duties with respect to your PHI. Our Surgery Center uses computerized systems to record and disclose Protected Health Information for specific purposes, including treatment, payment, and health care operations. The Surgical Center is also required to abide by the terms of our Notice (or another notice in effect at the time) when using or disclosing your Protected Health Information. We will not use or disclose your Protected Health Information for any purpose that is not permitted by our Notice.

Under the law, we are allowed to use or disclose your health information for the following purposes:

APPOINTMENT REMINDERS AND TIME: Your medical information may be used and disclosed for the purpose of contacting you with appointment reminders.

TREATMENT: Your medical information is essential to our ability to provide you with quality health care. At times, we share your medical information with other physicians or health care providers who will be involved in providing the care you need. For example, we may disclose your medical information to your primary care physician or a specialist who will perform surgery for you.

PAYMENT: We may use or share your health information to obtain payment for your care. We may tell your health insurance company about the treatment you are receiving so we can be reimbursed. We may also provide information about you to others in the health care system, such as those who help make decisions about prior authorizations and those who may bill for services provided to you.

HEALTH CARE OPERATIONS: We may use your health information or share it with others in order to conduct our business operations. We may, for example, evaluate the performance of our staff in caring for you, or educate our staff on how to improve the care they provide to people like you.

Disclosure to Family, Friends and Others Involve in Your Care: We may disclose medical information to family members, friends, and other medical providers involved in your care after you leave the office, surgery center, or hospital.  This will help us coordinate your care and provide additional services necessary for your health.

PUBLIC HEALTH: We may need to share your health information with public health officials or other people. This may include sharing with local and state health departments, child abuse agencies, law enforcement officials, or other appropriate parties.

VICTIMS OF ABUSE, NEGLECT, OR DOMESTIC VIOLENCE:  We may disclose your health information to a public health authority when required by law and if the public health authority is authorized to receive reports of abuse, neglect or domestic violence, or in situations where we believe that you have a communicable disease or when we think it is necessary for the protection of the public’s health.

HEALTH OVERSIGHT ACTIVITIES: We may, or required by law to disclose your health information to health oversight agencies during the course of audits and investigations. In some cases, these agencies are required by law to conduct audits, investigations and inspections.

JUDICIAL AND ADMINISTRATIVE PROCEEDINGS: We may, and are sometimes required by law, to disclose your health information in any administrative or judicial proceeding to the extent expressly authorized by a court or administrative order.

LAW ENFORCEMENT:  We may disclose your health information to law enforcement officials, such as the police if there is a reasonable belief that a patient’s condition presents a danger to the public. This disclosure may be made only if the patient has been notified of the situation and believes that this disclosure is necessary for law enforcement purposes.

CORRECTIONAL INSTITUTION: We may disclose your health information to a correctional institution if you are an inmate of a correctional institution and make certain requests to us.

ORGAN, TISSUE PROCUREMENT: We may disclose your health information to organizations involved in procuring, banking, or transplanting organs and tissues. These organizations may include hospitals and organ procurement organizations, including hospitals that offer donation services or are involved with tissue donation programs.

HEALTH SAFETY: We may use or disclose your health information to prevent or lessen serious or even imminent threats to the health or safety of a particular person or the general public.

RESEARCH:  Your health information may be disclosed to researchers for the purpose of conducting research that does not require your written authorization.

AS REQUIRED BY LAW: We may use or disclose your health information if required to do so by any other law, such as required by the FDA, to monitor the safety of a medical device, or when responding to court orders or subpoenas.

SPECIALIZED GOVERNMENT FUNCTIONS:  Your health information may be disclosed to government units with special functions, such as the Secret Service or NSA to protect the country or the President.

WORKER’S COMPENSATION: We may disclose your health information with another health care provider authorized to comply with state law relating to workers’ compensation or other similar programs.

FUNDRAISING: We may use your health information to contact you as a part of fundraising efforts. If you do not want to receive this information, please opt out.

USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

THE USE OR DISCLOSURE WITH YOUR AUTHORIZATION:  Before disclosing your health information to any third party other than those described above, you should sign an authorization form. You will be provided with the Authorization Form each time disclosure is made. If the disclosure requires your written authorization, you must complete and sign the form before we can make the disclosure. The information on the form must relate to what you have authorized us to do—for example; it cannot authorize anything beyond what is stated on the form.

FOR MARKETING: To ensure that we understand your marketing preferences and comply with the law, your provider must first receive your written authorization prior to using or disclosing your health information for marketing purposes. This includes giving you any materials related to our treatment, case management or care coordination services, or alternative treatments, therapies, providers, or care settings. However, in-person communication is not considered a marketing activity and therefore does not require Your Marketing Authorization.

SALE OF HI: We will maintain the confidentiality of your health information. We will not disclose any information to any third party without your authorization. This includes public health activities; sale, transfer, research; merger or consolidation of the Facility; treatment of the individual; services provided by a business associate, pursuant to a business associate agreement; as well as other purposes deemed necessary and appropriate by the U.S. Department of Health and Human Services (HHS).

HIGHLY CONFIDENTIAL INFORMATION: Under federal and state law, certain highly confidential information about you (“Highly Confidential Information”) must be kept in a safe place unless otherwise required by law. Highly confidential information includes the subset of your PHI that: (1) is maintained in psychotherapy notes; (2) is about mental illness, retardation, or developmental disabilities; (3) is about alcohol or drug abuse or addiction; (4) is about HIV/AIDS testing, diagnosis or treatment; (5) is about communicable disease(s), including venereal disease(s); (6) is about genetic testing; (7) is about child abuse and neglect; (8) is about domestic abuse of an adult; or (9) is about sexual assault.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

RIGHT TO REQUEST FOR ADDITIONAL RESTRICTIONS: You can request an accounting of certain disclosures of your health information made during any period of time prior to the date of your request. The accounting will include disclosures that occurred prior to April 14, 2003 and specific disclosures made within the past six years. You will be charged for an accounting statement if you request it more than once during a twelve (12) month period.

RIGHT FOR AMENDMENTS REQUEST OF RECORDS: You have the right to request that the health information maintained in your billing records be amended. If you desire to amend a billing record, please obtain an amendment request from the Facility Health Information Management Office, complete the form and return it to the Facility Health Information Management Office. Your request will be accommodated unless we believe that the information that would be amended is accurate or complete, or other special circumstances apply.

RIGHT FOR SUMMARY: You have the right to a summary of your health information, rather than receiving the entire record.  We can provide you with an explanation of the health information that was provided to you.

RIGHT TO INSPECT AND COPY OF HEALTH INFORMATION: You have the right to inspect and copy your PHI, which we have up to 30 days to make available to you. If we deny your request in certain limited circumstances, we will inform you in writing of our reasons for the denial and your right to have it reviewed by a person at our company who is authorized to reconsider the denial.

RIGHT FOR PAPER COPY OR ELECTRONIC OF RECORDS: You have a right to request access to your health information . We will give you or transmit a copy of your medical records in the form or format you request like a paper copy. In the case it is not readily producible in the form or format you request, we will provide a readable electronic copy.

RIGHT TO RECEIVE ACCOUNTING DISCLOSURES: You have the right to receive a list of disclosures we have made for purposes other than treatment, payment, or health care operations as described in this notice. This accounting is subject to some exceptions and limitations. If we charge you for providing this information, we will tell you what the costs are and provide you with an opportunity to withdraw or modify your request before incurring those costs.

COMPLAINTS: If you desire detailed information about your privacy rights, or are concerned that your privacy rights have been violated or disagree with decision made about access to your PHI, you may contact the Privacy & Security Officer by using our website’s “Contact Us” link or phone number listed on our website.

CHANGES TO THIS NOTICE: We reserve the right to change or amend our Notice of Privacy Practices. A copy of the current notice is located in our office and on our website. We will make any changes available to you with 30 days’ advance notice.