HIPPA

NOTICE OF PRIVACY PRACTICES

NORTHWEST FLORIDA SURGERY CENTER
767 AIRPORT ROAD
PANAMA CITY, FL 32405
PHONE (850) 747-0400 ” FAX (850) 913-9744

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.

Understanding Your Health Record

Northwest Florida Surgery Center’s mission is to provide the highest quality outpatient surgery services possible. In keeping with this philosophy, we strive to protect your privacy and keep secure all health information we maintain about you. Each time you visit Northwest Florida Surgery Center, a record is made that contains information such as your diagnosis, symptoms, examination and test results, and the treatment you were given. This record allows the many health care professionals who contribute to your care to communicate. It is also a legal document describing your care and is the means by which you or your insurance company can verify that you received the services you were billed for. Your record may also be used as a tool to improve our services, to market our facility, or to supply information to public health officials charged with improving the health of our nation.

Knowing and understanding what is in your medical record helps you to ensure that the information is accurate. Understanding how the information in your record is used for treatment and payment purposes helps you to better understand who and why others may access your health information, thus allowing you to make a more informed decision when authorizing others to have access to your private health information.

Your Health Information Rights

Although your health record is the physical property of Northwest Florida Surgery Center, the information in it belongs to you. You have the right to request a restriction on certain uses of your health information. You may request, for example, that family members not be included in discussions about your health or condition. Any use or disclosure of your medical information for purposes other than treatment, payment, or routine operational functions that improve our services will be made ONLY with your written, revocable authorization. This authorization form is available to you upon request from the receptionist. For example, you may wish your record to be sent to your attorney. We must have written authorization from you to disclose anything about you to any one or for any purpose other than treatment, payment or routine facility management.

You have the right to inspect and obtain a copy of your health record. We may deny your request to inspect your protected health information if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person, or that it is likely to cause substantial harm to another person referenced within the information. You have the right to have a decision to deny access reviewed by an outside person. To obtain and copy you medical information, you must submit a written request to the Privacy Officer whose contact information is listed on the last page of this Privacy Notice. If you request a copy of your information, we may charge you a fee for the costs of copying, mailing or other costs incurred by us in complying with your request. Please contact our Privacy Officer if you have questions about access to your medical record.

You may request amendment or correction to your health information for as long as we maintain the information. In certain cases, we may deny your request for an amendment. If we deny your request for an amendment, you have a 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. Copies of your requested amendment, subsequent denial, if applicable, and your written disagreement will become a permanent part of your medical record. Requests for amendment must be in writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendment.

You have the right to obtain an accounting of any disclosures of your health information, beyond those routine disclosures made for treatment, payment or routine healthcare facility management. We are not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures to friends or family members involved in your care, or certain other disclosures we are permitted to make without your authorization. The request for an accounting must be made in writing to our Privacy Officer. The request should specify the time period sought for the accounting. Accounting requests may not be made for periods of time in excess of six years. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.

You have the right to request that we communicate with you in certain ways. We will accommodate reasonable requests. For example, we can communicate with you by fax instead of by phone call or we can communicate with you at alternative locations (for example, to your office phone instead of your home phone). Requests must be made in writing to our Privacy Officer.

You may also revoke your authorization to use or disclose health information except to the extent that action has already taken place.

Upon request, you have a right to receive this Notice of Privacy Practices even if you have already received a copy of this notice.

Our Responsibilities

Northwest Florida Surgery Center is required to maintain the privacy and security of your health information, provide you with this notice describing our privacy practices with respect to the information we collect and maintain about you, abide by the terms of this notice, notify you if we are unable to agree to requested restriction, and to accommodate reasonable requests you may have made to us to communicate health information by alternative means or locations. We reserve the right to change our privacy practices and to make new provisions effective for all protected health information we maintain about you. If revisions are made to this Notice, a revised Notice will be redistributed to you should you return to Northwest Florida Surgery Center for another surgical procedure.

For More Information or To Report a Problem

If you have questions or would like additional information, you may contact our Privacy Officer whose contact information is listed on the last page of this notice. You have the right to express any complaints about your privacy rights and our practices to Northwest Florida Surgery Center. You may file a complaint verbally or in writing to our Privacy Officer. We encourage you to voice your concerns with us. You may also file a complaint with the Secretary of Health and Human Services if you believe that your privacy rights have been violated. You will not be retaliated against in any way for filing a complaint.

Examples of Uses and Disclosures of Your Health Information for Treatment, Payment and Health Care Operations

Northwest Florida Surgery Center may use your personal health information for purposes of providing treatment, obtaining payment for treatment, and conducting healthcare operations. Your protected health information may be used or disclosed only for these purposes unless Northwest Florida Surgery Center has obtained your authorization or if federal regulations or state law otherwise permits the use or disclosure. Disclosures of your health information may be made in writing, orally, or by facsimile.

We may use your health information for treatment purposes
For example, information such as your medical history, blood pressure, oxygen saturation, or blood type obtained by a nurse will be recorded in your record and used to determine the course of treatment that will ensure your safety during your procedure or surgery. Physicians may document the procedure performed and their expectations and instructions for recovery. Test results, such as tissue biopsies, may be maintained in your records.

We may use your health information for payment
For example, a bill may be sent to your insurance carrier. The information on, or accompanying the bill, may include information that identifies you, as well as your diagnosis, procedures and supplies used.

We may use your health information for routine healthcare facility management
For example, members of our infection control committee may use information in your health record to assess the effectiveness of our sterilization procedures. This information will then be used to continually improve the quality and effectiveness of the services we provide.

Notification/Communication with Family Members or Significant Others

Unless you object in writing, we may discuss your health information with a family member, a friend designated by you, or any other person responsible for your care, about your location during your stay at Northwest Florida Surgery Center (for example whether you are in pre-op, surgery or recovery) and we may brief them on your general condition. Again, unless you object in writing, we may discuss scheduling of the procedure or give appointment reminders to a family member by phone or leave the appointment information on your answering machine. Health professionals, using their best judgment, may communicate with a family member, other relative, close personal friend or any other person you identify, health information that is relevant to that person’s involvement in your care or payment related to your care. For example, we may discuss with your spouse the need for you to rest for the remainder of the day, or we may review the proper dosage for medication, or the fact that you are recovering nicely from your procedure. Should you wish any of the above named persons to be unauthorized to receive such information about you, you must request this in writing prior to receiving services at Northwest Florida Surgery Center. Please contact our Privacy Officer to request any restrictions you would like to make in sharing your health information with your family members or significant others.

24-Hour Call Backs

It is the policy of Northwest Florida Surgery Center to call patients within 24-hours of surgery to evaluate their condition and answer any questions they may have. Unless you object in writing, should you be unavailable to talk with our nurses at the time of the call, we may discuss your recovery with the caregiver who answers your phone.

Communications Between Physician and Those Responsible for Your Care

Following your surgery or procedure, your physician may come to our lobby to discuss your condition and outcome with the persons responsible for your care. Should you wish these discussions to be made in a private room, please have your caregiver request this from your physician when he or she reports to lobby to discuss your condition and give recovery instructions.

Semi-Private Pre-operative and Recovery Rooms

Northwest Florida Surgery Center utilizes curtains and partial walls to ensure the safety of our patients in the recovery and pre-op areas. Solid, four-walled rooms with doors do not allow for safe and continuous monitoring of our patients. Our staff has been trained to use quiet, discreet voices whenever discussing health information with you or with other members of the team responsible for your care. Should you object to the semi-private nature of our pre-operative and recovery areas, you will need to have your surgery or procedure performed at a facility other than Northwest Florida Surgery Center.

Business Associates

There are services provided to Northwest Florida Surgery Center through business contracts. Examples include transcription and pharmacy services. When we use these services, we may disclose your health information to the contracted business associate so that they can perform the functions we have contracted with them to do. To protect your health information, we require our business associates to appropriately safeguard your health information.

Other Disclosures of Your Health Information Required or Allowed by Law

We will disclose your protected health information when we are required do so by federal, state or local law. We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. We may disclose health information to the extent authorized by and the extent necessary to comply with laws relating to Worker’s Compensation. We may disclose to the Food and Drug Administration health information relative to adverse events with respect to products or product defects. Should you be an inmate of a correctional institution, we may disclose to the institutional agents thereof health information necessary for your health and the health and safety of other individuals. If a member of our work force or a business associate believes in good faith that we have engaged in unlawful conduct or otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public, we may disclose your health information to health oversight agencies and/or public health authorities, such as the Department of Health. Under the privacy standards, we must disclose your health information to the Department of Health and Human Services as necessary for them to determine our compliance with these standards. We may report health information to funeral directors as required by law. We may disclose your protected health information in cases of emergency. We may be required to disclose health information to notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease as authorized by law. We may notify government authorities if we believe that a patient is the victim of abuse, neglect, or domestic violence. We will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.

The facility’s contact person for all issues regarding patient privacy and your rights under the federal privacy standards is the Privacy Officer. Information regarding matters covered by this Notice can be requested by contacting the Privacy Officer. If you feel that your privacy rights have been violated by this facility you may submit a complaint to our Privacy Officer by sending it to:

Northwest Florida Surgery Center
767 Airport Road
Panama City, FL 32405

ATTN: Privacy Officer

The Privacy Officer can be contacted by telephone at (850) 747-0400.

Effective Date: April 14, 2003