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NOTICE OF PRIVACY PRACTICES
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.
Our
Privacy Commitment
How
We Use & Disclose Your Health Information
Other
Uses and Disclosures
Your
Individual Rights
Our
Privacy Duties
Who
Follows this Notice
Questions
and Complaints
Effective
Date: April 14, 2003
Our
Privacy Commitment {top}
The protection of the privacy of your health information is important
to us at Black Hills Surgery Center. In addition, we are required by
law to maintain the confidentiality of your health information and provide
you with this notice of our privacy practices. In this notice we describe
the ways that we may use and disclose health information about you.
How We Use & Disclose
Your Health Information {top}
We are permitted to use and disclose your health information for treatment,
payment, and health care operations. Following is a description and
examples of how we use your health information for those purposes.
Treatment: Your health information may be used to evaluate your
health, diagnose medical conditions, and provide quality care. The information
in your medical record, such as laboratory tests, X-rays or prescriptions,
will be available to other health professionals who may provide treatment
or who may be consulted by our staff members.
Payment: Your health information may be used by us and other health
care professionals involved in your treatment to obtain payment from
you, your insurance company, and other sources of coverage or payment.
For example, we may contact your insurance company to verify benefits
or to notify them of services to be provided that may require preauthorization.
Health Care Operations: We use health information to evaluate and promote
the quality of care and service provided to you and to support regular
business activities. For example, we may use health information for
evaluating the performance of staff, business planning, and financial
management of our company.
Other Uses and Disclosures {top}
We may also use your health information to:
- Remind
you of an appointment and obtain information via pre-operative telephone
calls.
-
Send you newsletters or announcements containing information you
may find interesting about us or with regard to treatment and management
of your medical condition.
- Disclose
information to family or other representatives involved in your
care or payment for your care, provided you do not object.
- Include
you in our patient directory for callers, visitors, and clergy,
unless you notify us of any restrictions or limitations.
There are also certain special circumstances in which we may use or
disclose your health information without your authorization as follows:
- For
public health reporting purposes such as reporting communicable
and other diseases and injuries permitted by law, victims of abuse
or neglect, or work-related illnesses.
- To
law enforcement agencies to support government audits and inspections
to facilitate investigations, health oversight activities, or to
comply with government-mandated reporting.
- For
lawsuits and similar proceedings.
- To
medical examiners, coroners, and funeral directors.
- For
organ and tissue donations.
- For
research in certain limited circumstances approved under federal
rules.
- To
avert a serious threat to health or safety.
- For
specialized government functions such as national security and intelligence
activities.
- For
workers’ compensation or other similar programs for work-related
injuries or illness.
Your Individual Rights
{top}
You have certain rights under federal privacy standards. You have the
right to:
- Request
restrictions on the use and disclosure of your protected health
information. We may not be required to agree with your request.
- Receive
confidential communication concerning your medical condition and
treatment. For example, you may request we contact you only at a
specific phone number or address.
- Inspect
and copy your protected health information. For limited reasons
as allowed by law, we may deny your access to specific information;
however, you may request a review of our denial. As permitted by
federal regulation, we require the requests be submitted in writing.
You may contact us to obtain a form to request this access. Reasonable
fees may apply.
- Request
to amend or submit corrections to your health information, provided
the request is in writing and you give us the reason for the request.
We may deny your request in certain circumstances, such as when
we believe the information is already accurate and complete.
- Receive
an accounting of certain disclosures of your health information
during a specified period of up to six years, excluding dates prior
to April 14, 2003. The accounting does not include disclosures made
for treatment, payment, health care operations, disclosures required
by law and other disclosures as referenced in this notice. The first
request in a 12-month period is free, but we may charge you for
our reasonable costs for additional requests in the same 12-month
period.
- Receive
a paper copy of this notice even if you previously agreed to receive
it electronically.
Our
Privacy Duties
{top}
Federal
regulations require that we protect the privacy of health information
that identifies a patient, or where there is reasonable basis to believe
the information can be used to identify a patient. We also are required
to abide by the terms of our Notice of Privacy Practices that is currently
in effect. As permitted by law, we reserve the right to amend or modify
our privacy practices. These changes may be a result of changes in federal
or state laws and regulations. Current notices will be posted in our
facilities and on our website, www.bhsc.com. Upon request, we will provide
you with a copy of the notice.
Use or disclosure of your health information for purposes other than
as described in our notice will require your written authorization.
You may revoke your authorization at any time, provided it is in writing.
However, your decision to revoke the authorization will not affect any
use or disclosure of information that occurred before you notified us
of your decision to revoke your authorization.
Who
Follows this Notice
{top}
This
notice describes the privacy practices of Black Hills Surgery Center
and Black Hills Imaging Center, as well as members of an organized health
care arrangement performing services in our facilities, unless they
provide you with a formal notice of their privacy practices. Members
of the organized health care arrangement covered by this notice may
include anesthesiologists, hospitalists, radiologists, pharmacists and
physical therapists. These health care providers are not employed by
us but are either authorized to provide services to patients in our
facilities or have a contractual relationship with us.
Questions
and Complaints
{top}
If
you would like further information concerning our privacy practices
or believe your privacy rights have been violated, you should contact
us using the following address or telephone number:
Privacy
Official
Black Hills Surgery Center, LLP
1868 Lombardy Drive
Rapid City, SD 57703
Telephone: 605-721-4900
Toll Free: 1-800-596-4519
You
will not be penalized or otherwise retaliated against for filing a complaint.
You may also file a complaint with the Secretary of the Department of
Health and Human Services.
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