HIPAA PRIVACY NOTICE
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THAT INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
If you have any questions about this Notice, please contact our Privacy Officer, Dror Rosenfeld.
New York Surgery Center Queens (NYSCQ) is committed to maintaining the privacy of your protected health information ("PHI"), which includes your demographic information, information that relates to your past, present or future physical or mental health or condition and related health care services you receive from NYSCQ and other health care providers. This Notice details how your PHI may be used and disclosed to third parties for purposes of your care, payment for your care, health care operations of NYSCQ, and for other purposes permitted or required by law. This Notice also details your rights regarding your PHI.
I. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
NYSCQ may use and/or disclose your PHI for purposes related to your treatment, payment for treatment, and conduction of health care operations. The following are examples of the types of uses and/or disclosures of your PHI that may occur.
Treatment – In order to provide, coordinate and manage your health care, NYSCQ will provide your PHI to those health care professionals, whether on NYSCQ staff or not, directly involved in your care so that they may understand your medical condition and needs and provide advice or treatment. This includes the coordination or management of your health care with a third party (e.g., a specialist or laboratory).
Payment – In order to get paid for some or all of the health care services provided by NYSCQ, NYSCQ may provide your PHI, directly or through a billing service, to appropriate third party payors, pursuant to their billing and payment requirements. For example, NYSCQ may need to provide your health insurance carrier or, if you are over 65, the Medicare program with information about health care services that you received from NYSCQ so that NYSCQ can be properly reimbursed. NYSCQ may also need to tell your insurance plan about the need to hospitalize you so that the insurance plan can determine whether or not it will pay for the expense.
Health Care Operations – In order for NYSCQ to operate in accordance with applicable law and insurance requirements and to provide quality and efficient care, it may be necessary for NYSCQ to compile, use and/or disclose your PHI. Disclosures may be made for any of the following NYSCQ activities: (a) quality assessment and improvement activities, including case management and care coordination; (b) competency assurance activities, including provider or health plan performance evaluation, credentialing, and accreditation; (c) conducting or arranging for medical reviews, audits, or legal services, including fraud and abuse detection and compliance programs; (d) specified insurance functions, such as underwriting, risk rating, and reinsuring risk; (e) business planning, development, management, and administration; and (f) business management and general administrative activities of the entity, including but not limited to: de-identifying protected health information, creating a limited data set, and certain fundraising for the benefit of the covered entity.
II. USES & DISCLOSURES- SPECIAL CIRCUMSTANCES NOT REQUIRING AUTHORIZATION
NYSCQ may use and/or disclose your PHI, without a written Authorization from you, in the following situations:
Required by Law – NYSCQ may disclose your PHI, when required by law, but such use or disclosure will be made in compliance with the law and limited to the requirements of the law.
Public Health Activities - NYSCQ may disclose your PHI, for public health activities and purposes, which include information collected by a public health authority, as authorized by law, to prevent or control disease, injury or disability. This includes reporting of communicable diseases to a public health authority and notification of persons who may have been exposed to a communicable disease.
Victims of Abuse, Neglect or Domestic Violence - NYSCQ may disclose your PHI to a government authority if required by law to make such disclosure. If NYSCQ is authorized by law to make such a disclosure, it will do so if it believes that the disclosure is necessary to prevent serious harm or if NYSCQ believes that you have been the victim of abuse, neglect or domestic violence. Any such disclosure will be made in accordance with the requirements of law, which may also involve notice to you of the disclosure.
Health Oversight Activities – NYSCQ may disclose your PHI to health oversight agency when required by law for activities including criminal investigations, audits, disciplinary actions, or general oversight activities relating to the community's health care system. Oversight agencies include government agencies involved in oversight activities that relate to the health care system, government benefit programs, government regulatory programs and civil rights law.
Federal Drug Administration – NYSCQ may disclose your PHI if required by the Food and Drug Administration to report adverse events, product defects or problems or biological product deviations, or to track products, or to enable product recalls, repairs or replacements, or to conduct post marketing surveillance.
Judicial and Administrative Proceedings – NYSCQ may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.
Law Enforcement Purposes – In certain instances, NYSCQ may disclose your PHI to a law enforcement official for law enforcement purposes. Law enforcement purposes include: (1) complying with a legal process (i.e., subpoena) or as required by law; (2) information for identification and location purposes (e.g., suspect or missing person); (3) information regarding a person who is or is suspected to be a crime victim; (4) in situations where the death of an individual may have resulted from criminal conduct; (5) in the event of a crime occurring on the premises of NYSCQ; and (6) a medical emergency (not on NYSCQ premises) has occurred, and it appears that a crime has occurred.
Coroner or Medical Examiner – NYSCQ may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death, or to a funeral director as permitted by law and as necessary to carry out its duties.
Cadaveric Organ, Eye, or Tissue Donation – If you are an organ donor, NYSCQ may disclose your PHI to the entity to whom you have agreed to donate your organs.
Research – If NYSCQ is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI such as approval of the research by an institutional review board and the requirement that protocols must be followed.
Serious Threat to Health or Safety – NYSCQ may disclose your PHI if it believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.
Essential Government Functions – When the appropriate conditions apply, NYSCQ may use PHI of individuals who are Armed Forces personnel: (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veteran Affairs of eligibility for benefits; or (3) to a foreign military authority if you are a member of that foreign military service. NYSCQ may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities including the provision of protective services to the President or others legally authorized.
Workers’ Compensation – If you are involved in a Workers' Compensation claim, NYSCQ may be required to disclose your PHI to an individual or entity that is part of the Workers' Compensation system.
Inmates - NYSCQ may disclose your PHI to a correctional institution or a law enforcement official if you are an inmate of that correctional facility and your PHI is necessary to provide care and treatment to you or is necessary for the health and safety of other individuals or inmates.
III. USES AND DISCLOSURES WITH OPPORTUNITY TO OBJECT
NYSCQ may use and disclose your PHI in the following situations. You have the opportunity to agree or object to the use of disclosure of all or part of your PHI. If you are incapacitated, in an emergency situation, or not available, your health care provider may make such uses and disclosures, if in the exercise of their professional judgment, the use or disclosure is determined to be in your best interests.
Unless you object, NYSCQ may disclose your PHI to a member of your family, a relative, a close friend or any other person you identify, is such information directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, you health care provider may disclose such information as necessary if based on professional judgment, he or she determines that it is in your best interest. Additionally, unless you object, NYSCQ may use or disclose protected health information for the purpose of notifying family members, personal representatives, or others responsible for your care of the your location, general condition, or death. Lastly, unless you object, NYSCQ may use or disclose your PHI to a public or private entity authorized to assist in disaster relief efforts.
IV. USES & DISCLOSURES REQUIRING DISCLOSURE
Other than as described above, uses and/or disclosures of protected health information will only be made by NYSCQ with your written authorization. A description of the PHI to be used or disclosed that identifies the information in a specific and meaningful fashion. You can revoke an authorization in writing at any time. If NYSCQ has already used or disclosed information in reliance upon the authorization, it will not be held accountable for disclosures made prior to the revocation.
V. YOUR RIGHTS
Access to Your PHI - You have the right to inspect and copy your protected health information as provided by law. To inspect and copy your PHI, you must submit a written request to The NYSCQ Privacy Officer. In certain situations that are defined by law, NYSCQ may deny your request, but you will have the right to have the denial reviewed. NYSCQ can charge you a fee for copying, mailing or other supplies associated with your request.
Amendments to Your PHI – You have the right to have your health care provider amend your protected health information, as provided by law. To request an amendment, you must submit a written request to The NYSCQ Privacy Officer. You must provide a reason that supports your request. NYSCQ may deny your request if it is not in writing, if you do not provide a reason and support of your request, if the information to be amended was not created by NYSCQ (unless the individual or entity that created the information is no longer available), if the information is not part of your PHI maintained by NYSCQ, if the information is not part of the information you would be permitted to inspect and copy, and/or if the information is accurate and complete. If you disagree with NYSCQ denial, you have the right to submit a written statement of disagreement.
Accounting for Disclosures of Your PHI – You have the right to receive an accounting of certain disclosures of your PHI that NYSCQ has made, if any. To request an accounting, you must submit a written request to The NYSCQ Privacy Officer. The request must state a time period which may not be longer than six years and may not include the dates before April 14, 2003. The request should indicate in what form you want the list (such as a paper or electronic copy). The first list you request within a 12 month period will be free, but NYSCQ may charge you for the cost of providing additional lists in that same 12 month period. NYSCQ will notify you of the costs involved and you can decide to withdraw or modify your request before any costs are incurred.
Restrictions on Use and Disclosure of Your PHI – You have the right to request restrictions on certain use and/or disclosure of your PHI as provided by law. However, NYSCQ is not obligated to agree to any requested restrictions. To request restrictions, you must submit a written request to The NYSCQ Privacy Officer. In your written request, you must inform NYSCQ of what information you want to limit, whether you want to limit the use or disclosure, or both, and to whom you want the limits to apply. If NYSCQ agrees to your request, NYSCQ will comply with your request unless the information is needed in order to provide you with emergency treatment.
Request for Confidential Communications – You have the right to receive confidential communications of PHI by alternative means or at alternative locations. You must make your request in writing to The NYSCQ Privacy Officer. NYSCQ will accommodate all reasonable requests.
Right to a Copy of the Notice – You have the right to receive a paper copy of this Privacy Notice upon request to The NYSCQ Privacy Officer.
You may complain to NYSCQ, or to the Secretary of Health and Human Services, Office of Civil Rights if you believe that your privacy rights have been violated by NYSCQ. To file a complaint with NYSCQ, you must contact The NYSCQ Privacy Officer. All complaints must be in writing. You may also contact a regional office of the Office of Civil Rights, which can be found at www.hhs.gov/ocr/regmail.html.
To obtain more information about your privacy rights, or to have any of your questions about your rights answered, you may contact The NYSCQ Privacy Officer, Dror Rosenfeld, at 4604 31st Avenue, Long Island City, NY 11103, or via email at firstname.lastname@example.org.
This Notice is in effect as of 10/2/2012.