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.
Effective Date: June 1, 2008
Updated December 1, 2009
If you have any questions about this notice, please contact our Privacy Officer.
Our Promise
We know that medical information about you and your health is private. We do our best to protect medical information about you. We make a record of the services provided to by Surgical Monitoring Associates. We need this record to give you good care and to follow certain rules and laws. This notice applies to all of the records at SMA, whether made by people working for SMA or your personal doctor.
We are required by law to:
- Make sure that your information is kept private.
- Tell you about the rules and laws we must follow.
- Do what this notice says.
Who will follow this notice?
All employees and contractors of SMA.
How we may use and give out medical information about you.
The following tells you the ways that we use and give out medical information. We will explain what we mean and give some examples. This will not tell you about each and every single way we may use or give out your information. However, all of the ways we are allowed to use and give out information will fall within one of the headings listed.
To provide services to you.
We may use your health information to provide services. We may give out medical information about you to doctors, doctors in training, nurses or other people who are part of your care.
To get paid.
We may use and give out health information about you so that the care you receive here will get paid by you, an insurance company, or a third party. For example, we may need to give your health plan information about services you received, so that your insurance will pay for the care. We may also tell your health plan about services you are going to get to find out if they will pay for your care.
To run SMA.
We may use and give out medical information about you in order to run SMA. For example, we may use information to see how our staff is providing services.
To contact you.
We may contact you for additional information.
Special situations.
We may give out information about you without your permission in the following situations:
As required by law.
When we are required to do so by federal, state, or local law.
To help avoid a serious threat to healthor safety.
To help avoid a threat to your health and safety or the health and safety of the public or another person. Any information we give out, however, would only be to someone able to help prevent the threat.
Military and Veterans.
If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority. We may give out to the Department of Veterans Affairs medical information about you to find out if you can get certain benefits.
Workers' Compensation.
For workers’ compensation or other programs that provide benefits for work-related injuries or illness.
Public Health authorities.
- For Public Health activities, such as reporting disease outbreaks.
- To report problems with products.
- To notify a person who may have been exposed to a disease or may be at risk for getting or giving someone else a disease or condition.
Health oversight activities.
For activities allowed by law that are necessary for the government to monitor the health care system, government programs, and make sure providers are following the civil rights laws. These oversight activities include audits, investigations, inspections, and licensure.
Lawsuits and disputes.
• If you are involved in a lawsuit or a dispute, we may give out medical information about you if we get a valid court or administrative order, subpoena, discovery request, or other lawful process by someone else involved in the case, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested..
Law enforcement.
If we are asked to do so by law enforcement officials or are required to do so by law:
Prisoners.
If you are a prisoner of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.
When we need your written permission to give out your medical information
We will need your written permission to use or give out your medical information for reasons not covered by this notice or the laws that apply to us. If you give us permission, you may take back that permission, in writing, at any time. If you take back your permission, we will no longer use or share medical information about you, except to take care of you, get paid and to run the hospital. You understand that we are unable to take back any information we have already shared with your permission and that we have to keep our records of the care that we have given you.
Your rights regarding medical information about you
Right to look at and copy.
Most of the time, you have the right to look at and get a copy of your health information. This includes billing records as well as any medical information. To look at or get a copy of your health information, please write to the Privacy Officer . If you ask for a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies.
Right to amend.
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to ask for an amendment for as long as the information is kept by SMA. To ask for an amendment, you must write to the Privacy Officer and provide a reason for your request. We may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.
- Is not part of the medical information kept by or for SMA.
- Is not part of the information that you would be permitted to inspect and copy.
- Is accurate and complete.
You have a right to submit a written statement to the Privacy Officer disagreeing with a denial of your request for an amendment.
Right to a list of disclosures.
You have the right to request an “accounting of disclosures” or a list of who outside of SMA has
received information about you. This does not apply to information provided to take care of you, for SMA to get paid, or to run SMA.
To ask for this list, you must put your request in writing to the Privacy Officer.
Your request must state a time period that may not be longer than six years. The first list you ask for within a 12-month period will be free. If you want more lists we may charge you for the costs of providing the list. We will tell you the cost and get your approval before we mail the list
.
Right to ask for limits.
You have the right to ask us to limit the medical information we use or give out about you to take care of you, to get paid, or to run the hospital. You also have the right to ask for a limit on the medical information we give out about you to someone who is involved in your care or the payment for the services you received We may not be able to agree to your request. If we do agree, we will do as you ask unless the information is needed to provide you emergency treatment. To ask for limits, you must send your request to the Privacy Officer, in writing. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, how we share your information, or both; and (3) to whom you want the limits to apply.
Right to confidential communications.
You have the right to ask us to get information to you by using a different address or phone number. You must notify the Privacy Officer, in writing if you want to us an alternate address or phone.
Right to a paper copy of this notice.
You have the right to a paper copy of this notice. To get a copy of this notice, ask for a copy from the Privacy Officer.
Changes to this notice.
We can change this notice. If this notice is changed it will apply to information we already have about you as well as any information we receive in the future. We will post a copy of the current notice on our Web site: www.surgmon.com
Complaints.
If you think your privacy rights have been violated, you may file a complaint with us by writing to the Privacy Officer providing enough detail to allow us to look into the matter at:
SMA
Privacy Officer
C/O Surgical Monitoring Associates
900 Old Marple Road
Springfield, PA 19064
You may also file a complaint with the Office of Civil Rights at:
Regional Manager of the Office of Civil Rights Region III,
150 S. Independence Mall W.
Suite 372, Public Ledger Building
Philadelphia, PA 19106-9111
(215) 861-4441
Privacy Complaints Number 610-328-1166 ext. 0
You will not be treated any differently for filing a complaint.
You will not be treated any differently for filing a complaint.
How to contact us.
If you have any questions about this notice or if you need to make a request to the Privacy Officer, please contact us at:
By calling the Privacy Officer at:
610-328-1166 ext 226
Or Writing:
Surgical Monitoring Associates
900 Old Marple Road
Springfield, PA 19064
Or e-mailing the Privacy Officer at:
privacy@surgmon.com
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