HIPAA Notice of Privacy Practices

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1 HIPAA 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. This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information (PHI) to carry out treatment, seek payment, for healthcare operations (TPO) and for other purposes that are permitted or required by law. It also describes your rights to access and control your Protected Health Information. Protected Health Information is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related healthcare services. Uses and Disclosures of Protected Health Information Your Protected Health Information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing healthcare services to you to pay your health ~.arc hills, to support the operation of the physician s practice, and any other use required by law. Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party. For example. we could disclose your protected health information. as necessary, to a home health agency that provides care to you. For~ example. your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. Payment: Your protected health information will be used, as needed, to obtain payment for your healthcare services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission. Healthcare Operations: We may use or disclose, as-needed, your protected health information in order to support the business activities of your physician s practice. These activities include, but are not limited to, quality assessment activities. employee review, activities, training of medical students, licensing, and conducting or arranging for other business activities. For example. we may disclose your protected health information to medical school students that see patients at our office. in addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. We may use or disclose your protected health information in the following situations without your authorization. These situations include: as Required By Law, Public Health issues as required by law, Communicable Diseases: Health Oversight: Abuse or Neglect: Food and Drug Administration requirements: Legal Proceedings: Law Enforcement: Coroners. Funeral Directors and Organ Donation: Research: Criminal Activity: Military Activity and National Security: Workers Compensation: Inmates: Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section Other Permitted and Required Uses and Disclosures Will Be Made Only With Your Consent, Authorization or Opportunity to Object unless required by law.

2 You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physician s practice has taken an action in reliance on the use or disclosure indicated in the authorization. Your Rights Following is a statement of your rights with respect to your protected health information. You have the right to inspect and copy your protected health information Under federal law; however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of. or use in. a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may he involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply Your physician is not required to agree to a restriction that you may request. If physician believes, it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not he restricted. You then have the right to use another Healthcare Professional. You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively i.e. electronically, You may have the right to have Your physician amend your protected health information. If we deny your request for amendment, you have the 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. You have the right to receive an accounting of certain disclosures we have, made. if any, of your protected health information. We reserve the right to change the terms of this notice and will inform you by mail of any changes. You then have the right to object or withdraw as provided in this notice. Complaints You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We wilt not retaliate against you for filing a complaint. This notice was published and becomes effective on/or before April We are required by law to maintain the privacy of and provide individuals with, this notice of our legal duties~ arid privacy practices with respect to protected health information If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer in person or by phone at our Main Phone Number

3 Policies Concerning Rights of Patients Procedures: 1. The QA Committee is responsible for the implementation and oversight of policies and procedures and receives complaints about privacy violations. 2. Our employees are in-serviced in HIPAA policies. The in-service certification is placed in each members personnel file. The in-service includes; a. Review of the Policies concerning HIPAA b. Telephone conversations c. Patient Rights to Privacy. d. Proper use of patient s personal information while in the presence of other multiple people e. Proper use of computer and scheduling of Patients. 3. Patients are treated with respect, consideration and dignity. 4. Patients are provided appropriate privacy & their satisfaction shall be surveyed. 5. Patient disclosures and records are treated confidentially, and, except when required by law, patients are given the opportunity to approve or refuse their release. Patient Confidentiality POLICY It is the policy of this Surgery Center to ensure that all medical records are locked up at the end of each working day. We do not utilize sign-in lists. Computer screens are kept private. Patient phone calls are kept out of hearing range of people in the waiting room. All patient interviews are done in private rooms. Patient medical records are only released under appropriate regulations and statutes. Medical records are accessible only to authorized individuals as defined by the facility. Records are stored in a secure area. POLICY (Employee/Vendors) Employees and medical center vendors and service contractors are to sign a confidentiality agreement with the surgery center to ensure patient confidentiality. Diagnostic Testing POLICY Testing performed is necessary and appropriate to the care being delivered. Patients are provided assistance to ensure compliance with obtaining the ordered tests. There is follow-up by the facility to ensure that the tests are completed. Patients always have the option of obtaining these services at a site of their choosing. If a patient is referred to a specific facility, it shall be an appropriately licensed facility. Any financial interest of the Center is revealed to the client at the time of scheduling.

4 PATIENT RIGHTS POLICY: All patients shall be informed of their rights & responsibilities as patients. OBJECTIVE: To assure considerate and appropriate care with the patient s complete understanding. PROCEDURE: 1. A copy of the patient s rights & responsibilities is posted in the reception area. 2. A Patient Satisfaction Questionnaire will be given to each post-op patient, to encourage the patient to voice his or her opinions. 3. ASC staff members shall be oriented to promote and understand patient rights. Complaint Resolution Process POLICY: There is a complaint resolution process for patients of the ASC. PROCEDURE: 1. The complaint resolution process is outlined & posted in the reception area. 2. A written complaint to the Medical Director is submitted to the front office personally or by mail. 3. The Medical Director or his authorized designate investigates the complaint within 15 days from receipt thereof. 4. The Governing Body reviews all complaints every quarter. 5. The Medical Director or Governing Body resolves the complaint & immediately institutes corrective measures if required. 6. The patient is informed of the results within 30 days of the receipt of the complaint. PATIENT'S BILL OF RIGHTS AND RESPONSIBILITY As an ambulatory healthcare patient, you have the right to: 1. Be given information about your rights and responsibilities for receiving ambulatory healthcare services. 2. Receive a timely appointment from the ambulatory healthcare provider regarding your request for ambulatory healthcare services. 3. Be given information of the ambulatory healthcare provider policies and procedures and charges for services including third party reimbursement. 4. Be given information concerning available ambulatory care services, including after hours and emergency services. 5. Choose your ambulatory healthcare providers. 6. Be given appropriate and professional quality ambulatory healthcare services without discrimination against your race, creed, color, religion, sex, national origin, sexual preference, handicap, or age. 7. Be treated with courtesy, respect, consideration, and dignity by all who provide ambulatory healthcare services to you. 8. Be free from physical and mental abuse and/or neglect. 9. Be given proper identification by name and title of everyone who provides ambulatory healthcare services to you. 10. Be given the necessary information so you will be able to give informed consent for your treatment prior to the start of any treatment. 11. Be given complete and current information concerning your diagnosis, treatment, alternatives, risks and prognosis required by your physician's legal duty to disclose, in terms and languages you can reasonably be expected to understand.

5 12. A plan of ambulatory healthcare that will be developed to meet your unique healthcare needs. 13. Participate in the development of your ambulatory healthcare plan. 14. Be given an assessment and update of your developed ambulatory healthcare plan as necessary. 15. Be given data privacy and confidentiality. 16. Review your clinical record at your request. 17. Be given information regarding anticipated transfer of your ambulatory healthcare to another healthcare facility and/or termination of ambulatory healthcare services to you. 18. Voice grievance with and/or suggest change in ambulatory healthcare services and/or staff without being threatened, restrained, and discriminated against. 19. Refuse treatment within the confines of the law. 20. Refuse to participate in experimental research. 21. Be given information concerning the consequences of refusing treatment or not complying with therapy. As an ambulatory healthcare patient, you have the responsibility to: 1. Give accurate and complete health information concerning your past illnesses, hospitalization, medications, allergies, and other pertinent items. 2. assist in maintaining a safe environment. 3. inform the ambulatory healthcare provider when you will not be able to keep an ambulatory healthcare visit. 4. Participate in the development and update of your ambulatory healthcare plan. 5. Adhere to your developed/updated ambulatory healthcare plan. 6. Request further information concerning anything you do not understand. 7. Give information regarding concerns and problems you have to any ambulatory healthcare provider staff member. INFORMATION MANAGEMENT POLICY An Information Technology Manager will plan the management of ASC's internal & external information. There will be an electronic data back-up nightly on a remote server. There will be a paper back-up for patient charts which will be located in one secure room. ASC shall provide online access to knowledge-based information resources during hours of operations. CONTENTS OF THE SURGICAL CHART POLICY Each patient undergoing surgery in the surgery center must have a surgical chart prepared prior to surgery and completed during and following surgery. Medical Records must be legible, be maintained for seven years, filed for easy access, secured according to HIPAA regulations. PROCEDURE The surgical chart must contain the following if applicable: a. Patient Name, Date of birth, Address, Home and work phone numbers, Contact information for person designated in case of emergency and legally authorized representative b. Patient sex, height and weight c. Legal status of patients receiving behavioral healthcare services d. Patient's language and communication needs e. Patients billing and/or insurance information f. Employer

6 g. Notation of special circumstances (e.g., hearing impaired, etc.) h. Allergies to medications or to food i. Relevant history and physical exam done on the day of surgery and covering the organs and systems included in the surgical procedure/s. An update stamp may be used on a previous history and physical that is within 30 days old. Otherwise, a new history and physical record must be completed. j. Patient s immunization information k. All findings, diagnoses, treatments, and documentation of physician s review, including follow-up instructions. l. Results of lab, X-ray, diagnostic studies, outside consultations, Op reports, etc., authenticated or initialed by provider m. Date and time of all health encounters and reports in chronological order n. Phone consultations o. Prescriptions and refills, with drug, dose, and amount p. Consent information, refusal of care, and release of information forms q. Notes regarding refusal of care, non-compliance, missed appointments, etc. r. Documented preventative care. s. Current Medications t. Bleeding tendencies u. Laboratory, pathology, X-ray reports are signed, dated and timed. Written copies are kept in the medical record. Laboratory tests are performed by a licensed and certified facility with the name of the pathologist on all pathology reports. v. Informed Consent forms which authorizes the surgeon by name to perform surgery or procedures, anesthesia, and describes the operative procedure. Expectations, alternatives, risks, and complications are discussed with the patient. w. A separate surgical log book must be maintained. The log book must contain: Date, Name of Patient, Age, Sex, Surgery, Surgeon s Name, Type of Anesthesia, Name of Anesthesia Provider, Name of Surgeon s Assistant, Nurse, Scrub Tech, Pre-operative Diagnosis, Postoperative Diagnosis, Time Surgery started, Time Surgery Ended, Time start in PACU, Time end in PACU, complications (if any) of the surgery or procedure, and specimens (if any) x. A separate anesthesia record must be maintained that contains: vital signs, all medications, IV solutions. y. The post-operative documentation or PACU record contains the patient's vital signs and level of consciousness, any medications including IV fluids, any unanticipated event or complication and the management thereof, name of licensed independent practitioner responsible for discharge. An Operative Report is written or dictated before the patient is transferred from the operating room except: 1. If an operative progress note is written immediately after the procedure in which case the full report can be written or dictated before the end of the day; 2. If the surgeon accompanies the patient from the operating room to the next unit of care in which case the report can be written or dictated in the new unit. Information introduced into the clinical record through transcription or dictation is authenticated by a time stamped signature of the author. OPERATIVE PROGRESS NOTE: Name of surgeon and assistant surgeon if applicable; Pre-operative diagnosis Post-operative diagnosis Name of all procedures performed Findings during procedure

7 Estimated blood loss Description of any implants or devices Specimen removed if applicable Description of any complications Post-operative condition of the patient OPERATIVE REPORT: Name of surgeon and assistant surgeon if applicable; Pre-operative diagnosis Post-operative diagnosis Name of all procedures performed Detailed description of the procedure Detailed description of every finding during the procedure Estimated blood loss Description of any implants or devices Specimen removed if applicable Description of any complications Post-operative condition of the patient *If the post-operative diagnosis is different from the pre-operative diagnosis, the Medical Director shall be informed. SUMMARY LIST is initiated for the patient s third visit which contains any significant medical diagnoses and conditions, operative and invasive operative procedures, adverse or allergic reactions, and current medications/herbal preparations. SUMMARIES of treatment and other documents provided by ASC are forwarded to other care providers when needed to provide care. The Nurses should complete and put the records they are responsible for together in proper order in the chart. The patient s name must be on each form within the chart. The surgeon will be responsible for the completed H&P on the day of surgery and operative report among other records. The anesthetist or anesthesiologist will be responsible for the anesthesia record. Once surgery is completed, the receptionist will make sure all forms in the chart are complete, signed and properly organized within the chart. An audit team shall then ensure the completeness of the chart. The surgical chart must remain within the surgery center in a locked room. The Medical Director shall ensure that the Medical Records are complete and in order. Under the direction of the Medical Director, the Office Manager and staff will ensure that: 1. Clinical records are readily available to authorized healthcare professionals. 2. Patient data is treated with confidentially. 3. All clinical records are completed within 21 days from the date services were provided. 4. Medical records are maintained for seven years. 5. The Medical Record is to be used by the Medical Staff to document: a. Reason for and methods of safe use of medications b. Disease management information c. Effective use of any medical equipment

8 d. Dietary intervention, when applicable e. Counseling on exercise and physical activity. 6. Records are Accessible only to authorized individuals. The staff is in-serviced on regulations regarding the release of information. The Medical Director is the person in charge of clinical records. The Quality Assurance Committee shall monitor compliance with policies on security and integrity of health information.

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