THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU THAT IS MAINTAINED BY THE PREMIER SURGICAL ASSOCIATES OF CENTRAL JERSEY OR ANY OF ITS MEMBER FACILITIES MAY BE USED AND DISCLOSED AND, HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact the PREMIER Privacy Officer at (732) 262-1600 or the Assistant Privacy Officer.
WHO WILL FOLLOW THIS NOTICE
This notice describes PREMIER’s practices, which are followed by:
- Those facilities within PREMIER that create and maintain medical information.
- Any healthcare professional authorized to enter information into your health record including, but not limited to, members of PREMIER’s Medical Staff.
- All departments and units of any PREMIER facility.
- Any member of a volunteer group we allow to help you while you are in an PREMIER facility.
- All employees, staff and other PREMIER personnel.
In addition, these entities, sites and locations may share medical information with each other for treatment, payment or PREMIER operations purposes described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at a PREMIER facility. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by PREMIER, whether made by PREMIER personnel or your personal doctor.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. In all cases where we may share your medical information with others, it is only the minimum necessary amount of information required to satisfy the need or request.
PREMIER SURGICAL LLC is required by law to:
- Ensure that medical information that identifies you is kept private;
- Inform you of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the notice that is currently in effect
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every potential use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of these categories.
TREATMENT – We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical support staff, volunteers, and clinical interns/students, as appropriate, or other PREMIER personnel who are involved in taking care of you at a
PREMIER facility. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of a PREMIER facility also may share medical information about you in order to coordinate the different things you need, such as prescriptions, laboratory tests and Xrays. We also may disclose some of your medical information to people outside of PREMIER who may be involved in your medical care after you leave a PREMIER facility, such as: family members, clergy or others we use to provide services that are part of your care. We may also disclose some of your medical information to outside medical equipment vendors and suppliers whose products are related to your medical care.
PAYMENT – We may use and disclose medical information about you so that the treatment and services you receive at a PREMIER facility may be billed to, and payment may be collected from you, an insurance company or another third party. For example, we may need to give your health plan information about surgery you received at PREMIER so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may also share insurance information with other medical providers (Emergency Department physicians, pathologists, radiologists, etc.) who provided you care but are independent contractors and are, therefore, not employed by PREMIER.
HEALTHCARE OPERATIONS – We may use and disclose medical information about you for PREMIER operations. These uses and disclosures are necessary to run a PREMIER facility and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many PREMIER patients to decide what additional services PREMIER should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical, nursing, volunteers, clinical interns/students, and other PREMIER personnel for review and learning purposes. We may also combine the medical information that we have with medical information from other healthcare systems to compare how we are doing. This will enable us to identify areas that we can improve upon in the care and services we offer. We will remove information that identifies you from this set of medical information, so others may use it to study healthcare and healthcare delivery. They, they will then not be able to identify you specifically.
APPOINTMENT REMINDERS – We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the PREMIER.
TREATMENT ALTERNATIVES – We may use and disclose medical information to inform you of recommended possible treatment options or alternatives that may be of interest to you.
HEALTH-RELATED BENEFITS AND SERVICES – We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE – We may release medical information about you to a family member or friend who is involved in your medical care unless otherwise prohibited by law. We may give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in a particular PREMIER facility. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort, so that your family can be notified about your condition, status and location. This would not include releasing psychiatric, alcohol or drug treatment records without your express written consent.
RESEARCH – Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We may then disclose information to people preparing to conduct a research project; for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave PREMIER. We will ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at PREMIER.
AS REQUIRED BY LAW – We may disclose medical information about you to federal, state, or other regulatory bodies, when required by law.
TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY – We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, 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.
WORKERS’ COMPENSATION – We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
PUBLIC HEALTH RISKS – We may disclose medical information about you:
- To prevent or control disease, injury or disability.
- To report births and deaths.
- To report suspected child abuse or neglect.
- To report reactions to medications or problems with products/medical devices.
- To notify people of recalls of products/medical devices they may be using.
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
- To notify the appropriate government authority if we believe an adult patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
HEALTH REGULATORY OVERSIGHT ACTIVITIES – We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include; for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
LAWSUITS AND DISPUTES – If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you or your counsel about the request, and to allow you or your counsel time to obtain an order protecting the information requested, if appropriate. We may also share information with our insurance carrier and/or attorney regarding legal action or potential legal action taken against us by you.
LAW ENFORCEMENT – We may release medical information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons or similar process.
- To identify or locate a suspect, fugitive, material witness, or missing person.
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s consent or if required by law even without consent.
- About a death we believe may be the result of criminal conduct.
- About unlawful conduct if it occurs at a PREMIER facility.
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS – We may release medical information to a coroner or medical examiner as required by law. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of a PREMIER facility to funeral directors as necessary to carry out their duties.
NATIONAL SECRUITY AND INTELLIGENCE ACTIVITIES – We may release medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS – We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
INMATES – If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with healthcare; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:
- Right to Inspect and Copy – You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records.
To inspect and receive a copy of medical information that may be used to make decisions about you, you must submit your request in writing to the Health Information Management Department or the Administrator at any PREMIER Senior Services facility. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. PREMIER has the right to charge a reasonable cost-based fee for these copies. The law does not require that copies of your medical information be provided to you immediately. PREMIER will make every effort to provide you with a copy of your complete chart as soon as possible, but in no event later than thirty (30) days after we have received a written request.
We may deny your request to inspect and copy in certain very limited circumstances. For example, PREMIER may withhold certain parts of a psychiatric record if the physician or psychologist believes that such review of the complete record would be deleterious to the patient’s best interests. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by the PREMIER facility will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
- RIGHT TO AMEND OR ADD – 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 request an amendment for as long as the information is kept by or for the PREMIER facility.
To request an amendment, your request must be made in writing and submitted to the PREMIER Privacy Officer or the Assistant Privacy Officer for the PREMIER facility. In addition, you must provide a reason that supports your request. We will act on an amendment within sixty (60) days of receipt of your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, 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 the PREMIER facility.
- Is not part of the information that you would be permitted to inspect and copy.
- Is accurate and complete.
We will advise you in writing if we decide to deny the request. If your request is denied, you may submit a written statement disagreeing with the denial (all or part). We may then prepare a written rebuttal to your statement of disagreement. The statement of disagreement and rebuttal will be included in any subsequent disclosure of that portion of the medical information to which the dispute entry relates. You may also attach a brief comment or statement pertaining to medical issues to your medical record after it is completed.
RIGHT TO AN ACCOUNTING OF DISCLOSURES -You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you.
To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer of the PREMIER facility holding your medical information. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
RIGHT TO REQUEST RESTRICTIONS – You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you have had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or for other purposes permitted by law.
To request restrictions, you must make your request in writing to the Privacy Officer at the PREMIER facility. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply (for example, disclosures to your spouse).
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS -You have the right to request that we communicate with you about medical matters in a reasonably certain way or at a reasonably certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to the Privacy Officer at the PREMIER facility. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
RIGHT TO A PAPER COPY OF THIS NOTICE – You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the PREMIER Privacy Officer or Assistant Privacy Officer at the telephone numbers at the end of this notice or via our contact us form.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical 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 at each PREMIER facility and on our website. The notice will contain the effective date on the first page in the top right-hand corner. In addition, each time you register at or are admitted to a PREMIER facility for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the PREMIER Privacy Officer or Assistant Privacy Officer, or with the Secretary of the Department of Health and Human Services, Office of Civil Rights. To file a complaint with PREMIER, contact the Privacy Officer or the Assistant Privacy Officer at PREMIER SURGICAL LLC, at the address at the end of this notice. To file a complaint with the Department of Health and Human Services you may write to: Office for Civil Rights, U.S. Department of Health and Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3313 New York, NY 10278. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
To write to or contact the Privacy Officer:
ATTN: Privacy Officer
525 ROUTE 70 EAST SUITE 1B
BRICK, NJ 08723