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.
Comprehensive Surgical Care Centers (CSC) is required by law to maintain
the privacy of your protected health information and to provide you with
this notice, which explains our legal duties and privacy practices with
respect to your protected health information. We must abide by the terms
set forth in this notice. However, we reserve the right to change the terms
of this notice and to make the new notice provisions effective for all
protected health information we maintain.
Uses and Disclosures of Your Protected Health Information:
Treatment: We are permitted to use your medical information as
necessary to provide you with medical treatment and services. We may
disclose information about you to physicians, nurses, technicians, medical
students, or other workforce members who are involved in taking care of
you at or through CSC. To assist with your care outside CSC, we may
disclose your information to other health-care providers.
Payment: We are permitted to use and disclose your medical information
to get paid for the services you received. For example, we may disclose
information about your exam or procedure to your insurance company so
that your insurance company will pay us. We also may tell your insurance
company about treatment you are going to receive in order to obtain
approval or to determine whether your insurance will cover the treatment.
We may disclose your health information to other providers who are
involved in your care for their payment purposes. For example, we may
release information to emergency responders to allow them to obtain
payment or reimbursement for services provided to you.
Health Care Operations: We are permitted to use your medical
information for our business operations. Business operations include
training of medical personnel, peer review, and quality improvement. We
may disclose your information to another health care provider or health
plan if they have a relationship with you and need the information for their
own business operations. For example, our quality management
department may use your health information to assess the quality of care
you received and to ensure that our system continues providing the quality
of care you and other patients deserve.
Appointment Reminders and Treatment Alternatives, and Health
related Benefits and Services: We may use and disclose your medical
information to contact you to remind you that you have an appointment
scheduled, to tell you about or recommend possible treatment options or
alternatives that may be of interest to you, or to tell you about a product or
service that may be of interest to you.
Family Members and Others Involved in Your Care: CSC may
disclose your medical information to your family members or friends who
are involved in your care, or to someone who helps to pay for your care.
CSC may also disclose your medical information to disaster relief
organizations to help locate individuals during a disaster, or to notify, or
assist in the notification, of a family member, a personal representative or
a person responsible for your care of your location, general condition or
death. If you do not want CSC to disclose your medical information to
family members or others in these circumstances, please notify CSC staff.
Health Oversight Activities: We may disclose your medical information
to a health oversight agency for activities authorized by law. These
oversight activities include government audits, investigations, and
inspections. We may also provide your medical information to a
government agency that oversees licensing of health care professionals,
such as the State Medical Board.
Incidental Disclosures: Incidental disclosures of your health information
may occur as a by-product of permitted use and disclosures of your health
information. These incidental disclosures are permitted if we have applied
reasonable safeguards to protect the confidentiality of your health
information.
Inmates: If you are an inmate of a correctional facility or are under 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 to provide you with health care or to protect
your health and safety or the health and safety of others, including the
correctional institution.
Law Enforcement: We may disclose your health information to law
enforcement officials as required by law or as directed by court order,
warrant, criminal subpoena, or other lawful process and in other limited
circumstances for purposes of identifying or locating suspects, fugitives,
material witnesses, missing persons, or crime victims.
Legal Proceedings: We may disclose health information about you in
response to a court or administrative order. We also may disclose medical
information about you in response to a civil subpoena, discovery request,
or other lawful process by someone involved in legal proceedings. In many
cases you will receive advance notice about this disclosure so that you will
have a chance to object to sharing your medical information.
Communicable Diseases: If authorized by law, we may disclose your
protected health information to a person who may have been exposed to a
communicable disease or may otherwise be at risk of contracting or
spreading a communicable disease.
Legal Proceedings: We may disclose your protected health information in
the course of any judicial or administrative proceeding; in response to an
order of a court or administrative tribunal; to the extent the disclosure is
expressly authorized; or, if certain conditions have been satisfied, in
response to a subpoena, discovery request or other lawful process.
Military and Veterans: If you are a member of the armed forces, we
may release health information about you as required by military command
authorities. We also may release health information about foreign military
personnel to the appropriate foreign military authority.
National Security, Intelligence, Activities, Protection Services for
the President, and Others: We may disclose your medical information to
authorized federal officials for lawful intelligence, counterintelligence, or
other national security activities authorized by law; for protection of the
U.S. President, other authorized persons or foreign heads of state; or for
special authorized investigations.
Public Health Activities: We may disclose your medical information for
public health activities as authorized by law. These activities typically
include reports to such agencies as the Department of Health and;
Human Services or the Food and Drug Administration: The
disclosures are usually made for the purpose of preventing or controlling
disease, injury, or disability. Examples include reporting of disease, injury,
and vital events such as births and deaths, reporting of child and elder
abuse, and reporting of reactions to medications and problems with
products.
Research: Under certain circumstances, we may use and disclose your
medical information for research purposes. All research projects are
subject to a special approval process by an Institutional Review Board. This
review process governs patient safety and welfare and the privacy of your
medical information. Under special circumstances involving research, a
Privacy Board has been established to monitor and protect your privacy
rights.
Marketing: We may use your medical information to provide you with
certain refill reminders, for treatment, case management or care
coordination, to direct or recommend alternative treatments, therapies,
health care providers, or settings of care, or to describe a health-related
product or service provided by CSC. CSC will obtain your authorization
prior to using or disclosing your protected health information for purposes
of marketing items and services to you and where CSC is paid to make the
communication
Fundraising: CSC may contact you to raise funds for CSC. You have the
right to opt out of receiving such communications. To opt out of receiving
such communications, send a written request to Attention: CSC Privacy
Officer at: 838 W. Elliot Rd Ste 102, Gilbert, AZ, 85233.
Sale of PHI: CSC may not sell your health information without your
written authorization.
Required by Law: We will disclose health information about you when
required to do so by federal, state, or local law.
To Avert a Serious Threat to Health or Safety: We may use and
disclose your medical information when necessary, to prevent a serious
threat to your health and safety or the health and safety of others
Workers’ Compensation: We may release your information about you
for workers’ compensation or similar programs as authorized by law. These
programs provide benefits for work-related injuries or illness.
Coroners, Medical Examiners and Funeral Directors: We may
disclose medical information concerning deceased patients to coroners,
medical examiners and funeral directors to assist them in carrying out their
duties.
Organ and Tissue Donation: We may disclose medical information to
organizations that handle organ, eye or tissue donation or transplantation if
you have previously agreed to organ donation.
Information with Additional Protection:
Certain types of medical information have additional protection under state
law. In some circumstances, CSC will require your consent to disclose
information about communicable disease and HIV/AIDS, drug and alcohol
abuse treatment, genetic testing, and mental health treatment.
Psychotherapy Notes: CSC will not use or disclose your psychotherapy
notes without your authorization, unless the use is by the person who
wrote the notes for purposes of treatment, for training of medical or
counseling professionals, or for CSC to defend itself in a legal proceeding
brought by you. In addition, any disclosure or use must be to the
Department of Health and Human Services; required by law; for the health
oversight of the practitioner that wrote the notes; to the coroner or medical
examiner; or to avert a serious threat to the health or safety of a person or
the public.
Other Uses and Disclosures
Uses and disclosures of your information not described in this notice
require your written authorization. If you provide CSC with an authorization
to use or disclose your medical information, you may revoke that
authorization, in writing, at any time. If you revoke your authorization, we
will no longer use or disclose your medical information for the reasons
covered by your written authorization. You understand that we cannot take
back any disclosures we have already made with your authorization, and
that we are required to retain our records of the care we provided to you.
To revoke your authorization, please write to the Medical Records
Department of the appropriate CSC location.
Copy of This Notice:
You have the right to receive a paper copy of this notice and any revisions
to it upon request. You may obtain a copy by asking our receptionist at
your next visit or by calling and asking us to mail you a copy.
Inspect and Copy:
You have the right to inspect and copy the medical information we
maintain about you in our designated record set for as long as we maintain
that information. This designated record set includes your medical and
billing records, as well as any other records we use for making decisions
about you. You may not inspect or copy psychotherapy notes; information
compiled in reasonable anticipation of, or use in, a civil, criminal, or
administrative action or proceeding; or medical information that is subject
to a law that prohibits access to the medical information.
In some circumstances, you may have a right to review our denial. If you
wish to inspect or copy your medical information, you must submit your
request in writing to the attention of our Privacy Officer, Comprehensive
Surgical Care 838 W. Elliot Rd Ste 102, Gilbert, AZ, 85233. Please identify in
your request the location or office at which you received services. We
may charge you a fee for the costs of copying, mailing, or other supplies
used in fulfilling your request. You may mail your request or bring it to our
office. We have 30 days to respond to your request for information that we
maintain at our practice sites, although we may extent the time an
additional 30 days but must inform you of this delay.
Request Amendment: You have the right to request that we amend
your medical information. You must make this request in writing to our
Privacy Officer. The request must state the reason for the amendment.
We may deny your request if it is not in writing or does not state the
reason for the amendment. We may also deny your request if the
information: was not created by us, unless you provide reasonable
information that the person who created it is no longer available to make
the amendment; is not part of the record which you are permitted to
inspect and copy; the information is not part of our designated record; or is
accurate and complete, in our opinion.
Request Restrictions: You may request that CSC restrict or limit the
health information it uses or discloses about you for treatment, payment or
health care operations. Additionally, you have the right to request our
disclosure of your health information to only certain individuals involved in
your care or the payment for your care, such as family members or friends.
CSC is not required to agree to your request for a restriction, unless you
request that we not share your medical information with your health
insurer about a service for which you (or someone other than your insurer)
has paid CSC in full and the disclosure is for the purpose of carrying out
payment or health care operations and is not otherwise required by law.
Accounting of Disclosures: You have the right to request a list of
certain disclosures of your medical information. Your request must be in
writing and must state the time period for the requested information. Your
first request for a list of disclosures within a 12month period will be free. If
you request an additional list within 12-months of the first request, we may
charge you a fee for the costs of providing the subsequent list. We will
notify you of such costs and afford you the opportunity to withdraw your
request before any costs are incurred.
Request Confidential Communications: You have the right to request
how we communicate with you to preserve your privacy. We may condition
the accommodation by asking you for information as to how payment will
be handled or specification of an alternative address or other method of
contact. You must submit your request in writing to our Privacy Officer.
The request must specify how or where we are to contact you. We will
accommodate all reasonable requests.
File a Complaint: You have the right to file a complaint if you believe we
have violated your privacy rights. We will not retaliate against you for filing
a complaint. Complaints may be submitted:
1.) In writing to our Privacy Officer
Attn: Privacy Officer
Comprehensive Surgical Care
838 W. Elliot Rd, Ste 102
Gilbert, AZ, 85233
2.) Compliance Hotline 1-833-336-9272. You have the option of filing the
compliant anonymously using the hotline.
3.) You can file a complaint with the U.S. Department of Health and Human
Services Office for Civil Rights by sending a letter to 200 Independence
Avenue, S.W., Washington, D.C. 20201, calling: 1-877-696-6775, or by
visiting www.hhs.gov/ocr/privacy/hipaa/ complaints/
Notification if Confidentiality is Breached: We are required to notify
affected individuals following a breach of unsecured medical information.
Changes to this Notice: CSC reserves the right to change the terms of
this notice and to make the new notice provisions effective for all medical
information we maintain. You may receive a copy of any revised notice at
the CSC facility after it becomes effective.