TRI-COUNTY SURGICAL
ASSOCIATES, P.A.
Notice of Health Information Practices
THIS NOTICE DESCRIBES
HOW INFORMATION ABOUT YOU MAY BE USED, DISCLOSED, AND HOW YOU CAN OBTAIN
ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Introduction
At Tri-County Surgical Associates, we are committed to treating and
using protected health information about you responsibly. This notice of
Health Information Practices describes the personal information we
collect, and how and when we disclose that information. It also
describes your rights as they relate to your protected health
information. This Notice is effective as of October 26, 2006 and applies
to all protected health information as defined by federal regulations.
Understanding Your Health Record/Information
Each time you visit the office of Tri-County Surgical Associates, there
is a record made of your visit. Typically, this record contains your
information from your physical examination, your symptoms, test results,
diagnosis, treatment, and a plan for future care or treatment. This
information, often referred to as your health or medical record, serves
as a:
-
Basis for planning your
care and treatment
-
Means of communication
among the many health professionals who contribute to your care Legal
document describing the care you receive
-
Means by which you, or a
third-party payer, can verify that services billed were actually
provided A tool for educating health care professionals
-
A source of data for
medical research
-
A source of information
for public health officials charged with improving the health of this
state and the nation
-
A tool with which we can
assess and continually work to improve the care we render and the
outcomes we achieve
Understanding the
information in your medical record and how that information is used
helps you to ensure its accuracy, better understand who, what, when,
where, and why others may access your health information, and make more
informed decisions when authorizing disclosures to others.
Your Health Information
Rights
Although your health
record is the property of Tri-County Surgical Associates, P.A., the
information belongs to you. You have the right to:
-
Obtain a paper copy
Inspect and copy your health record as provided for in 45 CFR 164.524
-
Amend your health record
as provided in 45 CFR 164.528
-
Obtain an accounting of
disclosures of your health information as provided in 45 CFR 164.528
-
Request communication of
your health information by alternative means or at alternative
locations
-
Request a restriction on
certain uses and disclosures of your information provided by 45 CFR
164.522, and
-
Revoke your
authorization to use or disclose health information except to the
extent that action has already been taken
Our Responsibilities
Tri-County Surgical
Associates is required to:
-
Maintain the privacy of
your health information
-
Provide you with this
notice as to our legal duties and privacy practices with respect to
information we collect and maintain about you, our patient
-
Abide by the terms of
this notice
-
Notify you if we are
unable to agree to a requested restriction, and
-
Accommodate reasonable
requests that you may have to communicate health information by
alternative means or at alternative locations
We reserve the right to
change our practices and to make the new provisions effective for all
protected health information we maintain. We will not use or disclose
your health information without your authorization, except as described
in this notice. We will also discontinue using or disclosing your health
information after we have received a written revocation of the
authorization according to the procedures included in the authorization.
For More Information or
to Report a Problem
If you have questions and
would like additional information, you may contact the Practice manager,
Jan Litton, 9239 Medical Plaza Drive, Charleston, SC, 29406,
843-797-5151.
If you believe that your privacy rights have been violated, you may file
a complaint with the Practice Manager or with the office for Civil
Rights, U.S. Department of Health and Human Services. There will be no
retaliation for filing a complaint with either the Practice Manager or
the Office for Civil Rights. The address for the OCR is listed below:
Office for Civil
Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C., 20201
Form 018
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