1. Union County Surgery Center (UCSC) is permitted to make use and disclose of protected health information for treatment, payment and health care operations, as described in the following examples:
    • a. For 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, or other hospital personnel who are involved in taking care of you after you are discharged. 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. We may also disclose medical information about you to people outside the surgery center who may be involved in your medical care after you leave the same day surgery center, such as family members.
    • b. For payment- We may use and disclose medical information about you so that the treatment and services you receive at the same day surgery center may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about surgery you received at the same day surgery center 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.
    • c. For health care operations- We may use and disclose medical information about you for same day surgery operations. These uses and disclosures are necessary to run the same day surgery center 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 same day surgery patients to decide what additional services the same day surgery center should offer, what services are not needed, and whether new treatments are effective. We may remove information that identifies you from this set of medical information so others may use it to study health care and healthcare delivery without learning who the specific patients are.
  2. UCSC is permitted or required, under specific circumstances, to use or disclose protected health information without the individual’s written authorization.
  3. Other uses and disclosures will be made only with the Individual’s written authorization, and the individual may revoke such authorization.
  4. UCSC intends to engage in (1) one or more of the following activities.
    • a. UCSC may contact the individual to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual or the patient.
    • b. A group health plan, or a health insurance issuer or HMO with respect to a group health plan, may disclose protected health information to the sponsor of the plan.
  5. The Individual has the following right regarding protected health information:
    • a. The right to request restrictions on certain uses and disclosures of protected health information. UCSC is not required to agree to a requested restriction, however.
    • b. The right to receive confidential communications of protected health information, as applicable.
    • c. The right to inspect and copy protected health information, as provided in the Privacy Regulation.
    • d. The right to amend protected health information, as provided in the Privacy Regulation.
    • e. The right to receive an accounting of disclosures of protected health information.
    • f. The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically.
  6. UCSC is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information.
  7. UCSC is required to abide by the terms of the Notice currently in effect.
  8. UCSC reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all the protected health information that it maintains.
  9. UCSC will provide individuals or patients with a revised Notice by oral instruction as a copy is provided for the individual/patient.
  10. Individuals may complain to the UCSC and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint is to address a corresponding letter to the following persons/institutions listed as New Jersey State Division of Health and Family Services to lodge complaints are: Division of Health Facilities Evaluation and Licensing New Jersey State Department of Health, CN 367, Trenton, NJ 08625-0367. State of New Jersey Office of the Ombudsman for the Institutionalized Elderly, CN 808, Trenton, NJ 08625-808.
  11. UCSC’s contact person for matters relating to complaints is the Director of Operations: 950 West Chestnut St., Union, NJ 07083. (908) 688-2700.
  12. This Notice is first in effect on April 14, 2003.
  13. Union County Surgery Center elects to limit the uses or disclosures that it is permitted to make. 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.