Patient Privacy

This notice describes how medical information about you may be used and disclosed, and how you can access this information. Please read it carefully.

SCOTT GYNECOLOGY & PELVIC SURGERY respects your privacy, and understands that your personal health information is very sensitive. We will not disclose your information to others unless you tell us to do so, or unless the law authorizes or requires us to do so.

The law protects the privacy of the health information we create and obtain in providing our care and services to you. For instance, your protected health information includes your symptoms, test results, diagnoses, treatment, health information from other providers, and billing and payment information relating to these services. Federal and state law allows us to use and disclose your protected health information for purposes of treatment and health care operations. State law requires us to get your authorization to disclose this information for payment purposes.

Our Responsibilities

We will:

• Protect your health information and keep it private
• Provide you this notice
• Follow the terms of this notice

Our Commitment
We are committed to protecting your health information. However, to comply with legal requirements and to offer quality health care, we need to keep a record of your IIHI (Individually Identifiable Health Information). The following notice explains how and when we may use your personal health information. It also details your rights and our duties towards using your health information. Part of our duty is to explain these policies to you. To comply with federal and state laws, we have to adhere to the terms of the current notice of privacy practices.

We may disclose your personal health information in the following ways:

1. Treatment: Your IIHI (Individually Identifiable Health Information) may be used to evaluate your health and diagnose medical conditions. It helps in providing the right treatment for you. For instance:
   • We may use lab results to diagnose your health.
   • We may use your IIHI to write prescriptions for you.
   • We may share your information with a pharmacy to order a prescription.
   •  We may disclose the information to other health care providers for reasons related to your treatment.
2. Payment: We may disclose your health information to bill and collect payments for items and services you may have received from us. For instance:
   • We may contact your insurance company to verify details.
   • We may disclose the details of your treatment to the insurance company to know if they will cover or pay for it.
   • We may disclose the information to collect payment from a third party.
   • We may disclose the information to other health care providers to help them bill, and collect payments.
3. Health Care Operations: We may disclose your IIHI to support our daily activities and management. For instance:
   • We may disclose the information to evaluate the quality of service you received.
   • We may disclose the information for business planning and cost-management.
   • We may disclose the information to obtain certificates, credentials, licenses, and accreditations.

Additional Uses of your IIHI (Individually Identifiable Health Information) requiring your consent/authorization

1. Appointment Reminders: When we make an appointment call for the next scheduled appointment, we may disclose some of the information, if you are unavailable, while leaving the message to a third person or voice mail. The nature of your visit, however, will be kept undisclosed.
2. Health-Related Benefits & Services: We may inform you about health related benefits and services which might of interest. For this purpose, we might disclose your IIHI to notify you.
3. Information release to Family/Friends: If authorized, we may disclose your IIHI to a family member(s) or friend involved in your case.

Special Circumstances

1. Disclosures Required By Law: If required by federal, state or local law, we will disclose your IIHI.
2. Public Health Risks: We may disclose your IIHI to public health authorities (authorized by law) that are collecting the information to:
   • Maintain vital records
   • Report child abuse/neglect
   • Prevent or control disabilities, diseases, and injuries
   • Notify an individual about a potential exposure to a communicable disease
   • Notify an individual about potential risk for contracting/spreading a disease
   • Report reactions to drugs/products/devices
   • Notify public if any drug, product or device has been recalled
   • Notify concerned authorities about any potential neglect or abuse of an adult individual
3. Health Oversight Activities: We may disclose your IIHI to a healthcare oversight agency (authorized by law) for the following activities:
   • Investigation
   • Inspections/Licensure/Audits
   • Surveys
   • Civil, administrative, and criminal procedures or actions
   • Activities to monitor government programs
4. Lawsuits and Similar Proceedings: If you are involved in a lawsuit or similar proceedings, we may disclose your IIHI, such as:
   • In response to a court or administrative order
   • In response to a discovery request
   • In response to subpoena
   • In response to a lawful process by another party involved in a dispute
     
     We will try to inform you before disclosing the information, however.
5. Law Enforcement: If asked by a law enforcement agency, we may disclose your IIHI, such as in case of:
   • Criminal conduct at our premises
   • Death by criminal conduct
   • Warrant, court orders, summons or any similar legal procedure
   • Search for a fugitive, suspect, a missing individual or a potential witness
   • Emergencies – to report a crime
6. Deceased Patients: We may disclose IIHI to identify a deceased person or to find out the cause of death. We may also provide information to funeral directors to help them perform their job.
7. Serious Threat to Health or Safety: We may disclose your IIHI to prevent/reduce a threat to your safety and health or to the health and safety of another person or the public in general. In such a case, the information will only be disclosed to a person/organization that will be able to prevent the threat.
8. Military: If you are a member of the U.S. or foreign military forces, then we may disclose your information if asked by appropriate authorities.
9. National Security: We may disclose your IIHI to Federal officials authorized by law for the purpose of national security or intelligence activities.
10. Inmates: If you are under the custody of a law enforcement officer or an inmate, then we may disclose your IIHI to correctional institutions.

Your Rights

You have the following rights regarding your IIHI (Individually Identifiable Health Information):

1. Confidential Communications: You have the right to ask for confidential communication about your health and other related issues. For this, you will have to make a written request to us, informing us about your preferred means of communication, specifying the preferred means of contact. We will try to accommodate all your requests, without asking for a reason.
2. Requesting Restrictions: You have the right to restrict the disclosure of your IIHI for payment, healthcare operations or treatments. You also have the right to request us to restrict the disclosure to certain individuals only.
   
   We are, however, not obligated to accept your request. Nevertheless, if we agree to your request, we are bound by our agreement, except if it is required by law, or in case of emergencies, or if the information is required for your treatment. In such a case, you will have to give a written request to our privacy office, clearly indicating:
   • What information you want restricted
   • Whether we should limit our practice’s use or disclosure or both
   • To whom are the limits applicable
3. Inspection and Copies: You have the right to inspect and collect a copy of your IIHI, including your billing and medical records. This does not, however, include psychotherapy notes. For this, you will have to submit a written request to our privacy officer.
   
   For inspection of your IIHI copy, you will have to schedule an appointment with our privacy officer. You will be charged a fee for this service.
   
   We may deny your request in certain circumstances, but you can request for a review of the denial. In such case, another officer will look into your case.
4. Amendment: You may request, in writing, to make changes in your IIHI if you think that the information is incorrect or incomplete. You will have to provide a reason for this request.
   We may deny your request, if you fail to submit the request along with the reason in writing. We may also deny it if the information is (in our opinion):
   • Complete & correct
   • Not part of the records we maintain
   • Not part of the IIHI that you can inspect or copy
   • Not created by us, unless the person/entity that created it is not present
5. Accounting of Disclosures: You have the right to “accounting of disclosures” for your IIHI. It is a list of some non-routine disclosures made by us for non-treatment or operations purposes. We do not document the use of your IIHI as part of your treatment or payment or healthcare operations. To obtain an accounting of disclosures, you need to submit your request in writing to our privacy officer, mentioning a time period - that should not be more than 6 years from the date of disclosure and the dates should not be before April 14, 2003.

   You will not be charged for the first list submitted within a 12-month period. For any additional list, you will be charged. We will notify you of the cost of additional request(s), and if you wish you may withdraw it.

6. Right to a Paper Copy of This Notice: You have the right to ask for a paper copy of this notice. You can contact our privacy officer to get a copy of this notice.
7. Right to File a Complaint: You have the right to file a written complaint in case you think your privacy rights have been violated. You can file the complaint either with our clinic or the Secretary of the Department of Health and Human Services (DHHS).
   

   To file a complaint with us, contact our privacy officer.

   To file a complaint with DHHS, contact them directly.

8. Right to Provide an Authorization for Other Uses and Disclosures: For uses and disclosures of your IIHI not mentioned in this notice or permitted by law, we will obtain an authorization from you in writing.

   You can revoke any authorization that you provide to us for the disclosure of your IIHI. Once you do so, we will no longer disclose or use the information for the reasons mentioned in the authorization.