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version of the Privacy Notice 
April 14, 2003
This notice describes how medical information about you
may be used and disclosed, and how you can gain access to this information.
Please review it carefully.
The Department of Health and Human Services has created a floor
of national protections for the privacy of your health information.
These standards for privacy protection are a provision of the Health
Insurance Portability and Accountability Act of 1996 (HIPPA) and
are currently the only national standards in place which guarantee
patients privacy, access to health information and control over
how health information may be utilized. All of your health care
providers are required to come into compliance with HIPAA by April
14, 2003. Compliance includes providing you with a written notice
describing your legal rights as well as the general privacy policies
implemented in the office.
Consultants in General Surgery, S. C. may disclose your protected
health information without your authorization for only three purposes:
1) treatment, 2) payment, 3) health care operations. All
other disclosures require your specific, written authorization.
Disclosures of your health information for treatment purposes includes
disclosures to your other health care providers for coordination
of your care, communicating recommendations for medical management
and facilitating continuity of your care. Consultants in General
Surgery, S.C. limits disclosures for treatment purposes to providers
readily identified or reasonably expected to be involved in your
health care. Prior to releasing your health records to unknown providers,
you would be contacted and asked to forward a written request and
instructions for the disclosure.
Disclosures made for payment purposes includes the release of information
to your health insurance carrier to the end of obtaining benefits
for services rendered by Consultants in General Surgery, S.C. physicians,
billing and collection activities.
Activities included in health care operations are strictly internal
functions pertaining to quality assessments, outcome evaluations,
staff training, legal and auditing functions and business planning.
Consultants in General Surgery, S.C., additionally, will use your
name and telephone number for the purpose of contacting you with
a reminder of any upcoming appointments. The scope of health care
operations does not include marketing or advertising
activities.
The extent of information released is limited to the minimum disclosure
necessary to accomplish the task. This means that your health record
will not be copied in its entirety and freely distributed to the
entity seeking information. Exceptions to the minimum necessary
rule are disclosures made to your other treating health care providers,
disclosures to you directly, mandatory disclosures to federal agencies
(i.e. The Department of Health and Human Services) for evaluating
our compliance with the privacy regulations, and disclosures required
by law (court order, subpoenas, etc.). Under these circumstances,
the record will be provided in its entirety or as requested. In
a workers compensation action, records relative to the injury/accident
only will be released to the employer or their agent. An accounting
of all disclosures made with regard to your health information will
be maintained in your chart and will be available for your review.
You have the right to restrict the use of your health information
at any time in writing. Restrictions, however, may impact your continuity
of care, insurance benefits and our ability to communicate treatment
alternatives or conduct quality assessments. While it is required
that you are provided with the opportunity to limit the use of your
health information, your physician is not obligated to honor the
restrictions you request. In the event your restrictions are refused,
you will be provided with a detailed, written communication explaining
the basis for the refusal. Thereafter, you have the right to dispute
the decision (once again, in writing). These communications will
be maintained as a permanent part of your record. If your request
for restriction is accepted, the restriction is binding until such
time as you revoke or revise it in writing. Restriction request
forms are available in the office.
You are also entitled to review the contents of your medical and
billing records; and you have the right to make written request
for amendments or alterations. The physician, again, is not required
to comply with your request for amendment; however, the request
itself must be retained as part of your record. You are entitled
to receive a copy of your record, although a fee will be imposed
for providing that to you. As of September 1, 2001, the State of
Illinois Public Act 92-0228 places a restriction on copying fees
for health records. Consequently, the following charges apply to
copying your medical chart:
- First copy to patient - no charge
- Each additional patient request or copies to others:
$20.00 handling fee, plus
$0.75 per page for the first 25 pages
$0.50 per page for the next 25 pages (26-50)
$0.25 per page for each page in excess of 50
Consultants in General Surgery, S.C. is required by law to comply
with the federal standards established to protect your health information
and your privacy. If you believe any member of our staff has compromised
your privacy, you may ask to speak with the privacy officer or the
office manager to file a formal complaint. You may also file a complaint
with the Secretary of the Department of Health and Human Services
(DHHS) directly. We encourage you to become an active participant
in protecting your health information and hereby make you aware
there are no punitive consequences for filing a grievance either
with our office of with the DHHS.
Consultants in General Surgery, S.C. reserve the right to change
privacy policies in accordance with the terms of the standards.
New or updated notices will be posted in our waiting room or on
our web site as changes become necessary to comply with federal
standards.
If you have any questions regarding your privacy rights, please
contact our office. Additional information regarding the final privacy
regulations can also be obtained by contacting the Department of
Health and Human Services at their web site www.hhs.gov
or by contacting the office of the DHHS region 5 director at 233
North Michigan Avenue, Chicago, IL 60601, (312) 353-5160.
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