NOTICE OF 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.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services we provide. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by South Denver Anesthesiologists, P.C. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
- 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 staff members or other healthcare professionals. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.
- For Payment. Your health information may be used to seek payment from your health plan or from other sources of coverage such as an automobile insurer. For example, your health plan may request and received information on dates of service, the services provided, and medical condition being treated.
- For Health Care Operations. We may use medical information about you in the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost-management analysis and customer service. An example would be an internal quality assessment review.
- Reminders and Treatment Alternatives. We may contact you prior to your procedure for a pre-operative assessment, and to discuss medication, fluid and food restrictions. Other reasons might include appointment reminders, treatment alternatives, or health-related benefits and services that may be of interest to you.
- Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
- As Required By Law. We will disclose medical 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 medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
- Workers' Compensation. We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- Public Health Risks. We may disclose medical information about you for public health activities as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.
- Lawsuits and Disputes. We may disclose your medical information for any judicial or administrative proceeding. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute.
Other than the circumstances described above, we will not disclose your health
information unless you provide written authorization. You may revoke your authorization
in writing at any time except to the extent that we have taken action in reliance upon the
authorization.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights regarding medical information we maintain about you:
- Right to Request Restrictions. You have the right to request restrictions or limitations on the medical information we use or disclose about you for treatment, payment or health care operations. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
- Right to Request Confidential Communications. You have the right to receive confidential communications concerning your medical condition and treatment. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you at work or by mail.
- Right to Inspect. You have the right to inspect and copy your medical information. To inspect and copy you medical information, you must submit your request in writing to the Privacy Officer. If you request a copy of the information, we may charge you a fee for the costs of copying, mailing, or other supplies associated with your request. The Practice must act on your request within 30 – 60 days.
- Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for South Denver Anesthesiologists, PC. To request an amendment, your request must be in writing and submitted to the Privacy Officer. In addition, you must provide a reason that supports your request. We will act on your request within 30 – 60 days.
- Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the “non-routine” disclosures we made of medical information about you. We will respond to your request within 60 – 90 days.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may obtain a copy of this notice at our website, http://www.sdapc.com or by calling our office at 303-761-5646.
Right to Revise Privacy Practices
We reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Whatever the reason for these revisions, we will provide you with a revised notice. The revised policies and practices will be applied to all protected health information that we maintain. Each notice will contain an effective date.
Requests to Inspect Your Medical Information
As permitted by law, we require that requests to inspect or copy your medical information be submitted in writing. You may obtain a form to request access to your records by contacting our office at 303-761-5646.
Complaints
If you believe your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your concern. If you would like to submit a comment or complaint about our privacy practices, you can do so by sending a letter outlining your concerns. You will not be penalized or otherwise retaliated against for filing a complaint. You may also file a complaint with the Department of Health and Human Services.
Contact Person
You may contact our Privacy Officer regarding our duties and your rights under the privacy regulations. The Privacy Officer can provide information regarding issues related to this Notice by request. Complaints should be directed to the Privacy Officer at the following address:
Attn: Privacy Officer
South Denver Anesthesiologists, PC
333 W. Hampden Ave., Suite #600
Englewood, CO 80110
303-761-5646
Effective Date
This Notice is effective April 14, 2003.
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