Patient Rights:
Patients are treated with respect, consideration and dignity.
Patients have the right to be free from abuse and harassment while at the
facility.
Patients are provided privacy.
Patient disclosures and records are treated confidentially and patients are
given the opportunity to approve or refuse their release, except when such release is required by law.
Patients are provided, to the degree known, complete information concerning
their diagnosis, evaluation, treatment and prognosis.
Should it be medically inadvisable to give such information to a patient, the
information will be provided to a person designated by the patient or to a legally authorized person.
Patients are given the opportunity to participate in decisions involving their
health care except when such participation is contraindicated for medical reasons.
Patients have the right to know the services available to them at the facility.
Patients have the right to be informed of provisions for after-hour and
emergency care, if needed.
Patients have the right to know the facility fees for services.
Patients have the right to be informed of patient conduct and responsibilities.
Patients have the right to refuse to participate in experimental research.
Patients have the right to know the credentials of health care professionals
providing their care.
Patient s have the right to change their provider if other qualified providers
are available.
Patients may offer suggestions, voice complaints, and/or grievances regarding
their care and/or services provided per state and federal regulations.
Patient Responsibilities:
Patients must provide complete and accurate information to the best of his/her
ability regarding his/her health status: medications taken, including over-the-counter products and
dietary supplements; and any known allergies or sensitivities.
Patients are expected to follow the treatment plan as prescribed by his/her
provider.
Patients must provide a responsible adult to transport him/her home from the
facility and remain with him/her for 24 hours following the procedure if so required by his/her
provider.
Patients are to cooperate with facility personnel and ask questions if they do
not understand.
Patients are expected to accept personal financial responsibility for any
charges not covered by his/her insurance plans. Patients who receive direct payment from their
insurances are expected to submit that payment to us within 10 days of receipt of such payment.
Patients must be respectful of all health care providers and ancillary staff as
well as other patients.
Complaints:You may contact the following for concerns or complaints related to your experience at the
Surgery Center:
Administrator
Ellicott City Ambulatory
Surgery Center
2850 N. Ridge Road, Ground Floor
Ellicott City, MD 21043
Maryland Department of Health and Mental Hygiene Office of Health Care
Quality
Spring Grove Hospital Center
Bland Bryant Building
55 Wade Avenue
Catonsville, MD 21228
Office of the Medicare
Beneficiary Ombudsman
www.cms.hhs.gov/center/ombuds
Advanced Directives
It is the policy of the Ellicott City Ambulatory Surgical Center, in accordance
with applicable MD law, to NOT honor “Do Not Resuscitate” (DNR) directives. Regardless, if you have an
Advanced Directive, please provide us with a copy so that we may add it to your facility record. If you
do not have an existing Advanced Directive and would like information to this end, please let us know.
We would be happy to provide you with the necessary forms and facts regarding your Maryland Healthcare
Proxy and Living Will.
HIPAA
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.
This Notice of Privacy Practices is being provided to you as a requirement of the Health Insurance
Portability and Accountability Act (HIPAA). This Notice describes how we may use and disclose your
protected health information to carry out treatment, payment, or healthcare operations, and for other
purposes that are permitted or required by law. It also describes your rights to access and control your
protected health information in some cases. Your “protected health information” means any of your
written and oral health information, including demographic data that can be used to identify you. This
is health information that is created or received by your healthcare provider, and that relates to your
past, present, or future physical or mental health or condition.
I. Uses and Disclosures of Protected Health Information
The Center may use your protected health information for purposes of providing treatment, obtaining
payment for treatment, and conducting healthcare operations. Your protected health information may be
used or disclosed only for these purposes unless the Center has obtained your authorization or the use
or disclosure is otherwise permitted by the HIPAA Privacy Regulations or state law. Disclosures of your
protected health information for the purposes described in this Notice may be made in writing, orally or
by facsimile.
Treatment. We will use and disclose your protected health information to
provide, coordinate or manage your health care and any related services. This includes the
coordination or management of your health care with a third party for treatment purposes. For
example, we may disclose your protected health information to a pharmacy to fulfill a prescription,
to a laboratory to order a blood test, or to a home health agency that is providing care in your
home. We may also disclose protected health information to other physicians who may be treating you
or consulting with the Center with respect to your care. In some cases, we may also disclose your
protected health information to an outside treatment provider for purposes of the treatment
activities of the other provider.
Payment. Your protected health information will be used, as needed, to
obtain payment for the services that we provide. This may include certain communications to your
health insurer to get approval for the surgery that we have scheduled. For example, we may need to
disclose information to your health insurer to get prior approval for the surgery. We may also
disclose protected health information to your insurance company to determine whether you are
eligible for benefits or whether a particular service is covered under your health plan. In order to
get payment for your services, we may also need to disclose your protected health information to
your insurance company to demonstrate the medical necessity of the services or, as required by your
insurance company, for utilization review. We may also disclose patient information to another
provider involved in your care for the other provider’s payment activities. This may include
disclosure of demographic information to the anesthesiologists for their payment of services.
Operations. We may use or disclose your protected health information, as
necessary, for our own healthcare operations in order to facilitate the function of the practice and
to provide quality care to all patients. Healthcare operations include such activities as:
- Quality assessment and improvement activities.
- Employee review activities.
- Employee review activities.
- Training programs, including those in which students, trainees, or practitioners in health care
learn under supervision.
- Accreditation, certification, licensing, or credentialing activities.
- Review and auditing, including compliance reviews, medical reviews, legal services, and
maintaining compliance programs.
-Business management and general administrative activities. In certain situations, we may also
disclose patient information to another provider or health plan for their healthcare operations.
Other Uses and Disclosures. As part of treatment, payment, and healthcare
operations, we may also use or disclose your protected health information for the following
purposes:
- To remind you of your surgery date.
- To inform you of potential treatment alternatives or options.
- To inform you of health-related benefits or services that may be of interest to you.
- To contact you to raise funds for the Center or an institutional foundation related to the
Center.
If you do not wish to be contacted regarding fundraising, please contact our
Privacy Officer.
II. Uses and Disclosures Beyond Treatment, Payment and Healthcare Operations Permitted Without
Authorization or Opportunity to Object
Federal privacy rules allow us to use or disclose your protected health information without your
permission or authorization for a number of reasons, including the following:
When Legally Required. We will disclose your protected
health information when we are required to do so by any federal, state, or local law.
When There Are Risks to Public Health. We may disclose your
protected health information for the following public activities and purposes:
- To prevent, control, or report disease, injury, or disability, as permitted by law.
- To report vital events such as birth or death, as permitted or required by law.
- To conduct public health surveillance, investigations, and interventions, as permitted or required
by law.
- To collect or report adverse events and product defects, track FDA regulated products, enable
product recalls, repairs or replacements to the FDA, and to conduct post marketing surveillance.
- To notify a person who has been exposed to a communicable disease or who may be at risk of
contracting or spreading a disease, as authorized by law.
- To notify a person who has been exposed to a communicable disease or who may be at risk of
contracting or spreading a disease, as authorized by law.
To Report Abuse, Neglect or Domestic Violence. We may notify government
authorities if we believe that a patient is the victim of abuse, neglect, or domestic violence. We
will make this disclosure only when specifically required or authorized by law, or when the patient
agrees to the disclosure.
To Conduct Health Oversight Activities. We may disclose your protected
health information to a health oversight agency for activities including audits; civil,
administrative or criminal investigations, proceedings or actions; inspections; licensure or
disciplinary actions; or other activities necessary for appropriate oversight as authorized by law.
We will not disclose your health information if you are the subject of an investigation and your
health information is not directly related to your receipt of health care or public benefits.
In Connection With Judicial and Administrative Proceedings. We may disclose
your protected health information in the course of any judicial or administrative proceeding in
response to an order of a court or administrative tribunal as expressly authorized by such order. In
certain circumstances, we may disclose your protected health information in response to a subpoena,
to the extent authorized by state law, if we receive satisfactory assurances that you have been
notified of the request or that an effort was made to secure a protective order.
For Law Enforcement Purposes. We may disclose your protected health
information to a law enforcement official for law enforcement purposes as follows: As required by
law for reporting of certain types of wounds or other physical injuries. Pursuant to court order,
court ordered warrant, subpoena, summons, or similar process. For the purpose of identifying or
locating a suspect, fugitive, material witness, or missing person. Under certain limited
circumstances, when you are the victim of a crime. To a law enforcement official, if the Center has
a suspicion that your death was the result of criminal conduct. In an emergency, in order to report
a crime.
To Coroners, Funeral Directors and for Organ Donation. We may disclose
protected health information to a coroner or medical examiner for identification purposes, to
determine cause of death, or for the coroner or medical examiner to perform other duties authorized
by law. We may also disclose protected health information to a funeral director, as authorized by
law, in order to permit the funeral director to carry out his/her duties. We may disclose such
information in reasonable anticipation of death. Protected health information may be used and
disclosed for cadaveric organ, eye or tissue donation purposes. • For Research Purposes. We may use
or disclose your protected health information for research when the use or disclosure for research
has been approved by an institutional review board or privacy board that has reviewed the research
proposal and research protocols to address the privacy of your protected health information. • In
the Event of a Serious Threat to Health or Safety. We may, consistent with applicable law and
ethical standards of conduct, use or disclose your protected health information if we believe, in
good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent
threat to your health or safety or to the health and safety of the public.
For Specified Government Functions. In certain circumstances, the federal
regulations authorize the Center to use or disclose your protected health information to facilitate
specified government functions relating to military and veterans activities, national security and
intelligence activities, protective services for the president and others, medical suitability
determinations, correctional institutions, and law enforcement custodial situations.
For Workers’ Compensation. The Center may release your health information to
comply with workers’ compensation laws or similar programs.
III. Uses and Disclosures Permitted Without Authorization, but with Opportunity to Object
- We may disclose your protected health information to your family member or a
close personal friend if it is directly relevant to the person’s involvement in your surgery or
payment related to your surgery. We can also disclose your information in connection with trying to
locate or notify family members or others involved in your care concerning your location, condition or
death.
- You may object to these disclosures. If you do not object to these
disclosures, or we can infer from the circumstances that you do not object, or we determine, in the
exercise of our professional judgment, that it is in your best interests for us to make disclosure of
information that is directly relevant to the person’s involvement with your care, we may disclose your
protected health information as described.
IV. Uses and Disclosures Which You Authorize
Other than as stated above, we will not disclose your health information other than with your 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.
V. Your Rights
You have the following rights regarding your health information:
- The right to inspect and copy your protected health information. You may
inspect and obtain a copy of your protected health information that is contained in a designated
record set for as long as we maintain the protected health information. A “designated record set”
contains medical and billing records, and any other records that your physician and the Center uses
for making decisions about you. These records must be given to you in paper format or electronic, as
per your request..
- Under federal law, however, you may not inspect or copy the following
records: psychotherapy notes; information compiled in reasonable anticipation of, or for
use in, a civil, criminal, or administrative action or proceeding; and protected health information
that is subject to a law that prohibits access to protected health information. Depending on the
circumstances, you may have the right to have a decision to deny access reviewed.
- We may deny your request to inspect or copy your protected health information
if, in our professional judgment, we determine that the access requested is likely to endanger your
life or safety, or that of another person, or that it is likely to cause substantial harm to another
person referenced within the information. You have the right to request a review of this decision.
- To inspect and copy of your medical information, you must submit a
written request to the Privacy Officer, whose contact information is listed on the last pages of
this Notice.If you request a copy of your information, we may charge you a fee for the
costs of copying, mailing, or other costs incurred by us in complying with your request. Please
contact our Privacy Officer if you have questions about access to your medical record.
- The right to request a restriction on uses and disclosures of your
protected health information. You may ask us not to use or disclose certain parts of your
protected health information for the purposes of treatment, payment or healthcare operations. You may
also request that we not disclose your health information to family members or friends who may be
involved in your care or for notification purposes as described in this Notice of Privacy Practices.
Your request must state the specific restriction requested and to whom you want the restriction to
apply. We are not required to agree to a requested restriction, except for requests to limit
disclosures to your health plan for purposes of payment or health care operations when you have paid
in full, out-of-pocket for the item or service covered by the request and when the uses or disclosures
are not required by law.
- The right to request to receive alternative means of confidential
communications from us. You may request an amendment to protected health information about
you in a designated record set for as long as we maintain this information. In certain cases, we may
deny your request for an amendment. If we deny your request for amendment, you have the right to file
a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide
you with a copy of any such rebuttal. Requests for amendment must be in writing and must be directed
to our Privacy Officer. In this written request, you must also provide a reason to support the
requested amendment.
- The right to receive an accounting. You have the right to
request an accounting of certain disclosures of your protected health information made by the Center.
This right applies to disclosures for purposes other than treatment, payment, or healthcare operations
as described in this Notice of Privacy Practices. We are also not required to account for disclosures
that you requested, disclosures that you agreed to by signing an authorization form, disclosures for a
Center directory, to friends or family members involved in your care, or certain other disclosures we
are permitted to make without your authorization. The request for an accounting must be made in
writing to our Privacy Officer. The request should specify the time period sought for the accounting.
We are not required to provide an accounting for disclosures that took place prior to April 14, 2003.
Accounting requests may not be made for periods of time in excess of six years. We will provide the
first accounting you request during any 12-month period without charge. Subsequent accounting requests
may be subject to a reasonable cost-based fee.
- The right to opt out of Marketing or Advertising for the
center. You have the right to request that your PHI not be used for purposes of Marketing
that would result in financial remuneration from a third party. If the center was interested in using
your PHI for Marketing, we would require your Authorization.
- The right to obtain a paper copy of this Notice. Upon
request, we will provide a separate paper copy of this notice, even if you have already received a
copy of the Notice or have agreed to accept this Notice electronically.
VI. Our Duties
The Center is required by law to maintain the privacy of your health information and to provide you with
this Notice of our duties and privacy practices. We are required to abide by terms of this Notice as may
be amended from time to time. We reserve the right to change the terms of this Notice and to make the
new Notice provisions effective for all protected health information that we maintain. If the Center
changes its Notice, we will provide a copy of the revised Notice by sending a copy of the Revised Notice
via regular mail or through in-person contact.
Notification of a Breach
In order to explain our duties to our patients regarding breaches in your
protected health information, it is important to understand what a breach is:
Definition of Breach
A breach is, generally, an impermissible use or disclosure under the Privacy
Rule that compromises the security or privacy of the protected health information such that the use or
disclosure poses a significant risk of financial, reputational, or other harm to the affected
individual. There are three exceptions to the definition of “breach.” The first exception applies to the
unintentional acquisition, access, or use of protected health information by a workforce member acting
under the authority of a covered entity or business associate. The second exception applies to the
inadvertent disclosure of protected health information from a person authorized to access protected
health information at a covered entity or business associate to another person authorized to access
protected health information at the covered entity or business associate. In both cases, the information
cannot be further used or disclosed in a manner not permitted by the Privacy Rule. The final exception
to breach applies if the covered entity or business associate has a good faith belief that the
unauthorized individual, to whom the impermissible disclosure was made, would not have been able to
retain the information. It is our duty, following a breach of unsecured protected health information to
provide notification of the breach to affected individuals, the Secretary, and, in certain
circumstances, to the media. In addition, business associates must notify covered entities that a breach
has occurred. Notification Requirements for a Breach Following a breach of unsecured protected health
information covered entities must provide notification of the breach to affected individuals, the
Secretary, and, in certain circumstances, to the media. In addition, business associates must notify
covered entities that a breach has occurred.
Individual Notice
We must notify the affected individuals following the discovery of a breach of
unsecured protected health information. This individual notice will be in written form by first-class
mail, or alternatively, by e-mail if the affected individual has agreed to receive such notices
electronically. If we have insufficient or out-of-date contact information for 10 or more individuals,
we must provide substitute individual notice by either posting the notice on the home page of its web
site or by providing the notice in major print or broadcast media where the affected individuals likely
reside. If we have insufficient or out-of-date contact information for fewer than 10 individuals, the we
may provide you substitute notice by an alternative form of written, telephone, or other means. These
individual notifications must be provided without unreasonable delay and in no case later than 60 days
following the discovery of a breach and must include, to the extent possible, a description of the
breach, a description of the types of information that were involved in the breach, the steps affected
individuals should take to protect themselves from potential harm, a brief description of what the
covered entity is doing to investigate the breach, mitigate the harm, and prevent further breaches, as
well as contact information for the covered entity. Additionally, for substitute notice provided via web
posting or major print or broadcast media, the notification must include a toll-free number for
individuals to contact the covered entity to determine if their protected health information was
involved in the breach.
Media Notice
If we experience a breach affecting more than 500 residents of a State or
jurisdiction are, in addition to notifying the affected individuals, required to provide notice to
prominent media outlets serving the State or jurisdiction. We will likely provide this notification in
the form of a press release to appropriate media outlets serving the affected area. Like individual
notice, this media notification must be provided without unreasonable delay and in no case later than 60
days following the discovery of a breach and must include the same information required for the
individual notice.
VII. Complaints
You have the right to express complaints to the Center and to the Secretary of
Health and Human Services if you believe that your privacy rights have been violated. You may complain
to the Center by contacting the Center’s Privacy Officer verbally or in writing, using the contact
information below. We encourage you to express any concerns you may have regarding the privacy of your
information. You will not be retaliated against in any way for filing a complaint.
Contact Person
The Center’s contact person for all issues regarding patient privacy and your
rights under the federal privacy standards is the Privacy Officer. Information regarding matters covered
by this Notice can be requested by contacting the Privacy Officer. Complaints against the Center can be
mailed to the Privacy Officer at the following address: Ellicott City Ambulatory Surgical Center 2850 N.
Ridge Road Ellicott City, MD ATTN: Privacy Officer The Privacy Officer can be contacted by telephone at
(410) 461-1600. This Notice is effective July 2013.