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.
Saratoga Emergency Physicians is required by law to maintain the privacy of
your health information and to provide you with notice of its legal duties and
privacy practices with respect to your health information. If you have questions
about any part of this notice or if you want more information about the privacy
practices at Saratoga Emergency Physicians please contact the Compliance Officer.
Compliance Officer
454 Maple Avenue
Saratoga Springs, NY 12866
518-587-1141
Saratoga Emergency Physicians participates with two Organized Health Care
Arrangements identified as:
Saratoga Hospital - Saratoga Springs, NY
Nathan Littauer Hospital - Gloversville, NY
An Organized Health Care Arrangement consists of a clinically integrated care
setting in which individuals typically receive health care from more than one
health care provider.
This arrangement provides that participants may adopt a joint privacy notice
for the sharing of protected health information. Saratoga Emergency Physicians
honors the Notice of Privacy Practices within the Organized Health Care Arrangements
mentioned, in addition to Saratoga Emergency Physicians Notice of Privacy Practices.
Effective Date of This Notice: April 14, 2003
I. How Saratoga Emergency Physicians may Use or Disclose Your Health Information
Saratoga Emergency Physicians collect health information from you and stores
it in a chart and on a computer within the Health Care Organization where health
services are delivered. This is your medical record. The medical record is the
property of the Health Care Organization where you received health care services
but the information in the medical record belongs to you. Saratoga Emergency
Physicians protect the privacy of your health information. The law permits Saratoga
Emergency Physicians to use or disclose your health information for the following
purposes:
1. Treatment: Saratoga Emergency Physicians
provide treatment within three Organized Health Care Arrangement settings
(i.e. Emergency Services, Inpatient Hospital Services and Urgent Care
Services). We use and disclose PHI (Protected Health Information) to diagnose
and treat your injury or illness. In addition, information about the care
delivered may be forwarded to your primary care physician for follow-up
services. We may also disclose PHI to other providers involved in your
treatment.
2. Payment: We may use and disclose PHI to
obtain payment for services that we provide to you. An example would be
to disclose information to your health insurance company in order to obtain
reimbursement after we have treated you.
3. Regular Health Care Operations: We may
use and disclose PHI for health care operations. An example would be to
utilize your health information to evaluate the quality and competence
of our physicians, physician assistants and nurse practitioners. PHI may
be disclosed to our Compliance Officer in order to resolve any complaints
you may have.
4. Information provided to you.
5. Directory: Saratoga Emergency Physicians
does not maintain a directory. As an Affiliate of Organized Health Care
Arrangements your name may be listed in the hospital directory as well
as, where you are located in the facility, your general medical condition
and your religious affiliation.
6. Notification and communication with family:
We may disclose your health information to notify or assist in notifying
a family member, your personal representative or another person responsible
for your care about your location, your general condition or in the event
of your death. If you are able and available to agree or object, we will
give you the opportunity to object prior to making this notification.
If you are unable or unavailable to agree or object, our health professionals
will use their best judgment in communication with your family and others.
7. Required by law: As required by law: we
may use and disclose your health information. Emergencies:
We may use or disclose your health information if you need emergency treatment
or if we are required by law to treat you but are unable to obtain your
consent. Communication Barriers: We may use
and disclose your health information if we are unable to obtain your consent
because of substantial communication barriers, and we believe you would
want us to treat you if we could communicate with you.
8. Public health: As required by law, we
may disclose your health information to public health authorities for
purposes related to: preventing or controlling disease, injury or disability;
reporting child abuse or neglect; reporting domestic violence; reporting
to the Food and Drug Administration problems with products and reactions
to medications; and reporting disease or infection exposure.
9. Health oversight activities: We may disclose
your health information to health agencies during the course of audits,
investigations, inspections, licensure and other proceedings.
10. Judicial and administrative proceedings:
We may disclose your health information in the course of any administrative
or judicial proceeding.
11. Law enforcement: We may disclose your
health information to a law enforcement official for purposes such as
identifying or locating a suspect, fugitive, material witness or missing
person, complying with a court order or subpoena and other law enforcement
purposes.
12. Deceased person information: We may disclose
PHI to medical examiners, coroners, and funeral directors as authorized
by law.
13. Organ donation: We may disclose your
health information to organizations involved in procuring, banking or
transplanting organs and tissues.
14. Research: We may disclose your health
information to researchers conducting research that has been approved
by an Institutional Review Board or Saratoga Emergency Physicians privacy
board.
15. Public safety: We may disclose your health
information to appropriate persons in order to prevent or lessen a serious
and imminent threat to the health or safety of a particular person or
the general public.
16. Specialized government functions: We
may disclose your health information for military, national security,
prisoner and government benefit purposes.
17. Worker’s compensation: We may disclose
your health information as necessary to comply with worker’s compensation
laws.
18. Marketing: We must obtain your written
authorization prior to using your PHI to send you any marketing materials.
We may communicate with you about products or services relating to your
treatment, case management or care coordination, or alternative treatments,
therapies, providers or care settings.
19. Change of Ownership: In the event that
Saratoga Emergency Physicians is sold or merged with another organization,
your health information/record will become the property of the new owner.
II. When Saratoga Emergency Physicians May Not Use or Disclose Your Health
Information
Except as described in this Notice of Privacy Practices, Saratoga Emergency
Physicians will not use or disclose your health information without your written
authorization. You may revoke your authorization in writing at any time.
III. Your Health Information Rights
1. You have the right to request restrictions on certain uses and disclosures
of your health information. While we will consider all requests for additional
restrictions carefully, we are not required to agree to a requested restriction.
If you wish to request additional restrictions, you must do so in writing, and
direct your request to the Compliance Officer of the Saratoga Emergency Physicians.
We will send you a written response.
2. You have the right to receive your health information through a reasonable
alternative means or at an alternative location. Should you request an alternative
location we will accommodate any reasonable written request for you to receive
PHI by alternative means of communication or at alternative locations.
3. You have the right to inspect and copy your health information. You will
be referred to the health care organization that delivered your care and maintains
your medical record. Saratoga Emergency Physicians will facilitate your access
upon your request.
4. Saratoga Emergency Physicians billing information will be made available
for your inspection and copies provided. To inspect or obtain a copy of your
billing information please submit your request in writing to the Compliance
Officer of Saratoga Emergency Physicians. If you request a copy of the information,
we may charge a fee for the costs of copying, mailing or other supplies we use
to fulfill your request. The standard fee is $0.75 per page and must be paid
at the time we give the copies to you.
5. You have a right to request that Saratoga Emergency Physicians amend your
health information. While your request would be carefully considered Saratoga
Emergency Physicians is not required to change your health information and will
provide you with information about Saratoga Emergency Physicians denial and
how you can disagree with the denial. You will also be referred to the Health
Care Organization where your care was delivered to facilitate this request.
6. You have a right to receive an accounting of disclosures of your health
information made by Saratoga Emergency Physicians. Saratoga Emergency Physicians
does not have to account for the disclosures described in parts 1 (treatment),
2 (payment), 3 (health care operations), 4 (information provided to you), 5
(directory listings) and 16 (certain government functions) of section I of this
Notice of Privacy Practices.
7. You have a right to a paper copy of this Notice of Privacy Practices.
If you would like to have a more detailed explanation of these rights or if
you would like to exercise one or more of these rights, contact
Compliance Officer
454 Maple Avenue
Saratoga Springs, NY 12866
IV. Changes to this Notice of Privacy Practices
Saratoga Emergency Physicians reserve the right to amend this Notice of Privacy
Practices at any time in the future, and to make the new provisions effective
for all information that it maintains, including information that was created
or received prior to the date of such amendment. Until such amendment is made,
Saratoga Emergency Physicians is required by law to comply with this Notice.
Should this notice be changed, the new notice will be posted to the Internet
site at www.seppc.com.
A new notice will be forwarded to each participating Health
Care Arrangement.
V. Complaints
Complaints about this Notice of Privacy Practices or how Saratoga Emergency
Physicians handles your health information should be directed to: the Compliance
Officer.
No one will retaliate or take action against you for filing a complaint.
Compliance Officer
Saratoga Emergency Physicians
454 Maple Avenue Saratoga Springs
NY 12866
518-587-1141
If you are not satisfied with the manner in which this office handles a complaint,
you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your compliant to one of the regional Offices for
Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.