Privacy Notice

Each time you visit a healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment and billing-related information. This notice applies to all of the records of your care generated by our staff. This also applies to your personal information such as address, phone number and social security number.


Our Responsibilities: We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices.

Uses and Disclosures: How we may use and disclose Health Information about you.

The following categories describe examples of the way we use and disclose health information:

  • For Payment: We may use and disclose health information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example, we may need to give your insurance company information about your surgery so they will pay us or reimburse you for the treatment. We may also tell your health plan about treatment you are going to receive to determine whether your plan will cover it.


  • For Treatment: We may use health information about you to provide you treatment or services. We may disclose health information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you.


  • For Health Care Operations: Members of the medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all patients we serve. We may disclose information to doctors, nurses, and students for educational purposes. We will remove information that identifies you from this set of health information to protect your privacy. We may also use and disclose health information:
    • To business associates we have contracted with to perform the agreed upon service and billing for it;
    • To remind you that you have an appointment for medical care;
    • To assess your satisfaction with our services;
    • To tell you about possible treatment alternatives;
    • To tell you about heath-related benefits or services;
    When disclosing information, appointment reminders and billing/collections efforts, we may leave messages on your answering machine or voice mail.
  • Business Associates: There are some services provided in our organization through contracts with business associates. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you, your insurance company or a third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

  • Individuals Involved in Your Care or Payment for Your Care: We may release health information about you to a friend or family member who is involved in your medical care or who helps pay for your care. In addition, we may disclose health 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.

  • Research: We may disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research and granted a waiver of the authorization requirement.

  • Future Communications: We may communicate to you via newsletters, mail outs or other means regarding treatment options, health related information, disease-management programs, wellness programs, or other community based initiatives or activities our facility is participating in.

  • Affiliated Covered Entity: Protected health information will be made available to facility personnel at local affiliated facilities as necessary to carry out treatment, payment and health care operations. Caregivers at other facilities may have access to protected health information at their locations to assist in reviewing past treatment information as it may affect treatment at this time.
    As required by law, we may also use and disclose health information for the following types of entities, including but not limited to:

    • Food and Drug Administration
    • Public Health or Legal Authorities charged with preventing or controlling disease, injury or disability
    • Correctional Institutions
    • Workers Compensation Agents
    • Organ and Tissue Donation Organizations
    • Military Command Authorities
    • Health Oversight Agencies
    • National Security and Intelligence Agencies

 

  • Law Enforcement/Legal Proceedings: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

CHANGES TO THIS NOTICE
We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we receive in the future.

Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, you have the Right to:

  • Inspect and Copy: You have the right to inspect and obtain a copy of the health information that may be used to make decisions about your care.
  • Amend: If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. We may deny your request and if this occurs, you will be notified of the reason for the denial.
  • Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. 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.
  • A Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at anytime.

 

 

 


 

Surgical Specialists of Northern Virginia

Breast Care Consultants of Northern Virginia

telephone