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.
Privacy Information
Surgical Institute of South Dakota, P.C., hereinafter referred to as ‘Surgical Institute”, 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 Surgical Institute, please contact:
Mark A. Hatting, Executive Director
Surgical Institute of South Dakota, P.C.
911 E. 20th Street, Suite 800
Sioux Falls, SD 57105
Telephone: (605) 334-0393
Fax: (605) 334-6028
Effective Date of This Notice: April 14, 2003
I. How Surgical Institute May Use or Disclose Your Health Information
Surgical Institute collects health information from you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of Surgical Institute, but the information in the medical record belongs to you. Surgical Institute protects the privacy of your health information. The law permits Surgical Institute to use or disclose your health information for the following purposes:
1. Treatment. Treatment means the provision, coordination, or management of health care and related services by one or more health care providers. Permitted disclosures for treatment purposes include the consultations between Surgical Institute and other providers, such as your primary care physician, cardiologists, oncologists, and/or other specialists; nurses; technicians; medical student; and other hospital or clinic personnel involved in your medical care.
2. Payment. Permitted disclosures for payment purposes include the activities undertaken by Surgical Institute to obtain reimbursement for the services we provide to you, such as sending a copy of an operative report to your insurance company, upon their request, in order to obtain payment.
3. Regular Health Care Operations. Regular health care operations include the activities we undertake to support treatment or payment, including utilization review and medical chart audits performed to ensure we are compliant with applicable rules and regulations, and disclosure to other physicians, nurses, technicians, medical students, and other hospital or clinic personnel for review and learning purposes.
4. Information provided to you.
5. 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.
6. Required by law. As required by law, we may use and disclose your health information.
7. 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.
8. Health oversight activities. We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
9. Judicial and administrative proceedings. We may disclose your health information in the course of any administrative or judicial proceeding.
10. 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.
11. Deceased person information. We may disclose your health information to coroners, medical examiners and funeral directors.
12. Organ donation. We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
13. Research. We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board or Surgical Institute's privacy board.
14. 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.
15. Specialized government functions. We may disclose your health information for military, national security, and prisoner purposes.
16. Worker's compensation. We may disclose your health information as necessary to comply with worker's compensation laws.
17. Marketing. We may contact you to provide appointment reminders or to give you information about other treatments or health-related benefits and services that may be of interest to you.
18. Change of Ownership. In the event that Surgical Institute is sold or merged with another organization, your health information/record will become the property of the new owner.
II. When Surgical Institute May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, Surgical Institute will not use or disclose your health information without your written authorization. If you do authorize Surgical Institute to use or disclose your health information for another purpose, 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. Surgical Institute is not required to agree to the restriction that you requested.
2. You have the right to receive your health information through a reasonable alternative means or at an alternative location. To exercise this right, the request must be in writing and indicate the method and/or location that the information is to be disclosed. If Surgical Institute is unable to fulfill this request, you will be notified in writing, and a reasonable alternative will be arranged. Surgical Institute reserves the right to charge you its' reasonable costs associated with this request.
3. You have the right to inspect and copy your health information.
4. You have a right to request that Surgical Institute amend your health information that is incorrect or incomplete. Surgical Institute is not required to change your health information and will provide you with information about Surgical Institute's denial and how you can disagree with the denial.
5. You have a right to receive an accounting of disclosures of your health information made by Surgical Institute, except that Surgical Institute does not have to account for the disclosures described in parts 1 (treatment), 2 (payment), 3 (health care operations), and 4 (information provided to you), of section I of this Notice of Privacy Practices.
6. 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:
Mark A. Hatting, Executive Director
or
Theresa K. Beck, Business Office Manager
Surgical Institute of South Dakota, P.C.
911 E. 20th Street, Suite 800
Sioux Falls, SD 57105
Telephone: (605) 334-0393
Fax: (605) 334-6028
IV. Changes to this Notice of Privacy Practices
Surgical Institute reserves 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, Surgical Institute is required by law to comply with this Notice.
If this Notice is amended, it will be posted in our office and on our website, and you will be given a copy of the amendment upon request.
V. Complaints
Complaints about this Notice of Privacy Practices or how Surgical Institute handles your health information should be directed to:
Mark A. Hatting, Executive Director
or
Theresa K. Beck, Business Office Manager
Surgical Institute of South Dakota, P.C.
911 E. 20th Street, Suite 800
Sioux Falls, SD 57105
Telephone: (605 334-0393
Fax: (605) 334-6028
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 www.hhs.gov/ocr/regmail.html.
Online Forms
