De-identified Information – Your PHI is altered so that it does not identify you and, even without your name, cannot be used to identify you.

Business Associate – To a business associate, which is someone who Linden Oaks contracts with to provide a service necessary for your treatment, payment for your treatment and health care operations (e.g., billing service).  Linden Oaks will obtain satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI.

Personal Representative – To a person who, under applicable law, has the authority to represent you in making decisions related to your health care.

Public Health Activities - Such activities include, for example, information collected by a public health authority, as authorized by law, to prevent or control disease, injury or disability.  This includes reports of child abuse or neglect.

Federal Drug Administration - If required by the Food and Drug Administration to report adverse events, product defects or problems or biological product deviations, or to track products, or to enable product recalls, repairs or replacements, or to conduct post marketing surveillance.

Abuse, Neglect or Domestic Violence - To a government authority if Linden Oaks is required by law to make such disclosure.  If Linden Oaks is authorized by law to make such a disclosure, it will do so if it believes that the disclosure is necessary to prevent serious harm or if Linden Oaks believes that you have been the victim of abuse, neglect or domestic violence.  Any such disclosure will be made in accordance with the requirements of law, which may also involve notice to you of the disclosure.

Health Oversight Activities - Such activities, which must be required by law, involve government agencies involved in oversight activities that relate to the health care system, government benefit programs, government regulatory programs and civil rights law.  Those activities include, for example, criminal investigations, audits, disciplinary actions, or general oversight activities relating to the community's health care system.

Judicial and Administrative Proceeding - For example, Linden Oaks may be required to disclose your PHI in response to a court order or a lawfully issued subpoena. 

Law Enforcement Purposes - In certain instances, your PHI may have to be disclosed to a law enforcement official for law enforcement purposes.   Law enforcement purposes include: (1) complying with a legal process (i.e., subpoena) or as required by law; (2) information for identification and location purposes (e.g., suspect or missing person); (3) information regarding a person who is or is suspected to be a crime victim; (4) in situations where the death of an individual may have resulted from criminal conduct; (5) in the event of a crime occurring on the premises of Linden Oaks; and (6) a medical emergency (not on Linden Oaks premises) has occurred, and it appears that a crime has occurred.

Coroner or Medical Examiner - Linden Oaks may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death, or to a funeral director as permitted by law and as necessary to carry out its duties. 

Organ, Eye or Tissue Donation - If you are an organ donor, Linden Oaks may disclose your PHI to the entity to whom you have agreed to donate your organs.

Research - If Linden Oaks is involved in research activities, your PHI may be used, but such use is subject to numerous governmental requirements intended to protect the privacy of your PHI such as approval of the research by an institutional review board and the requirement that protocols must be followed. 

Avert a Threat to Health or Safety - Linden Oaks may disclose your PHI if it believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.

Specialized Government Functions - When the appropriate conditions apply, Linden Oaks may use PHI of individuals who are Armed Forces personnel: (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veteran Affairs of eligibility for benefits; or  (3) to a foreign military authority if you are a member of that foreign military service.  Linden Oaks may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities including the provision of protective services to the President or others legally authorized.

Inmates - Linden Oaks may disclose your PHI to a correctional institution or a law enforcement official if you are an inmate of that correctional facility and your PHI is necessary to provide care and treatment to you or is necessary for the health and safety of other individuals or inmates. 

Workers' Compensation - If you are involved in a Workers' Compensation claim, Linden Oaks may be required to disclose your PHI to an individual or entity that is part of the Workers' Compensation system.

Disaster Relief Efforts – Linden Oaks may use or disclose your PHI to a public or private entity authorized to assist in disaster relief efforts.

Required by Law - If otherwise required by law, but such use or disclosure will be made in compliance with the law and limited to the requirements of the law.

Revoke any Authorization, in writing, at any time.  To request a revocation, you must submit a written request to the The Linden Oaks Privacy Officer.

Request restrictions on certain use and/or disclosure of your PHI as provided by law.  However, Linden Oaks is not obligated to agree to any requested restrictions.  To request restrictions, you must submit a written request to The Linden Oaks Privacy Officer.  In your written request, you must inform Linden Oaks of what information you want to limit, whether you want to limit the use or disclosure, or both, and to whom you want the limits to apply.  If Linden Oaks agrees to your request, Linden Oaks will comply with your request unless the information is needed in order to provide you with emergency treatment.

Receive confidential communications of PHI by alternative means or at alternative locations.  You must make your request in writing to The Linden Oaks Privacy Officer.  Linden Oaks will accommodate all reasonable requests.

Inspect and copy your PHI as provided by law.  To inspect and copy your PHI, you must submit a written request to The Linden Oaks Privacy Officer.  In certain situations that are defined by law, Linden Oaks may deny your request, but you will have the right to have the denial reviewed.  Linden Oaks can charge you a fee for copying, mailing or other supplies associated with your request.

Amend your PHI as provided by law.  To request an amendment, you must submit a written request to The Linden Oaks Privacy Officer.  You must provide a reason that supports your request.  Linden Oaks may deny your request if it is not in writing, if you do not provide a reason and support of your request, if the information to be amended was not created by Linden Oaks (unless the individual or entity that created the information is no longer available), if the information is not part of your PHI maintained by Linden Oaks, if the information is not part of the information you would be permitted to inspect and copy, and/or if the information is accurate and complete.  If you disagree with Linden Oaks denial, you have the right to submit a written statement of disagreement.

Receive an accounting of disclosures of your PHI as provided by law.  To request an accounting, you must submit a written request to The Linden Oaks Privacy Officer.  The request must state a time period which may not be longer than six years and may not include the dates before April 14, 2003.  The request should indicate in what form you want the list (such as a paper or electronic copy).  The first list you request within a 12 month period will be free, but Linden Oaks may charge you for the cost of providing additional lists in that same 12 month period.  Linden Oaks will notify you of the costs involved and you can decide to withdraw or modify your request before any costs are incurred.

Receive a paper copy of this Privacy Notice upon request to The Linden Oaks Privacy Officer.

Complain to Linden Oaks, or to the Secretary of Health and Human Services, Office of Civil Rights.  You may also contact a regional office of the Office of Civil Rights, which can be found at www.hhs.gov/ocr/regmail.html.  To file a complaint with Linden Oaks, you must contact The Linden Oaks Privacy Officer.  All complaints must be in writing.

To obtain more information on, or have your questions about your rights answered, you may contact The Linden Oaks Privacy Officer, John J. Goehle, at 10 Hagen Drive, Rochester, NY 14625 or via email at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

PRACTICE'S REQUIREMENTS

Linden Oaks:

• Is required by law to maintain the privacy of your PHI and to provide you with this Privacy Notice of Linden Oaks legal duties and privacy practices with respect to your PHI.
• Is required to abide by the terms of this Privacy Notice.
• Reserves the right to change the terms of this Privacy Notice and to make the new Privacy Notice provisions effective for all of your PHI that it maintains.
• Will not retaliate against you for making a complaint.
• Must make a good faith effort to obtain from you an acknowledgement of receipt of this Notice.
• Will post this Privacy Notice on Linden Oaks web site.
• Will provide this Privacy Notice to you by e-mail if you so request.  However, you also have the right to obtain a paper copy of this Privacy Notice.

EFFECTIVE DATE

This Notice is in effect as of 07/14/04.

*(Linden Oaks Surgery Center Inc., Lindsay House Surgery Center LLC, and Vito C. Quatela, MD, PLLC, are separate legal entities under common ownership and control. For purposes of this Privacy Notice, the entities will be and referred to independently and collectively as the “Linden Oaks”).