PLEASE REVIEW THIS NOTICE CAREFULLY.


The Rochester Regional Health Linden Surgery Center includes the physicians and other providers who work at the Surgery Center.  Some of those providers are not employees of the Rochester Regional Health Linden Surgery Center.  However, for purposes of compliance with the HIPAA Privacy Rules, the Rochester Regional Health Linden Surgery Center is deemed to be an Organized Health Care Arrangement, which means: that it operates as an integrated unit; that all providers will share protected health information in order to carry out treatment (including coverage for each other), payment for treatment and health care operations; that this Notice is provided as a joint notice made by each of them; and, that each of them will abide by the terms of this Notice.

POLICY STATEMENT

The Rochester Regional Health Linden Surgery Center is committed to maintaining the privacy of your protected health information ("PHI"), which includes information about your medical condition and the care and treatment you receive from Linden Surgery and other health care providers.  This Notice details how your PHI may be used and disclosed to third parties for purposes of your care, payment for your care, health care operations of Linden Surgery, and for other purposes permitted or required by law.  This Notice also details your rights regarding your PHI.

USE OR DISCLOSURE OF PHI

The Rochester Regional Health Linden Surgery Center may use and/or disclose your PHI for purposes related to your care, payment for your care, and health care operations. The following are examples of the types of uses and/or disclosures of your PHI that may occur. 

Care – In order to provide, coordinate and manage your care, the Rochester Regional Health Linden Surgery Center will provide your PHI to those health care professionals, whether on the Rochester Regional Health Linden Surgery Center staff or not, directly involved in your care so that they may understand your medical condition and needs and provide advice or treatment (e.g., a specialist or laboratory). 

Payment – In order to get paid for some or all of the health care provided by the Rochester Regional Health Linden Surgery Center, the Rochester Regional Health Linden Surgery Center may provide your PHI, directly or through a billing service, to appropriate third party payors, pursuant to their billing and payment requirements.  For example, the Rochester Regional Health Linden Surgery Center may need to provide your health insurance carrier or, if you are over 65, the Medicare program with information about health care services that you received from the Rochester Regional Health Linden Surgery Center so that the Rochester Regional Health Linden Surgery Center can be properly reimbursed. The Rochester Regional Health Linden Surgery Center may also need to tell your insurance plan about the need to hospitalize you so that the insurance plan can determine whether or not it will pay for the expense.

Health Care Operations – In order for the Rochester Regional Health Linden Surgery Center to operate in accordance with applicable law and insurance requirements and to provide quality and efficient care, it may be necessary for the Rochester Regional Health Linden Surgery Center to compile, use and/or disclose your PHI. 

AUTHORIZATION NOT REQUIRED

The Rochester Regional Health Linden Surgery Center may use and/or disclose your PHI, without a written Authorization from you, in the following instances:

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 The Rochester Regional Health Linden Surgery Center contracts with to provide a service necessary for your treatment, payment for your treatment and health care operations (e.g., billing service). The Rochester Regional Health Linden Surgery Center 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 the Rochester Regional Health Linden Surgery Center is required by law to make such disclosure.  If the Rochester Regional Health Linden Surgery Center 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 the Rochester Regional Health Linden Surgery Center 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, the Rochester Regional Health Linden Surgery Center 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 Surgery; and (6) a medical emergency (not on Linden surgery premises) has occurred, and it appears that a crime has occurred.

Coroner or Medical Examiner - the Rochester Regional Health Linden Surgery Center 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, the Rochester Regional Health Linden Surgery Center may disclose your PHI to the entity to whom you have agreed to donate your organs.

Research - If the Rochester Regional Health Linden Surgery Center 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 - the Rochester Regional Health Linden Surgery Center 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, the Rochester Regional Health Linden Surgery Center 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 Surgery 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 Surgery 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, the Rochester Regional Health Linden Surgery Center may be required to disclose your PHI to an individual or entity that is part of the Workers' Compensation system.

Disaster Relief Efforts – the Rochester Regional Health Linden Surgery Center 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.

AUTHORIZATION
Uses and/or disclosures, other than those described above, will be made only with your written Authorization, which you may revoke at any time.

SIGN-IN SHEET
The Rochester Regional Health Linden Surgery Center may use a sign-in sheet at the registration desk. The Rochester Regional Health Linden Surgery Center may also call your name in the waiting room when your physician is ready to see you.

APPOINTMENT REMINDER
The Rochester Regional Health Linden Surgery Center may, from time to time, contact you to provide appointment reminders.  The reminder may be in the form of a letter or postcard. The Rochester Regional Health Linden Surgery Center will try to minimize the amount of information contained in the reminder. The Rochester Regional Health Linden Surgery Center may also contact you by phone and, if you are not available, a message will be left for you.

TREATMENT ALTERNATIVE/BENEFITS
The Rochester Regional Health Linden Surgery Center may, from time to time, contact you about treatment alternatives, or other health benefits or services that may be of interest to you.

FUNDRAISING
The Rochester Regional Health Linden Surgery Center may use and/or disclose some of your PHI in order to contact you for fundraising activities supportive of The Rochester Regional Health Linden Surgery Center.  Any fundraising materials sent to you will describe how you may opt out of receiving any further communications.

YOUR RIGHTS

You have the right to:

Revoke any Authorization, in writing, at any time.  To request a revocation, you must submit a written request to the Rochester Regional Health Linden Surgery Center Privacy Officer.

Request restrictions on certain use and/or disclosure of your PHI as provided by law.  However, the Rochester Regional Health Linden Surgery Center is not obligated to agree to any requested restrictions.  To request restrictions, you must submit a written request to the Rochester Regional Health Linden Surgery Center Privacy Officer.  In your written request, you must inform the Rochester Regional Health Linden Surgery Center 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 the Rochester Regional Health Linden Surgery Center agrees to your request, the Rochester Regional Health Linden Surgery Center 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 Rochester Regional Health Linden Surgery Center Privacy Officer. The Rochester Regional Health Linden Surgery Center 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 Rochester Regional Health Linden Surgery Center Privacy Officer.  In certain situations that are defined by law, the Rochester Regional Health Linden Surgery Center may deny your request, but you will have the right to have the denial reviewed. the Rochester Regional Health Linden Surgery Center 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 Rochester Regional Health Linden Surgery Center Privacy Officer.  You must provide a reason that supports your request. The Rochester Regional Health Linden Surgery Center 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 the Rochester Regional Health Linden Surgery Center (unless the individual or entity that created the information is no longer available), if the information is not part of your PHI maintained by the Rochester Regional Health Linden Surgery Center, 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 the Rochester Regional Health Linden Surgery Center 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 Rochester Regional Health Linden Surgery Center 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 the Rochester Regional Health Linden Surgery Center may charge you for the cost of providing additional lists in that same 12 month period. The Rochester Regional Health Linden Surgery Center 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 Rochester Regional Health Linden Surgery Center Privacy Officer.

Complain to Rochester Regional Health at Linden Surgery Center, 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 the Rochester Regional Health Linden Surgery Center, you must contact the Rochester Regional Health Linden Surgery Center 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 Rochester Regional Health Linden Surgery Center Privacy Officer, Katherine Sheridan, at 10 Hagen Drive, Rochester, NY 14625 or via email at This email address is being protected from spambots. You need JavaScript enabled to view it..

 

PRACTICE'S REQUIREMENTS

The Rochester Regional Health Linden Surgery Center:

• Is required by law to maintain the privacy of your PHI and to provide you with this Privacy Notice of the Rochester Regional Health Linden Surgery Center 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 the Rochester Regional Health Linden Surgery Center 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.