Loveland Surgical Associates

 PRIVACY NOTICE
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.
This notice is effective as of 04/14/03

Uses and Disclosure of Health Information

Loveland Surgical Associates uses and discloses your protected health information for treatment, payment and healthcare operations. Some of the examples of when our office may use or disclose your healthcare information, for these purposes, are:
•Sharing test results with other healthcare providers for confirmation of a diagnosis;
•Providing your diagnosis or other information about your health to your insurance carrier or our billing service to obtain payment for the healthcare services we provide;
•Reviewing information as part of our quality improvement program.

Other Uses and Disclosures

Loveland Surgical Associates may also use or disclose your protected health information, in compliance with guidelines outlined by the law, for the following purposes:
•Providing you with information related to your health;
•Contacting you regarding appointments, information about treatment alternatives, or other health related services;
•Incidental uses and disclosures (e.g., listing your name on a sign-sheet, etc);
•Compliance with all laws (including reports of suspected abuse, negligence or violence);
•Providing certain specified information to law enforcement or correctional institutions;
•Providing information to a coroner, medical examiner, funeral director, or organ procurement organization;
•Public health activities when requested by a health authority or the FDA:
•Responding to health oversight agencies;
•Responding to court or administrative tribunal orders, subpoenas, discovery requests or other lawful process;
•Research activities;
•When necessary to avert a serious threat to health or safety;
•Military affairs, veteran affairs, national security, intelligence, Department of State, or presidential protective service activities;
•Providing information regarding your location, general condition or death to public or private disaster relief agencies; or
•Informing a family member, other relative or personal close friend when: 
 •Information is relevant to the individual’s involvement with 
 •Notification of your location, general condition, or death is necessary; 
 •Assistance is required for your healthcare (e.g., pick up prescriptions or other documents, note follow-up care instructions, etc).

Authorization for other uses

Loveland Surgical Associates will make other uses and disclosure of your protected health information only after obtaining your written authorization. If you authorize a use not contained in this notice, you may revoke your authorization at any time by notifying us in writing that you wish to revoke your authorization.

Your Rights Regarding the Privacy of Your Health Information

Subject to limitations outlined by the law, you have certain rights related to use and disclosure of your protected health information, including the right to:
•Request restrictions on certain uses and disclosures. However, Loveland Surgical Associates is not obligated to agree to requested restrictions;
•Receive confidential communications of protected health information;
•Inspect and copy your protected health information with some limited exceptions;
•Receive an accounting of disclosures of your health information;
•Amend your health information;
•Obtain a copy of this notice.

LOVELAND SURGICAL ASSOCIATES’ DUTIES REGARDING THE PRIVACY OF YOUR HEALTH INFORMATION

Subject to limitations outlined by the law, Loveland Surgical Associates has certain duties related to your protected health information, including:
•Loveland Surgical Associates is required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices with respect to protected health information.
•Loveland Surgical Associates is required to abide by the terms of the privacy notice that is currently in effect.
•Loveland Surgical Associates reserves the right to change privacy practice described in this notice and to make such change effective for all protected health information. Revised notice will be posted in our office and will be available to our patients.

CONCERNS

If you believe your privacy rights have been violated, you may make a complaint by contacting Terri Davis, Practice Manager and Privacy Officer, at 970-669-3212, or the Secretary for the Department of Health and Human Services. No individual will be retaliated against for filing a complaint.