Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN
ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. Surgery Center of Oradell is permitted to make use and disclose of
   protected health information for treatment, payment and health care
   operations, as described in the following examples: 
    

   a. For treatment- We may use medical information about you to provide
   you with medical treatment or services. We may disclose medical
   information about you to doctors, nurses, technicians, or other hospital
   personnel who are involved in taking care of you after you are discharged.
   For example, a doctor treating you for a broken leg may need to know if
   you have diabetes because diabetes may slow the healing process. We may
   also disclose medical information about you to people outside the surgery
   center who may be involved in your medical care after you leave the same
   day surgery center, such as family members.
    

   b. For payment-We may use and disclose medical information about you
   so that the treatment and services you receive at the same day surgery
   center may be billed to and payment may be collected from you, an
   insurance company, or a third party. For example, we may need to give
   your health plan information about surgery you received at the same day
   surgery center so your health plan will pay us or reimburse you for the
   surgery. We may also tell your health plan about a treatment you are going
   to receive to obtain prior approval or to determine whether your plan will
   cover the treatment.
    

   c. For health care operations- We may use and disclose medical
   information about you for same day surgery operations. These uses and
   disclosures are necessary to run the same day surgery center and make
   sure that all of our patients receive quality care. For example we may use
   medical information to review our treatment and services and to evaluate
   the performance of our staff in caring for you. We may also combine
   medical information about many same day surgery patients to decide what
   additional services the same day surgery center should offer, what services
   are not needed, and whether new treatments are effective. We may remove
   information that identifies you from this set of medical information so others
   may use it to study health care and healthcare delivery without learning who
   the specific patients are.
    

2. Surgery Center of Oradell is permitted or required, under specific
   circumstances, to use ordisclose protected health information without the
   individual’s written authorization.
    

3. Other uses and disclosures will be made only with the Individual’s written
   authorization, and the individual may revoke such authorization.
    

4. Surgery Center of Oradell intends to engage in (1) one or more of the
   following activities.
    

   a. Surgery Center of Oradell may contact the individual to provide
   appointment reminders or information about treatment alternatives or other
   health-related benefits and services that may be of interest to the individual or
   the patient.
    

   b. A group health plan, or a health insurance issuer or HMO with respect to
   a group health plan, may disclose protected health information to the sponsor
   of the plan.
    

5. The Individual has the following right regarding protected health
   information:
    

   a. The right to request restrictions on certain uses and disclosures of
   protected health information. Surgery Center of Oradell is not required to agree
   to a requested restriction, however.
    

   b. The right to receive confidential communications of protected health
   information, as applicable.
    

   c. The right to inspect and copy protected health information, as provided in
   the Privacy Regulation.
    

   d. The right to amend protected health information, as provided in the
   Privacy Regulation.
    

   e. The right to receive an accounting of disclosures of protected health
   information.
    

   f. The right to obtain a paper copy of the Notice from the covered entity
   upon request. This right extends to an individual who has agreed to receive
   the Notice electronically.
    

6. Surgery Center of Oradell is required by law to maintain the privacy of protected
   health information and to provide individuals with notice of its legal duties and
   privacy practices with respect to protected health information.
    

7. Surgery Center of Oradell is required to abide by the terms of the Notice
   currently in effect.
    

8. Surgery Center of Oradell reserves the right to change the terms of this Notice.
   The new Notice provisions will be effective for all the protected health information
   that it maintains.
    

9. Surgery Center of Oradell will provide individuals or patients with a revised Notice
   by oral instruction as a copy is provided for the individual/patient.
    

10. Individuals may complain to the Surgery Center of Oradell and to the Secretary of the
    Department of Health and Human Services, without fear of retaliation by the
    organization, if they believe their privacy rights have been violated. A brief
    description of how the individual may file a complaint is to address a
    corresponding letter to the following persons/institutions listed as New
    Jersey State Division of Health and Family Services to lodge complaints are:
    Division of Health Facilities Evaluation and Licensing New Jersey
    State Department of Health,CN 367, Trenton, NJ 08625-0367.State of
    New Jersey Office of the Ombudsman for the Institutionalized
    Elderly, CN 808, Trenton, NJ 08625-808.
     

11. Surgery Center of Oradell‘s contact person for matters relating to complaints is the Director of Operations: 680 Kinderkamack Rd., Ste 100. Oradell, NJ 07649. (201) 367-2273.
     

12. This Notice is first in effect on July 4, 2015.
     

13. Surgery Center of Oradell elects to limit the uses or disclosures that it is
    permitted to make. If you provide us permission to use or disclose medical
    information about you, you may revoke that permission in writing, at any
    time. If you revoke your permission, we will no longer use or disclose
    medical information about you for the reasons covered by your written
    authorization. You understand that we are unable to take back any
    disclosures we have already made with your permission, and that we are
    required to retain our records of the care that we provided to you.