DEARBORN SURGERY CENTER LLC PRIVACY NOTICE
Effective date: January 19, 2023
THIS NOTICE IS TO INFORM YOU HOW YOUR PERSONAL AND MEDICAL INFORMATION MAY BE USED AND DISCLOSED BY THE DEARBORN SURGERY CENTER, AS WELL AS HOW YOU MAY GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW CAREFULLY.
Your Private Information
When you come to the Dearborn Surgery Center, or visit with an Independent health care providers that serve patients with-in this facility, a record is made. These records contain your demographic information (name, address, telephone number, social security number, birth date and health insurance information). They also contain other information including how you say you feel, what health problems you have, treatments you may have been given, observations by health care providers, diagnosis and plans of care. This information is used for a number of purposes, which are explained in more detail in this document. This information is known as Protected Health Information or PHI.
This Privacy Notice provides you with information about the privacy practices of the Dearborn Surgery Center LLC facility and services. Independent health care providers that serve patients with-in this facility are also included. Independent providers specifically covered by this notice include:
* Long Lake Anesthesiology Consultants, PLC
* Fairview Pathology Group, P.C.
* Beaumont Lab
* Other caregiving entities contracted with the DSC to provide care to you as a patient.
Patient Privacy Protectors
Dearborn Surgery Center employees know how important it is to protect the privacy of our patients. Every physician and DSC employee serves as a Patient Privacy Protector.
For years, the Dearborn Surgery Center has upheld strict privacy and confidentiality policies consistent with state law affecting licensed health professionals and the provider-patient privilege. On April 14, 2003, a new federal law went into effect – protecting patients from having their protected health information revealed or used without their permission. The new law made the Dearborn Surgery Center’s efforts to protect your privacy more important than ever.
Our Privacy Pledge
We understand that your health information is personal. We care about your privacy and pledge to guard your information with care. We will not sell information about you. We will take steps to protect your information from people who do not have the need and/or legal right to see it. This pledge is an important part of our relationship with you. It supports the complete and honest communication necessary to providing quality patient care.
We are required to maintain your privacy and provide you with this Privacy Notice. It tells you about ways your protected health information is used. It describes your rights and our obligations regarding the use and disclosure of health information.
We may find it necessary to revise or update this Privacy Notice in the future. We are required to inform you of these changes by making a revised Privacy Notice available. Any revised notice can be obtained at our ambulatory surgery center and on our website at www.dearbornsurgery.com.
We will also ask you to sign or initial a form that states you have received this Privacy Notice from us.
How We May Use and Disclose Your Protected Health Information (PHI):
Your health information is used and disclosed in a number of very common ways that benefit you. We must have your written permission (called an authorization) to use and disclose your health information, except for the uses and disclosures described below. Additionally, Michigan law may require we obtain your specific prior authorization to use and disclose certain health information, such as behavioral health, substance abuse, and HIV/AIDS information.
1. Treatment
Information is provided to doctors, nurses, pharmacists, technicians and other health care workers who are involved in your care. For example, nurses caring for you will have access to your health information to follow doctors’ orders, coordinate care and document your progress. Another example is communication with your doctor(s) about a surgery/procedure you received so that appropriate action can be taken.
2. Payment
To help you receive benefits under your health insurance plan, we give information about the care you received to your health insurer(s). For example, your health insurer may require details of a surgery you had at the Dearborn Surgery Canter before it will pay for the care. Your health insurer may also require information about care you need before approval for the service.
3. Health Care Operations
Information about you may be used to maintain or improve our quality of services. For example, we may conduct a study of people who received treatment for a particular surgery to determine if our existing service is meeting community needs. You may also be contacted or sent a survey to get your comments on how well we served your needs.
4. You and Your Personal Representative
Generally, a health care provider or health plan must allow your personal representative to inspect and receive a copy of protected health information about you. Therefore, we may disclose your health information to you or your personal representative (an individual who has the legal right to act on your behalf) without your written authorization
5. Others Involved With Your Care
We may share your health information with family members or friends who are professionals. We will exercise professional judgment in determining when friends and/or family members may receive health information (e.g., a family member picking up a prescription from the pharmacy for a sick individual). We will not share your PHI with anyone that you request us not to share with.
6. Other Uses and Disclosure
Appointment Reminders
We may send you a reminder about an appointment for medical care.
7. Education
Many healthcare professionals, such as physicians receive training at Dearborn Surgery Center. These physicians/medical students/therapists may review health information as part of their training in order to learn more about certain illnesses and treatments.
8. Sale and Marketing
We do not sell your medical information or disclose it to companies that wish to sell their products to you. We may engage in face-to-face communication to you to inform you about our health related services. We may also give you promotional gifts of nominal value as a method of marketing our services. Before we can use medical information for other marketing purposes or receive payment for sending marketing communications, we must first obtain your written authorization.
9. Business Associates
We may disclose your health information to our business associates, such as a computer consultant or copy service, so they can perform the job we have asked them to do. To protect your health information, we require all business associates to appropriately safeguard your information.
10. To Avert a Serious Threat to Health or Safety
We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety, the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
SPECIAL SITUATIONS
Organ and Tissue Donation. We may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation. We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work related injuries or illness.
Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following:
* To prevent or control disease, injury or disability.
* To report births and deaths.
* To report child abuse or neglect.
* To report reactions to medications or problems with products.
* To notify people of recalls of products they may be using.
* To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
* To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence; we will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protesting the information is requested.
Law Enforcement. We may release medical information if asked to do so by a law enforcement official:
* In response to a court order, subpoena, warrant, summons or similar process.
* To identify or locate a suspect, fugitive material witness, or missing person.
* About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement.
* About a death we believe may be the result of criminal conduct.
* About criminal conduct at the surgery center.
* In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may verbally release medical information to a coroner, medical examiner or funeral director for the purpose of reporting a death, identifying the deceased person or other duties. We may also release your medical records to a coroner or medical examiner for the purpose of determining the cause of death, but we will only do so with proper authorization or pursuant to a court ordered subpoena.
National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care (2) to protect your health and safety or the health and safety of others or (3) for the safety and security of the correctional institution.
Privacy Rights
Right to Request Restrictions
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations except when specifically authorized by you, when required by law, or emergency circumstances.
We are not required to agree to your request unless you are asking us to restrict the use and disclosure of your medical information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid us “out-of-pocket” in full. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
If you do request a restriction, you must tell us (1) what information you want to limit (2) whether you want to limit our use, disclosure or both (3) to whom you want the limits to apply.
You do have the right to request a limit on the medical information we disclose about you to those involved in your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had to your spouse. You will be given the opportunity to request such a restriction on admission. To request a restriction you may contact our local Privacy Officer at the Dearborn Surgery Center.
Right to Request Alternate Methods of Communication
You may request an alternate method of receiving confidential mailings and other communications of your health information. For instance, you may request that your health information be sent to your office or to a post office box rather than to your home address. You may also request that calls be made to a certain telephone number. We do not require that you state a reason for your request. To request alternate communication, you may contact our local Privacy Officer at the Dearborn Surgery Center.
Right to Review and Copy
You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may exclude records such as psychotherapy notes.
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to our local Privacy Officer. The contact number for our local Privacy Officer can be found under the section of the document titled “Local Privacy Officer”.
Someone from this department will contact you within 30 days about your request. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
If your medical information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your medical information in the form or format you request, if it is readily producible in such form or format. If the medical information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form of format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may, under certain circumstances, request the denial be reviewed. Another licensed health care professional chosen by the surgery center will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Request an Amendment
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Dearborn Surgery Center.
To request an amendment, your request must be made in writing and submitted to our local Privacy Officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
* Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.
* Is not part of the medical information kept by or for the surgery center.
* Is not part of the information which you would be permitted to inspect and copy.
* Is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request a periodic accounting of the disclosures of your health information so that you will be aware of who has had access to your information. Your request may specify a time period of up to six years. We are not required to provide an accounting for disclosures prior to April 14, 2003. Not every disclosure made is included in the accounting. Disclosures you authorized in writing, routing internal disclosures such as those made to the Dearborn Surgery Center personnel in the course of providing your treatment, and/or disclosures made in connection with payment are all examples of things not included in the accounting. The accounting will state the time of the disclosure, the purpose for which it was disclosed and a description of the information disclosed. If there is any fee for the accounting, we will let you know what it is before the accounting is done. To request an accounting, you may contact our local Privacy Officer at the Dearborn Surgery Center.
Right to Receive a Copy
Copies of this Privacy Notice will be available upon request at the Dearborn Surgery Center and is also available on our website at www.dearbornsurgery.com.
Right to Receive Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured medical information.
Uses Requiring Patient Authorization
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. 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.
CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice at the Dearborn Surgery Center and on our website. The notice will contain on the first page, at the top, the effective date.
Privacy Officer and Patient Concerns
You may believe that your information has not been handled in a way that respects your privacy. You may also seek to appeal a denial of your request to review or amend your health information. Please feel free to express your concerns to our Administrator at the Dearborn Surgery Center. Our Administrator is very helpful and experienced in responding to questions about our facility or services.
Local Privacy Officer
You can make an issue or complaint known by calling:
Administrator
Dearborn Surgery Center LLC
313-253-2069
Another way you can express your concern is to contact the
Secretary of Health and Human Services
200 Independence Avenue SW, Washington DC, 20201
202-619-0257 or 877-696-6775.
Please note that services provided by the Dearborn Surgery Center will not be affected by you raising a privacy issue.
The Privacy Protectors
Dearborn Surgery Center employees and physicians are here to provide excellent healthcare and world-class customer service. We’re also here to protect your privacy. We thank you for choosing the Dearborn Surgery Center.
In accordance with section 1557 of the Affordable Care Act – Final Rule 7-19-2016, the DSC will not discriminate on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, gender identity, and sex characteristics), in covered health programs or activities. 42 U.S.C. 18116.. The Dearborn Surgery Center will make every effort to resolve any complaint/grievance that a patient/patient representative presents. All grievances must be in writing within 15 days of an incident. (Additional information is available in the booklet under “Reporting Grievances” which is available to you.
Reference: SUMMARY OF THE HIPAA PRIVACY RULE. Retrieved January 19, 2023 from www.HHS.go