NOTICE OF PRIVACY PRACTICES

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.

As your healthcare provider, we will maintain a record of your visit that contains your symptoms, reports of examinations and test results, diagnoses, treatments, correspondence with other providers and plans for future care or treatment.

Your health record is the physical property of this practice; however the information it contains belongs to you. You have the following rights and we request that you notify the Privacy Officer of the Practice of your requests for any of these actions:

a. Request Restrictions: You have a right to request restrictions on the use of your information.

b. Obtain a Paper Copy of this Notice: You have a right to receive a paper copy of this Notice.

c. Inspect and Copy: You have a right to inspect and receive a copy of your health information. If you request a copy of your information, you may be charged a reasonable fee for photocopying, retrieval, labor, postage and supplies used.

d. Amend: You have the right to request that we amend your health information.

e. Obtain an Accounting of Disclosures: You have the right to request an accounting of certain disclosures of information that have been made about you. This listing includes those disclosures of your information other than treatment, payment or healthcare purposes and is within a specified period of up to six years. The first listing of disclosures is provided as a complimentary service to you, but you may be charged a reasonable fee for additional requests made within a twelve-month period.

f. Request Communications of your Health Information: You have the right to request that you receive communications regarding your information in a certain manner or at a certain location.

g. Revoke Your Authorization for Disclosure: You have the right to revoke an authorization for disclosure of information that was previously given.

Our practice is required to:

a. Confidentiality: Maintain the privacy of your health information.

b. Provide a copy of this notice: We will provide you with a copy of this notice of our legal duties and privacy practices with respect to the information we collect and maintain about you.

c. Abide by the terms of this notice.

d. Unable to restrict: We will notify you if we are unable to agree to a requested restriction of your information.

e. Provide alternative means or alternative locations: We will accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our privacy practices and to make new provisions effective for all protected health information we keep. Should our information practices change, we will notify you of these changes when you return to our office. We will not use or disclose your health information without your authorization, except as described in this notice.

a. If you have a question or would like additional information, please contact: 
Office Manager, Carle M. Garland, Bedford Surgical Associates, Inc.
(814) 623-1002

b. If you have a concern about the privacy of your information, you may contact our privacy officer/practice manager. Your concerns will be responded to by our practice, but you may also file a complaint with the secretary of Health and Human Services in the U.S. Office of Civil Rights. The privacy officer will supply information about this procedure.

a. Treatment:

1. We will use your health information for treatment purposes. As an example, information given to a nurse or physician will be recorded in your health record and used to determine the best treatment for you. Members of the healthcare team will document your treatment goals, actions taken and clinical observations.

2. We will provide your other healthcare providers with copies of various reports that will help them to treat you for any subsequent conditions that may arise.

b. Payment: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, your diagnoses, treatments and supplies used.

c. Healthcare Operations: The physicians and members of your healthcare team may use the information to evaluate the quality of care you received as well as the care received by others similar to you. This information will be used to improve the effectiveness of healthcare operations and services we provide.

d. Business Associates: There are some services provided through contracts with business associates. As an example, we contract with a company that provides information services for the computer system we operate. When these services are contracted, we may disclose your health information to this business associate so that they can perform the work we require. To protect your health information, the business associate must appropriately safeguard your information.

e. Notification: We may disclose information to notify or assist in notifying a family member, personal representative or other person responsible for your care, information about your general condition.

f. Communication with family: We will use good judgment in disclosing to a family member, or any other person you identify health information relevant to that persons involvement in your care or payment related to your care.

g. Research: We will disclose only limited information to approved researchers that participate in research approved by our institutional review board. We will obtain a written authorization from you to disclose information for other re-search purposes.

h. Funeral Directors: We may disclose health information to funeral directors consistent with state law that allows them to carry out their duties.

i. Organ Donation: If you are an organ donor, we may disclose your information to organizations that help procure, bank or transport organs for tissue donation and transplantation purposes.

j. Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

k. Fund raising: We may contact you as part of a fund-raising effort.

l. Food and Drug Administration: We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects or post-marketing surveillance information to enable product recalls, repairs or replacement.

m. Workers Compensation: In accordance with state law, we may disclose health information as is required for processing a claim under workers compensation.

n. Public Health: Under South Carolina law, we may disclose your health information to the health department in order to prevent or control disease, injury or disability.

o. Correctional institution: If you are an inmate of a correctional institution, we may disclose to the institution or its agents health information that is needed for your health or the health and safety of other individuals.

p. Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

q. Health investigation: Federal and state laws make provisions for your health information to be released to appropriate health authorities provided that a member of our staff or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise endangered one or more patients, workers or the public.

r. Other disclosures: All other uses and disclosures of your information will only be made with your written authorization. If you have authorized us to use or disclose information about you, you may revoke this authorization at any time.

Effective Date of Notice: April 1, 2003