This Notice describes how health information about you may be used and disclosed and how you can get access to this information. Please Review It Carefully.
The Endoscopy Center, Inc. (referred to as “practice” or “we”) is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices at The Endoscopy Center, Inc., please contact:
Lori Lindblom, R.N., (605) 721-8121
2820 Mount Rushmore Road
Rapid City, SD 57701
How The Endoscopy Center, Inc. May Use or Disclose Your Health Information
Our Pledge Regarding Health Information: The Endoscopy Center, Inc. understands health information about you and your healthcare is personal. We are committed to protecting health information about you. We create a record of care and services you receive from us. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this healthcare practice, whether made by your personal doctor or others working in this office. This notice will tell you about the way in which we may use and disclose health information about you. We also describe your rights to the health information we keep about you, and describe certain obligations we have regarding the use and disclosure of your health information.
We are required by law to:
- Make sure health information that identifies you is kept private
- Give you notice of our legal duties and privacy practices with respect to health information about you
- Follow the terms of this notice that is currently in effect
How We May Use and Disclose Health Information About You
The following categories describe a non-exhaustive list of ways we may use and disclose health information. For each category of uses and disclosures we will explain what we mean. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
- Treatment: We may use health information about you to provide you with healthcare treatment or services. We may disclose health information about you to doctors, nurses, technicians, health students, or other personnel who are involved in taking care of you. They may work at our offices, at the hospital if you are hospitalized under our supervision, or at another doctor’s office, lab, pharmacy, or other healthcare provider to whom we may refer you for consultation, to include but not limited to x-rays, lab tests, prescription refills, or for other treatment purposes.
- Payment: We may use and disclose health information about you so the treatment and services you receive from us may be billed to and payment collected from you, an insurance company, or a third party. For example, we may need to disclose your health information about your office visit so your health plan will pay us or reimburse you for the visit. We may also tell your payor/health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
- Specialized government functions: We may disclose your health information for military, national security, prisoner and government benefits, such as the Department of Veterans Affairs, Tricare/Champus, and Indian Health plans.
- Worker’s compensation: We may disclose your identifiable health information as necessary to comply with worker’s compensation laws or similar programs. These programs provide benefits for work-related injuries or illness.
- Regular health care operations: We may use and disclose health information about you for operations of our healthcare practice. These uses and disclosures are necessary to run our practice and make sure all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, whether certain new treatments are effective, or to compare how we are doing with others and to see where we can make improvements.
- Information provided to you: We may use and disclose health information to tell you about health related services or recommended possible treatment options or alternatives that may be of interest to you.
- Notification and communication with family: We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
- Required by law: As required by federal, state or local law, we may use and disclose your health information.
- Public Health: As required by law, we may disclose your identifiable health information to public health authorities for purposes related to: preventing or controlling disease; injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure to the State Health Department.
- Health oversight activities: We may disclose your identifiable health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
- Judicial and Administrative proceedings: We may disclose your health information in the course of any administrative or judicial proceeding. We may disclose this information about you in response to a subpoena. We may also disclose this information about you in response to a discovery request or other lawful process by someone involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
- Emergency treatment situations: We may use or disclose your identifiable health information in emergency treatment situations, if we attempt to obtain such consent as soon as is reasonably practical after the delivery of such treatment.
- Required treatment: If we are required by law to treat you and we attempt to obtain consent, but are unable to obtain such consent, we may use or disclose your health information.
- Attempts to gain consent: If we attempt to obtain consent from you but are unable to obtain such consent due to substantial barriers to communicating with you, and we determine, in the exercise of professional judgment, your consent to receive treatment is clearly inferred from the circumstances, we may use or disclose your health information.
- Law Enforcement: We may disclose your health information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, court ordered warrant or 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 our facility; and
- 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, Health Examiners and Funeral Directors: We may release identifiable health information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties.
- Organ donation: If you are an organ donor, we may release identifiable health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donor bank, as necessary to facilitate organ or tissue donation and transplantation.
- Research: We may disclose your identifiable health information on a de-identifiable basis to researchers conducting research that has been approved by an Institutional Review Board or The Endoscopy Center’s privacy board.
- Public safety: We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
- Communication: We may contact you to provide appointment reminders or to give you information about other treatments or health related benefits and services that may be of interest to you.
- Change of Ownership: In the event The Endoscopy Center is sold or merged with another organization, your health information/record will become the property of the new owner.
When The Endoscopy Center May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, The Endoscopy Center, Inc. will not use or disclose your health information without your written authorization. If you do authorize The Endoscopy Center, Inc. to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
Your Health Information Rights
Right to Inspect and Copy: You have the right to inspect and copy health information that may be used to make decisions about your care. This includes health and billing records, but there are exceptions, including, but not limited to, psychotherapy notes.
To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to Lori Lindblom, Privacy Officer.
We may deny your request to inspect and copy in limited circumstances. If you are denied access to health information, you may request the denial be reviewed. Another licensed health care professional chosen by our practice will review your request and 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 Amend: If you feel the health 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 we keep the information. To request an amendment, your request must be made in writing, submitted to Lori Lindblom, Privacy Officer, and must be contained on one page of paper legibly handwritten or typed. In addition, you must provide a reason to support your request for an amendment.
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 health information kept by or for our practice.
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Any amendment we make to your health information will be disclosed to those whom we disclose information as previously specified.
Right to An Accounting of Disclosures: You have the right to request a list accounting for any disclosures of your health information we have made, except for uses and disclosures for treatment, payment, and health care operations as previously described.
To request this list of disclosures, you must submit your request in writing to Lori Lindblom, Privacy Officer. Your request must state a time period which may not be longer that six years and may not include dates before April 14, 2003. We will mail you a list, or have available for pick-up, disclosures in paper form within 60 days of your request, or notify you if we are unable to supply the list within that timeframe and by what date we can supply the list; but this date will not exceed a total of 90 days from the date you made the request.
Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or healthcare operations. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
Right to Request Confidential Communications: You have the right to request we communicate with you about health matters in a certain way or at a certain location. For example, you can ask we only contact you at work or by email.
Right to a Paper Copy of this Notice: You have a right to a paper copy of this Notice at any time. To obtain a copy, please request a copy from Administration, Reception Desk, or the Privacy Officer.
Changes to this Notice of Privacy Practices
The Endoscopy Center, Inc. reserves the right to amend this Notice of Privacy Practice at any time in the future. We will post a copy of the current notice in our facility. This notice will contain on the last page the effective date.
Complaints about this Notice of Privacy Practices or how the Endoscopy Center, Inc. handles your health information should be directed in writing to:
Lori Lindblom, R.N.
2820 Mt. Rushmore Rd.
Rapid City, SD 57701
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your complaint to one of the regional Offices for Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/index.html.
Effective – 8/23/2016