Notice of Privacy Practices for Plastic Surgery Associates

Original Effective Date: April 14, 2003

This Notice describes how medical information about you (or a patient for whom you are a personal representative) may be used and disclosed and how you may get access to this information. Please review it carefully.

A federal regulation known as the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule requires that we provide detailed notice in writing of our privacy practices. This Notice is long, but the HIPAA Privacy Rule requires us to address many specific items in this Notice.

You may contact our Privacy Official as necessary at:
Plastic Surgery Associates
Attention: Privacy Officer
800 West State Street; Suite 300
Doylestown, PA 18901
(Phone) 215-348-3415
(Fax) 215-348-4313

I. Our Commitment To Protecting Health Information About You
In this Notice, we describe the ways that we may use and disclose health information about our patients. The HIPAA Privacy Rule requires that we protect the privacy of health information that identifies a patient, or where there is a reasonable basis to believe the information can be used to identify a patient. This information is called “protected health information” or “PHI.” This Notice describes your rights as our patient and our obligations regarding the use and disclosure of PHI. We are required by law to:
• Maintain the privacy of PHI about you;
• Make available this Notice of our legal duties and privacy practices with respect to PHI; and
• Comply with the terms of our Notice of Privacy Practices that is currently in effect.

We reserve the right to make changes to this Notice and to make such changes effective for all PHI we may already have about you. If and when this Notice is changed, we will post a copy in our office in a prominent location. We will also provide you with a copy of the revised Notice upon your request made to our Privacy Official.

II. How We May Use And Disclose Protected Health Information About You
Uses And Disclosures For Treatment, Payment, And Health Care Operations
The following categories describe the different ways we may use and disclose PHI for treatment, payment or health care operation. The examples included with each category do not list every type of use or disclosure that may fall within that category. Some listed examples may fall into more than one category.

Treatment: We may use and disclose PHI about you to provide, coordinate or manage your health care and related services. We may consult with other health care providers regarding your treatment and coordinate and mange your health care with others. For example, we may use and disclose PHI when you need a prescription, lab work, x-ray or other health care services. In addition, we may use and disclose PHI about you when referring you to another health care provider. For example, if you are referred to another physician, we may disclose PHI to your new physician regarding whether you are allergic to any medications, or a diagnosis. Information, such as pathology reports, may be sent to the physician who referred you to this office, or to another physician you are being referred to. Within our office, the physician and other staff involved in your care may review your medical record, and share and discuss your medical information with each other.

Payment: We may use and disclose PHI so that we can bill and collect payment for the treatment and services provided to you. Before providing treatment or services, we may share details with your health plan concerning the services you are scheduled to receive. For example, we may ask for payment approval from your health plan before we provide care or services. We may use and disclose PHI to find out if your health plan will cover the cost of care and services we provide. We may use and disclose PHI to confirm you are receiving the appropriate amount of care to obtain payment for services. We may use and disclose PHI for billing, claims management and collection activities. We may disclose PHI to insurance companies providing you with additional coverage. We may use and disclose PHI to provide information to a collection agency or our attorney for purposes of securing payment of a delinquent account, and disclose PHI in a legal action for purposes of securing payment of a delinquent account. We may disclose limited PHI to consumer reporting agencies relating to collection of payments owed to us.
We may also disclose PHI to another health care provider or to a company or health plan required to comply with the HIPAA Privacy Rule for the payment activities of that health care provider, company or health plan. For example, we may allow a health insurance company to review PHI for the insurance company’s activities to determine the insurance benefits to be paid for your care. We may also use and disclose PHI to a family member or other person designated as responsible for payment of services rendered to you as the patient.

Health Care Operation: We may use and disclose PHI in performing business activities, which are called health care operations. Health care operations include doing things that allow us to improve the quality of care we provide and to reduce health care costs. We may use and disclose PHI about you in the following health care operations:

• Reviewing and improving the quality, efficiency and cost of care that we provide to our patients. For example, we may use PHI about you to develop ways to assist our physicians and staff in deciding how we can improve the medical treatment we provided to others.
• Improving health care and lowering costs for groups of people who have similar health problems and helping to manage and coordinate the care for these groups of people. We may use PHI to identify groups of people with similar health problems to give them information, for instance, about treatment alternatives and educational classes.
• Reviewing and evaluating the skills, qualifications and performance of health care providers taking care of you and other patients in the practice.
• Providing training programs for students, trainees, health care providers or non-health care professionals (for example, billing personnel) to help them practice or improve their skills.
• Cooperating with outside organizations that assess the quality of the care that we provide, including allowing a health insurer access to your PHI for a medical necessity or quality review audit.
• Cooperating with outside organizations that evaluate, certify or license health care providers or staff in a particular field or specialty. For example, we may use or disclose PHI so that one of our nurses may become certified as having expertise in a specific field of nursing.
• Cooperating with various people who review our activities. For example, PHI may be seen by doctors reviewing the services provided to you, and by accountants, lawyers and others who assist us in complying with the law and managing our business.
• Assisting us in making plans for our practice’s future operations.
• Resolving grievances within the practice.
• Reviewing our activities and using or disclosing PHI in the event that we sell our practice to someone else or combine with another practice.
• Business planning and development, such as cost management analysis.
• Business management and general administrative activities of our practice, including managing our activities related to complying with the HIPAA Privacy Rule and other legal requirements.
• Creating “de-identified” information that is not identifiable to any individual.
• Paging you in the waiting room when it is time to go to an exam room.
• Mailing bills in envelopes with our name and return address.
• Sharing the medical care provided to you with our billing staff so that they can appropriately bill for the care.
• Sharing medical information about you with our attorneys to defend a legal action if necessary.

If another health care provider, company or health plan that is required to comply with the HIPAA Privacy Rule has or once had a relationship with you, we may disclose PHI about you for certain health care operations of that health care provider or company. For example, such health care operations may include: reviewing and evaluating the skills, qualifications and performance of health care providers; providing training programs for students, trainees, health care providers or non-health care professionals; cooperating with outside organizations that evaluate, certify or license health care providers or staff in a particular field or specialty; and assisting with legal compliance activities of that health care provider or company.

We may also disclose PHI for the health care operations of an “organized health care arrangement” in which we participate. An example of an “organized health care arrangement” is the joint care provided by a hospital and the doctors who see patients at the hospital.

Communications From Our Office: We may contact you to remind you of appointments, including initial appointments; and to provide you with information about treatment alternatives or other health related benefits and services that may be of interest to you. This includes leaving messages with other persons who answer the phone or on the answering machine. We may notify you of test results, surgery times, changes in scheduling or other information necessary to you by letter, postcard or phone, including leaving messages with other persons or on an answering machine.

Other Uses And Disclosures We Can Make Without Your Written Authorization

Uses And Disclosures For Which You Have The Opportunity To Agree or Object: We may use and disclose PHI about you in some situations where you have the opportunity to agree or object to certain uses and disclosures of PHI about you. If you do not object, then we may make these types of uses and disclosures of PHI.
• Individuals Involved In Your Care Or Payment For Your Care: We may disclose PHI about you to a family member, close friend or any other person identified by you, if that information is directly relevant to the person’s involvement in your care or payment for your care. If you are present and able to consent or object (or if you are available in advance), then we may only use or disclose PHI if you do not object after you have been informed of your opportunity to object. If you are not present or you are unable to consent or object, we may exercise professional judgment in determining whether the use or disclosure of PHI is in your best interests. For example, if you are brought into this office and are unable to communicate normally with the doctor for some reason, we may find it is in your best interest to give your prescription and other medical supplies to the friend or relative who brought you in for treatment. We may also use and disclose PHI to notify such persons of your location, general condition or death. We also may coordinate with disaster relief agencies to make this type of notification. We also may use professional judgment and our experience with common practice to make reasonable decisions about your best interests in allowing a person to act on your behalf; such as pick up filled prescriptions, medical supplies, x-rays or other things that contain PHI about you.

Other Uses And Disclosures We Can Make Without Your Written Authorization Or Opportunity To Agree Or Object
We may use and disclose PHI about you in the following circumstances without your authorization or opportunity to agree or object, provided that we comply with certain conditions that may apply.

Required By Law: We may use and disclose PHI as required by federal, state or local law. Any disclosure complies with the law and is limited to the requirements of the law.

Public Health Activities: We may use or disclose PHI to public health authorities or other authorized persons to carry out certain activities related to public health, including the following activities:
• To prevent or control disease, injury or disability;
• To report disease, injury, birth or death;
• To report child abuse or neglect;
• To report reactions to medications or problems with products or devices regulated by the federal Food and Drug Administration or other activities related to qualify, safety or effectiveness of FDA regulated products or activities;
• To locate and notify persons of recalls of products they may be using;
• To notify a person who may have been exposed to a communicable disease in order to control who may be at risk of contracting or spreading the disease. In the case of HIV related information, we must comply with state law limitations on HIV contact tracing and disclosure.
• To report to your employer, under limited circumstances, information related primarily to workplace injuries or illness or workplace medical surveillance.

Abuse, Neglect Or Domestic Violence: We may disclose PHI in certain cases to proper government authorities if we reasonably believe that a patient has been a victim of domestic violence, abuse or neglect.

Health Oversight Activities: We may disclose PHI to a health oversight agency for oversight activities. For example, PHI may be disclosed for audits, investigations, inspections, licensure and disciplinary activities and other activities conducted by health oversight agencies to monitor the health care system, government health care programs and compliance with certain laws.

Lawsuits And Other Legal Proceedings: We may use or disclose PHI when required by a court or administrative tribunal order. We may also disclose PHI in response to subpoenas, discovery requests or other required legal process when efforts have been made to advise you of the request or to obtain an order protecting the information requested.

Correctional Institutions And Other Law Enforcement Custodial Situations: We may disclose PHI to a correctional institution or a law enforcement official having custody of you when they request the information for a purpose such as health care, safety or security.

Law Enforcement: Under certain conditions, we may disclose PHI to law enforcement officials for the following purposes where the disclosure is:
• About a suspected crime victim if, under certain limited circumstances, we are unable to obtain a person’s agreement because of incapacity or emergency;
• To alert law enforcement of a death that we suspect was the result of criminal conduct;
• Required by law;
• In response to a court order, warrant, subpoena, summons, administrative agency request or other authorized process;
• To identify or locate a suspect, fugitive, material witness or missing person;
• About a crime or suspected crime committed at our office;
• In response to a medical emergency not occurring at the office, if necessary to report a crime, including the nature of the crime, the location of the crime or the victim and the identity of the person who committed the crime.

Coroners, Medical Examiners, Funeral Directors: We may disclose PHI to a coroner or medical examiner to identify a deceased person and determine the cause of death. In addition, we may disclose PHI to funeral directors, as authorized by law, so that they may carry out their jobs.

Organ And Tissue Donation: If you are an organ donor, we may use or disclose PHI to organizations that help procure, locate and transplant organs in order to facilitate an organ, eye, or tissue donation and transplantation.

Research: We may use and disclose PHI about you for research purposes under certain limited circumstances. We must obtain a written authorization to use and disclose PHI about you for research purposes except in situations where a research project meets specific, detailed criteria established by the HIPAA Privacy Rule to ensure the privacy of PHI.

To Avert A Serious Threat To Health Or Safety: We may use or disclose PHI about you in limited circumstances when necessary to prevent a threat to the health or safety of a person or to the public. This disclosure can only be made to a person who is able to help prevent the threat.

Specialized Government Functions: Under certain circumstances we may disclose PHI.
• For certain military and veteran activities, including determination of eligibility for veterans for veterans benefits and where deemed necessary by military command authorities;
• For national security and intelligence activities;
• To help provide protective services for the president and others;
• For the health or safety of inmates and others at correctional institutions or other law enforcement custodial situations for the general safety and health related to corrections facilities.

Disclosures Required By HIPAA Privacy Rule: We are required to disclose PHI to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPAA Privacy Rule. We are also required in certain cases to disclose PHI to you upon your request to access PHI or for an accounting of certain disclosures of PHI about you.

Workers’ Compensation And Similar Programs: We may disclose PHI as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or similar programs, established by law, that provide benefits for work related injuries or illness without regard to fault. For example, this would include submitting a claim for payment to a patient’s employer’s workers’ compensation carrier when we treat you for a work injury.

Business Associates: Certain functions of the practice are performed by a business associate such as a billing company, an accountant firm or a law firm. We may disclose PHI to our business associates and allow them to create and receive protected health information on our behalf. Whenever we have a business associate arrangement that involves the use or disclosure of PHI, we are required to have a written agreement that protects the privacy of the PHI.

Other Uses And Disclosures Of Protected Health Information Require Your Authorization
All other uses and disclosures of PHI about you will only be made with your written authorization. If you have authorized us to use or disclose PHI about you, including photographs, you may revoke your authorization at any time in writing, except to the extent we have taken action based on the authorization.

III. Your Rights Regarding Protected Health Information About You
Under federal law, you have the following rights regarding PHI about you. We are not required to accommodate a request that is unreasonable.

Right To Request Restrictions: You have the right to request additional restrictions on the PHI that we may use for treatment, payment and health care operations. You may also request additional restrictions on our disclosure of PHI to certain individuals involved in your care that otherwise are permitted by the Privacy Rule. We are not required to agree to your request. If we do agree to your request, we are required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency. To request restrictions, you must make your request in writing to our Privacy Official. In your request, please include, (1) the information that you want to restrict; (2) how you want to restrict the information (for example, restricting use to this office, only restricting disclosure to persons outside this office or restricting both; and (3) to whom you want those restrictions to apply.

Right To Receive Confidential Communications: You have the right to request that you receive communications regarding PHI in a certain manner or at a certain location. For example, you may request that we contact you at home, rather than at work. You must make your request in writing to our Privacy Official. You must specify how you would like to be contacted (for example, by regular mail to your post office box and not your home). We are required to accommodate reasonable requests.

Right To Inspect And Copy: You have the right to request the opportunity to inspect and receive a copy of PHI about you in certain records that we maintain. This includes your medical and billing records, but does not include psychotherapy notes or information gathered or prepared for a civil, criminal or administrative proceeding. We may deny your request to inspect and copy PHI only in limited circumstances. To inspect and copy PHI please contact our Privacy Official. If you request a copy of PHI about you, we may charge you a reasonable fee for the copying, postage, labor and supplies used in meeting your request. Other possible reasons for denial of access to your PHI includes: information that was obtained from someone other than a health care provider under a promise of confidentiality and the requested access would be reasonably likely to reveal the source of the information; a licensed health care professional determines that the requested access would endanger the life or physical safety of you or another person; a licensed health care professional determines that the requested access is reasonably likely to cause substantial harm to a non-health care provider named in the information; the access is requested by a personal representative and a licensed health care professional determines that the requested access is reasonably likely to cause substantial harm to you or another person.

Right To Amend: You have the right to request that we amend PHI about you as long as such information is kept by or for our office. To make this type of request you must submit your request in writing to our Privacy Official. You must also give us a reason for each requested change. We may deny your request in certain cases, including if it is not in writing or if you do not give us a reason for the request.

Right To Receive An Accounting Of Disclosures: You have the right to request an accounting of certain disclosures that we have made of PHI about you. This is a list of disclosures made by us during a specified period of up to six years. A requested accounting generally will list for each covered disclosure: the date, the name and address of the recipient, a brief description of the disclosed information, and a brief statement of the purpose of the disclosure. Your right to an accounting does not apply to all disclosures, including disclosures made: for treatment, payment and health care operations; for use in or related to a facility directory; to family members or friends involved in your care; to you directly; pursuant to an authorization of you or your personal representative, or for certain notification purposes (including national security, intelligence, correctional and law enforcement purposes) and disclosures made before April 14, 2003.

If you wish to make such a request, please contact our Privacy Official. The first list that you request in a 12 month period will be free, but we may charge you for our reasonable costs of providing additional lists in the same 12 month period. We will tell you about these costs and may require advanced payment of these costs. You may choose to cancel your request at any time before costs are incurred.

Timely Action: We generally are required to act on a request for access by providing the access (or a written notice of denial) within 30 days after receipt if the information is maintained on-site, or within 60 days after receipt if the information is maintained off-site. If we cannot comply within these time periods, we must notify you in writing of the reason for the delay and when we will comply.

Right To A Paper Copy Of This Notice: You have the right to receive a paper copy of this Notice at any time. You are entitled to a paper copy of this Notice even if you have previously agreed to receive this Notice electronically. To obtain a paper copy of this Notice, please contact our Privacy Official.

IV. Complaints
If you believe your privacy rights have been violated, you may file a complaint with our office or the Secretary of the United States Department of Health and Human Services. To file a complaint with our office, please contact our Privacy Official in writing at the address and number listed in this Notice. We will not retaliate or take action against you for filing a complaint.

V. Questions
If you have any questions about this Notice, please contact our Privacy Official at the address and telephone number listed in this Notice.