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.
Bear Creek Surgery Center, LLC., (ASC) 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 ASC, please see the contact information at the end of this document.

  1. HOW ASC MAY USE OR DISCLOSE YOUR HEALTH INFORMATION

ASC collects and protects the privacy of your health information.  The law permits ASC to use of disclose your health information for the following purposes:

  1. TREATMENT: ASC may use your health information to provide you with medical treatment or services.  For example, information obtained from you by a front office personnel or nurse is necessary to determine what treatment you should receive.
  2. PAYMENT: ASC may use and disclose health information about you for payment for treatment and services you receive.  For example, your health information may be sent to a third party payer such as an insurance company or health plan in order for ASC to receive payment for services rendered.
  3. HEALTHCARE OPERATIONS: ASC may use and disclose health information about you for operational purposes.  For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and other to evaluate the performance of our staff, assess the quality of care and outcomes in your case and similar cases, and to determine how to continually improve the quality and effectiveness of the health care we provide.
  4. INFORMATION PROVIDED TO YOU AND ON YOUR AUTHORIZATION: You may give ASC written authorization to use or disclose your health information.
  5. 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.
  6. REQUIRED BY LAW: As required by law, ASC may use and disclose your health information.  For example, ASC may disclose health information for the following reasons; judicial and administrative proceedings, to a law enforcement official for purposes of identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes; to the Department of Health and Human Services to determine if we are in compliance with federal laws; or to appropriate persons in order to prevent or lessen a serious and imminent threat to the public or safety of a particular person or the general public.
  7. PUBLIC HEALTH: As required by law, ASC may use and disclose your 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; to aid with disaster relief, and reporting disease or infection exposure.
  8. HEALTH OVERSIGHT ACTIVITIES: ASC may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure, and other proceedings.
  9. DECEASED PERSON INFORMATION AND ORGAN DONATIONS: ASC may disclose your health information to coroners, medical examiners, funeral directors, or to organizations involved in procuring, banking or transplanting organs and tissues.
  10. RESEARCH: ASC may disclose your health information to researchers conducting research that has been approved by an institutional Review Board.
  11. WORKER’S COMPENSATION: ASC may disclose your health information as necessary to comply with worker’s compensation laws.
  12. MARKETING: ASC may contact you to give you information about treatments or health –related benefits and services that may be of interest to you.
  13. GOVERNMENT FUNCTIONS: Specialized government functions such as protection of public officials or reporting to various branches of the armed services may require use or disclosure of your health information.
  14. APPOINTMENTS: ASC may use you information to provide appointment reminders by telephone, email or postal service.
  15. BUSINESS ASSOCIATES: We work with other businesses to help ASC operate successfully.  We may disclose your health information to these business associates so that they can perform the tasks we hired them to do.  Our business associates must guarantee us that they will respect the confidentially of your personal health information.
  1. WHEN ASC MAY NOT USE OR DISCLOSE YOUR HEALTH INFORMATION

Except as described in the Notice of Privacy Practices, ASC will not use or disclose your health information without your written authorization.

  1. YOUR HEALTH INFORMATION
  1. You have the right to request restrictions on certain uses and disclosures of your health information.  ASC is not required to agree to the restrictions that you request.
  2. You have the right to receive your health information through a reasonable alternative means or at an alternative location.  Request must be made in writing detailing the alternative methods chosen and could be applicable to fees.
  3. You have the right to inspect and/or obtain a copy of your health information for a reasonable fee.
  4. You have the right to request that ASC amend your health information that is incorrect or incomplete.  ASC is not required to change your health information and will provide you information about the denial process.
  5. You have the right to receive and accounting or disclosure of your health information made by ASC except that ASC does not have to account for the disclosure described in treatment, payment, healthcare operation, and government functions of section I of this notice.  The first accounting of disclosers within a twelve-month period is free.  Any additional accountings in that time frame are subject to a fee.
  6. You have the right to revoke your authorization to use or disclose health information except to the extent that action has already been taken.
  7. You have the right to obtain a paper copy of this Notice upon request.
  8. You have the right to be notified in the event of a breach in ASC’s patient information.
  9. You have the right to request that your health plan not be informed of your treatment at ASC if you pay in full and your insurance company is not billed.

 

  1. CHANGES TO THIS NOTICE OF PRIVACY PRACTICES

ASC reserves the right to amend this Notice of Privacy Practices at any time in the future.  Until such amendment is made, ASC is required by law to comply with this notice.  A paper copy of this notice is available if you request a copy.

  1. COMPLAINTS

If you believe that your privacy rights have been violated or if you have complaints about this Notice of Privacy Practices, contact the ASC Administrator at:
Bear Creek Surgery Center, LLC.
100 Bourland Road, Suite 110
Keller, TX 76248
Phone: 817-518-9130 Fax: 817-518-9110

If you are not satisfied with the manner in which ASC handles a complaint, you may submit a formal written complaint to the Department of Health and Human Services, Office for Civil Rights.  You will not be retaliated against for filing a complaint.