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.
At Surgical Care Affiliates (“SCA”),
we understand that medical information about you and your health is personal,
and we are committed to protecting that information. This Notice of Privacy
Practices describes how we and the medical staff and personnel who provide you
with care or services at this facility may use and disclose your Protected
Health Information (“PHI”) to carry out treatment, payment or healthcare
operations and for other purposes that are permitted or required by law. It
also describes your rights to access and control your PHI, which is information
about you, including demographic information that may identify you and that
relates to your past, present or future physical or mental health or condition
and related healthcare services. We are required by law to maintain the privacy
of your PHI, to provide notice of our legal duties and privacy practices with
respect to your PHI, to notify affected individuals following a breach of
unsecured PHI, and to abide by the terms of this Notice of Privacy Practices.
We may change the terms of our notice
at any time. The new notice will be effective for all PHI that we maintain at
that time. Upon your request, you can receive any revised Notice of Privacy
Practices by accessing our website www.scasurgery.com, contacting the facility
where you received services, or by contacting the
1. How We May Use and Disclose Your
We may use or disclose your PHI as
described in this section. The following are examples of the types of uses and
disclosures of your PHI that SCA is permitted to make without your specific
authorization. These examples are not meant to be exhaustive, but to describe
the types of uses and disclosures that may be made by our facility.
Where State or federal law restricts one of
the described uses or disclosures, SCA will follow the requirements of such
State or federal law.
The following are
general descriptions only.
They do not
cover every example of disclosure within a category.
However, all of the ways SCA is permitted to
use and disclose your PHI will fall within one of the categories in this Notice
of Privacy Practices.
We may use PHI about you to provide you with medical
treatment or services. We may disclose medical information about you to
doctors, nurses, technicians, medical students or other personnel who are
involved in your care to, for example, plan a course of treatment for you. We
also may disclose PHI about you to individuals outside of SCA who may be
involved in your medical care, such as family members or others we use to
provide services that are part of your care.
Your PHI will be used, as needed, to obtain payment for
your healthcare services. This may include certain activities that your health
insurance plan may undertake before it approves or pays for the healthcare
services we recommend for you, such as making a determination of eligibility or
coverage for insurance benefits, reviewing services provided to you for medical
necessity and undertaking utilization review activities. For example, obtaining
approval for a surgery may require that your relevant PHI be disclosed to your
We may use or disclose your PHI as needed to support our
business activities. These activities include, but are not limited to, quality
assessment activities, employee review activities, training of medical
students, licensing, and conducting or arranging for other healthcare
For example, your health
information may be disclosed to members of the medical staff, risk or quality
improvement personnel and others to:
• Evaluate the performance of our
• Assess the quality of care and
outcomes in your case and similar cases;
• Learn how to improve our facilities
and services; or
• Determine how to continually
improve the quality and effectiveness of the health care we provide.
In addition, we may use a sign-in
sheet at the registration desk where you will be asked to sign your name and
indicate your physician. We may also call you by name in the waiting room when
your healthcare provider is ready to see you. We may use or disclose your PHI,
as necessary, to contact you to remind you of your appointment.
We will share your PHI with third
party “business associates” that may perform various activities (e.g., billing
or transcription services) for SCA. Whenever an arrangement between our
facility and a business associate involves the use or disclosure of your PHI,
we will require the business associate to appropriately safeguard it.
2. Other Permitted and Required Uses
and Disclosures That May Be Made With Your Authorization or Opportunity to
have the opportunity to authorize or object to the
use or disclosure of all or part of
your PHI. You may revoke your authorization at any time, but your revocation
will only be effective for future uses and disclosures and will not affect any
use or disclosure made in reliance on your authorization.
you are not present or able to authorize or object
to the use or disclosure of the PHI,
provider may, using professional
judgment, determine whether the disclosure
is in your best interest. In this
case, only the
that is relevant to your healthcare will be disclosed. We may use and disclose
the following instances.
Other uses and disclosures
not described in this Notice of Privacy Practices will be made only with your
Unless you object, we will use and disclose in our
facility directory your name, the location at which you are receiving care,
your condition (in general terms) and your religious affiliation. All of this
information, except religious affiliation, will be disclosed to people that ask
for you by name. Members of the clergy will be told of your religious
Others Involved in Your Healthcare.
Unless you object, we may disclose to a member of your
family, a relative, a close friend or any other person you identify, your PHI
that directly relates to that person’s involvement in your healthcare. If you
are unable to agree or object to such a disclosure, we may disclose such
information as necessary if we determine that it is in your best interest based
on our professional judgment. We may use or disclose PHI to notify or assist in
notifying a family member, personal representative or any other person that is
responsible for your care of your location, about your general condition or
death. Finally, we may use or disclose your PHI to an authorized public or
private entity to assist in disaster relief efforts and to coordinate uses and
disclosures to family or other individuals involved in your healthcare.
with few exceptions, unless you provide written authorization, we will not use
or disclose your PHI for marketing purposes and we will not sell your PHI.
3. Other Permitted and Required Uses
and Disclosures That May Be Made Without Your Authorization or Opportunity to
We may use or disclose your PHI
without your authorization in the following situations:
Required By Law.
We may use or disclose your PHI to the extent that the use
or disclosure is required by law. The use or disclosure will be made in
compliance with the law and will be limited to the relevant requirements of the
law. You will be notified, as required by law, of any such uses or disclosures.
We may disclose your PHI for public health activities and
purposes to a public health authority that is permitted by law to collect or
receive the information. The disclosure will be made for the purpose of
controlling disease, injury or disability. We may also disclose your PHI, if
directed by the public health authority, to a foreign government agency that is
collaborating with the public health authority.
We may disclose your PHI, if authorized by law, to a
person who may have been exposed to a communicable disease or may otherwise be
at risk of contracting or spreading the disease or condition.
We may disclose PHI to a health oversight agency for
activities authorized by law, such as audits, investigations and inspections.
Oversight agencies seeking this information include government agencies that oversee
the healthcare system, government benefit programs, other government regulatory
programs and civil rights laws.
Abuse or Neglect.
We may disclose your PHI to a public health authority that
is authorized by law to receive reports of child abuse or neglect. In addition,
we may disclose your PHI to the governmental entity or agency authorized to receive
such information if we believe that you have been a victim of abuse, neglect or
domestic violence. In this case, the disclosure will be made consistent with
the requirements of applicable federal and state laws.
Food and Drug Administration (“FDA”).
We may disclose your PHI to a person or company required
by the FDA to report information such as adverse events and product defects, to
enable product recalls, to make repairs or replacements, or to conduct post
We may disclose PHI in response to a court or
administrative order. We may also disclose PHI in response to a subpoena,
discovery request, or other lawful process, but only if a reasonable effort has
been made to tell you about the request or to obtain an order protecting the
We may release PHI for certain law enforcement purposes
including, for example, reports required by law, to comply with a court order
or warrant, or to report or answer questions about a crime.
Coroners, Funeral Directors and Organ Donation.
We may disclose PHI to a coroner,
funeral director or medical examiner
to permit them to carry out their
We may disclose your PHI to researchers when their
research has been approved by an institutional review board that has reviewed the
research proposal and established protocols to ensure the privacy of your PHI.
Consistent with applicable federal and state laws, we may
disclose your PHI if we believe that the use or disclosure is necessary to
prevent or lessen a serious and imminent threat to the health or safety of a person
or the public. We may also disclose PHI if it is necessary for law enforcement
authorities to identify or apprehend an individual.
Military Activity and National
When the appropriate conditions
apply, we may use or disclose PHI of individuals who are Armed Forces personnel
(1) for activities deemed necessary by appropriate military command authorities
(2) for the purpose of a determination by the Department of Veterans Affairs of
your eligibility for benefits or (3) to foreign military authority if you are a
member of that foreign military services. We may also disclose your PHI to
authorized federal officials for conducting national security and intelligence
activities, including for the provision of protective services to the President
of the United States or other officials.
Your PHI may be disclosed by us as authorized to comply
with workers compensation laws and other similar legally established programs.
Required Uses and Disclosures.
the law, we must make disclosures to you and to the U.S. Department of Health
and Human Services when required to determine our compliance with the
requirements of the Federal Privacy Standards.
4. Your Rights.
Following is a statement of your rights with respect to
your PHI and a brief description of how you may exercise these rights. We have
the right to deny your request in certain circumstances. We will inform you if
your request is denied.
Right to Access Your PHI.
You may inspect and obtain a copy of PHI about you that is
contained in a designated record set for as long as we maintain the PHI. A
“designated record set” contains medical and billing records and any other
records that your healthcare provider and SCA use for making decisions about
you. Under federal law, however, you may not inspect or copy the following
records: psychotherapy notes; information compiled in reasonable anticipation
of, or use in, a civil, criminal or administrative action or proceeding; and,
PHI that is subject to law that prohibits access to PHI. Depending on the
circumstances, a decision to deny access may be reviewable.
If the information you request is maintained
electronically, and you request an electronic copy, we will provide a copy In
the electronic form and format you request, if the information can be readily
produced in that form and format.
information cannot be readily produced in that form and format, we will work
with you to come to an agreement on form and format.
Please contact the facility’s Medical
Records Department if you have questions about access to your PHI. If you
request a copy of the information, we may charge a fee for the costs of
retrieving, copying, mailing and any other supplies associated with your
request. Your records remain the property of SCA.
Right to Request a Restriction on the
Use or Disclosure of Your PHI.
may ask us not
use or disclose any part of your PHI for the
purposes of treatment, payment or healthcare
operations. You may also request that
your PHI not be disclosed to family members
or friends who may be involved in your care or
for notification purposes as
described in the
of Privacy Practices. Your request must
state the specific restriction requested and to
whom you want the restriction to
Except as provided in the
following paragraph, we are not required to agree to your request.
However, if we do agree to the request, we
will honor the restriction until you revoke it or we notify you.
We will comply with any restriction request if (1)
except as otherwise required by law, the disclosure is to a health plan for
purposes of carrying out payment or health care operations (and is not for
purposes of carrying out treatment); and (2) the PHI pertains solely to a
health care item or service for which the health care provider involved has
been paid out-of-pocket in full.
not responsible for notifying subsequent health care providers of your request
for restrictions on disclosures to health plans for those items and services,
so you will need to notify other providers if you want them to abide by the
restrictions, you must make your request in writing to SCA.
In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit our use,
disclosure, or both; and (3) to whom you want the limits to apply (for example,
disclosures to your spouse).
Right to Request to Receive
Confidential Communications From Us
have the right
request that we communicate with you about
medical matters in a certain way or at a certain
location. We will attempt to
requests. We will not request an
explanation from you as to the basis for the
request. Please make this request in
facility’s Medical Records Department.
Right to Request Amendment.
If you think that the PHI we have about you is wrong or incomplete,
you may ask us to amend the information. In certain cases, we may deny your
request for an amendment. If we deny your request for amendment, you have the
right to file a statement of disagreement with us and we may prepare a rebuttal
to your statement and will provide you with a copy of any such rebuttal. Please
contact the facility’s Medical Records Department if you have a question about
amending your medical record.
Right to Request an Accounting of
You may request a list of our disclosures
of your PHI, subject to several
exceptions and limitations. For example, this
right does not apply to disclosures
than treatment, payment or healthcare
operations, and it excludes disclosures we
may have made to you, to family
involved in your care, or for notification
purposes. You have the right to receive specific
information regarding these
To request this list or
accounting of disclosures, you must submit your request in writing to SCA's
Your request must state
a time period that may not be longer than six years prior to the request date
and may not include dates before April 14, 2003.
The first list you request within a 12-month
period will be free.
lists during the same 12-month period, we may charge you for the cost of
providing the list.
We will notify you
of the cost Involved and you may choose to withdraw or modify your request at
the time before any costs are incurred.
Right to Be Notified of a Breach.
You have a right
to be notified in the event that we discover a breach of unsecured PHI, as defined
under federal law.
Right to Obtain a Paper Copy of This
You have the right to obtain a paper
notice, even if you agreed to receive such
notice electronically. You may ask us to give you
a copy of this notice at any time. To
of this notice, you can make your request in writing to SCA’s
information is below).
5. Questions and Complaints.
You may file a complaint with us or
with the Secretary of the Department of Health and Human Services if you
believe your privacy rights have been violated by us. You may file a complaint
with us by notifying our
of your complaint. We will not retaliate against you for filing a complaint.
For further information about the complaint process, or to make any requests or
inquiries, you may contact our
Surgical Care Affiliates
569 Brookwood Village Suite 901
Birmingham, AL 35209
Telephone: (205) 545-2713
This notice was effective on April
14, 2003 and revised on April 28, 2015.