Capital Region Urologic Surgeons
Notice Of Privacy Practices
Capital Region Urological Surgeons, PLLC
Seth A. Capello M.D., Theodore T. Chang M.D., Martin S. Engelstein M.D., Daniel J. Finn M.D., Ramsay L. Kuo M.D., Charles D. Martin M.D., Brian P. Murray M.D., G. Michael Ortiz M.D., Michael Perrotti M.D., Stuart A. Rosenberg M.D., Charles Schwartz M.D., Brian S. Yamada M.D., David H. Zornow M.D., Linda M. Abriel A.N.P., Catherine L. Marsh A.N.P., and Sandra M. Thompson F.N.P.
As Required by the Privacy Regulations Created as a Result of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully. We at Capital Region Urological Surgeons, PLLC are dedicated to maintaining the privacy of your protected health information. Protected health information (PHI) is any information about you that may identify you and relates to your past, present, or future physical or mental health or condition and related health care services. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to: (i) maintain the confidentiality of health information that identifies you; (ii) provide you with this notice of our legal duties and your rights; (iii) abide by the terms of this notice of privacy practices currently in effect.
This notice describes the practices of the physicians and staff at Capital Region Urological Surgeons, PLLC (hereinafter referred to as CRUS). All of the individuals, entities, sites, and locations of CRUS will follow the terms of this notice.
We may use and disclose your PHI in different ways. All the ways in which we may use and disclose information will fall within one of the following categories, but not every use or disclosure in a category will be listed.
1. Treatment. We may use your PHI to provide, coordinate, or manage your healthcare and related services. We may disclose your PHI to other health care providers for purposes related to your care or treatment. For example, we might use your PHI to write a prescription for you, and have to disclose your PHI to a pharmacy when we order a prescription for you.
2. Payment. We may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits, and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, or to bill you directly for services and items. We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.
3. Health Care Operations. We may use and disclose your PHI to operate our business. For examples, we may use your PHI for quality assessment activities, training of medical residents, to conduct cost-management and business planning activities for our practice. We may disclose your PHI to other health care providers and entities to assist in their health care operations.
4. Appointment Reminders. We may use and disclose your PHI to contact you and remind you of an appointment.
5. Treatment Options. We may use and disclose your PHI to inform you of potential treatment options or alternatives.
6. Health-Related Benefits and Services. We may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
7. Release of Information to Family/Friends. We may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you, but we will obtain your agreement before doing so. Although we must be able to speak with your physicians or other healthcare providers, you can let us know if we should not speak with other individuals, such as your spouse or other family members.
8. Disclosures Required By Law. We will use and disclose your PHI when we are required to do so by federal, state or local law.
9. Public Health Risks. We may disclose your PHI to public health authorities that are authorized by law to collect information to maintain vital records, such as births and deaths. Other examples are reporting child abuse or neglect,
preventing or controlling disease, injury or disability; notifying a person regarding potential exposure to a communicable disease; reporting reactions to drugs or problems with products or devices; notifying individuals if a product or device they may be using has been recalled ; notifying the appropriate government agency or authority regarding the potential abuse or neglect of an adult patient (including domestic violence).
10. Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
11. Lawsuits and Similar Proceedings. We may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
12. Law Enforcement. We may release PHI for law enforcement purposes regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement; concerning a death we believe has resulted from criminal conduct; regarding criminal conduct at our offices; in response to a warrant, summons, court order, subpoena or similar legal process and other such examples.
13. Deceased Patients. We may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. We also may release information in order for funeral directors to perform their jobs.
14. Organ and Tissue Donation. We may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks if you are an organ donor.
15. Research. We may use and disclose your PHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PHI for research purposes except when an Institutional Review Board or Privacy Board has determined that your privacy interests and rights will be adequately protected in any research proposal. We may also use and disclose your PHI to prepare or analyze a research protocol and for other research purposes.
16. Health or Safety Threats. We may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
17. Military. We may disclose your PHI if you are a member of
18. National Security. We may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
19. Inmates. We may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official for security, safety, or other important purpose.
21. Workers’ Compensation. We may release your PHI for workers’ compensation and similar programs.
Other permitted and required uses and disclosures of PHI will be made only with your written consent, authorization, or opportunity to object unless required by law. If you provide us with such permission, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose your PHI for the reasons covered by your written authorization. We will be unable to take back any disclosures already made based upon your original permission.
You have the following defined rights regarding your PHI that we maintain about you.
1. Confidential Communications. You have the right to request that we communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. We will accommodate reasonable requests. You do not need to give a reason for your request.
2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI. You may ask us not to use or disclose any part of your PHI for the purposes off treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends. Your physician is not required to agree to a restriction that you may request. If your physician believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If we do agree to the restriction we may not use or disclose your PHI in violation of that restriction except for emergency treatment. To request a restriction in our use or disclosure of your PHI, make your request in writing indicating the information you wish restricted, whether you are requesting to limit our use, disclosure or both, and to whom you want the limits to apply.
3. Inspection and Copies. You have the right to inspect and obtain a copy of your PHI. Under federal law you may not inspect or copy psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; information that is subject to law that prohibits access to PHI. We may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. You must request an amendment in writing and provide us the reason supporting your request for amendment. Under certain circumstances we may deny your request. If we deny your request you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and provide you a copy of our rebuttal.
5. Accounting of Disclosures. You have the right to ask for a list of instances when we have used or disclosed your medical information for reasons other than routine disclosures our practice has made of your PHI for reasons other than your treatment, payment of services furnished to you, our healthcare operations, or disclosures you give us authorization to make. Requests must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but we may charge you for additional lists within the same 12-month period. We will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
6. Right to a Paper Copy of This Notice. You are entitled to receive a copy of our notice of privacy practices upon request.
7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services. We will not retaliate in any way if you choose to file a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. We will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note, we are required to retain records of your care.
The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that we has created or maintained in the past, and for any of your records that we may create or maintain in the future. We will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.
To exercise any of your rights, if you have any complaints or comments concerning our Privacy Practices , or if you would like to obtain more information about this Notice of Privacy Practices you may contact:
Capital Region Urological Surgeons, PLLC
Attn: Benjamin Norris
Practice Administrator
Telephone: 518-438-1019
Capital Region Urological Surgeons, PLLC
Attn: G. Michael Ortiz, M.D.
Privacy Officer
Telephone: 518-583-0111
This Notice of Privacy Practice is effective April 14, 2003.
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