The Physicians' Surgery Center Lancaster General, LLC 2150

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The Physicians’ Surgery Center Lancaster General, LLC

2150 Harrisburg Pike

Lancaster, PA 17604

PRIVACY NOTICE

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.

This Privacy Notice is being provided to you pursuant to the Health Insurance

Portability and Accountability Act of 1996, and the regulations promulgated

thereunder, as each may be amended from time to time (collectively, “HIPAA”).

The Physicians’ Surgery Center Lancaster General, LLC (“the Center”) is

dedicated to protecting your privacy, including the protected health information

(“PHI”) about you that we generate and maintain. This Privacy Notice describes

how we may use and share your PHI, and your rights related to the PHI about you.

As required by law, we must maintain the privacy of PHI, provide you with this

Privacy Notice of our legal duties and privacy practices with respect to such

information, and abide by the terms of this Privacy Notice.

I. Uses and Disclosures of PHI

The Center may use your PHI for

different purposes, including

providing treatment, obtaining payment for treatment, and conducting

health care operations. For each of these categories, we have provided

a description and examples. Your PHI may be used or disclosed only

for these purposes unless the Center has obtained your authorization

or the use or disclosure is otherwise permitted by HIPPA and by state

law.

Disclosures of your PHI for the purposes described in this Privacy

Notice may be made in writing, orally or by facsimile.

A. Treatment

We will use and disclose your PHI to provide, coordinate

and/or manage your health care and any related services. This

includes coordination or management of your health care with a

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third party for treatment purposes. For example, and without

limitation, we may disclose your PHI in the following

situations:

 To members and representatives of the provider of

professional anesthesia services at the Center for

purposes of planning and providing anesthesia services to

you.

 To other practitioners who may be treating you or

consulting with the Center regarding your care.

 To a pharmacy to fill a prescription.

 To a laboratory to order a blood test or pathology exam

of tissue removed during surgery (when relevant).

 If you require admission to a hospital following surgery,

to the ambulance/transport service provider and/or to the

hospital to which you are transported.

 In certain instances, to an outside treatment provider for

the treatment activities of the outside provider.

B. Payment

Your PHI will be used, as needed, to obtain payment for the

services we provide. For example, and without limitation, we

may disclose your PHI in the following situations:

 To your insurance company to obtain prior approval for

procedure(s).

 To your insurance company to determine whether you

are eligible for benefits, whether a particular service is

covered under your coverage, or to learn of the

parameters of your coverage (e.g., co-payment and

deductible).

 To your insurance company to demonstrate medical

necessity of the services, or as required by your insurance

company, for utilization review and similar activities.

 To another provider involved in your care for the other

provider’s payment activities. This may include

disclosure of demographic information to the

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professional anesthesia provider, a laboratory and others

for payment of their services.

If federal or state law requires us to obtain a written release

from you prior to disclosing PHI for payment purposes, we will

ask you to sign a release.

C. Operations

We may use or disclose your PHI, as necessary, for our own

health care operations to facilitate the Center’s functions and to

provide quality care to all patients. Health care operations

include, without limitation, activities such as quality

assessment, employee review, training programs (for students,

trainees or certain practitioners), accreditation, licensure,

certification, credentialing, internal reviews and audits, business

management, financial reviews and audits, general

administrative functions and compliance with certain reporting

requirements (of government and other entities). We may

disclose your PHI to certain vendors of supplies and devices to

comply with reporting, registration or other similar

requirements. In certain situations, we may also disclose PHI to

another provider or health plan for their health care operations.

D. Other Uses and Disclosures

As part of treatment, payment and health care operations, we

may also use or disclose your PHI for the following purposes:

to remind you of your date of surgery, to inform you of the time

to arrive at the Center, to inform you of certain preparations for

your procedures(s) (e.g., what you may eat and when,

medications to be taken, suggested clothing to wear, expected

duration of stay at the Center, etc.), to inform you of health

related benefits or services that may be of interest to you, to

inquire about your condition after your procedure(s) and to

inquire about your satisfaction with our services. We may also

provide certain information about the status of your

procedure(s) and your condition to the individual(s) who

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accompany you to the Center or will be taking you home from

the facility. In addition, we may leave a message on a home

answering machine regarding certain of the matters noted above

(e.g., preparations for your procedure). Furthermore, we may

speak with an individual who answers the phone at your home

regarding one or more of the matters noted above. For example,

if you are not available, we may speak with an individual at

your home regarding your condition after your procedure(s). If

you do not wish for us to speak with anyone but you directly

about any one or more of these matters, please contact our

Privacy Officer.

Also note that the Center’s preoperative and postoperative areas

do not provide absolute patient privacy. Nevertheless, we will

extend our best efforts to minimize the likelihood of revealing

your PHI to other patients and individuals in these areas. For

example, we will speak to you in the lowest reasonable voice,

we will draw a curtain around the area you are occupying when

this does not compromise clinical care and we will make

reasonable efforts to restrict access to your medical record. If

you do wish to be cared for in these areas, contact the Privacy

Officer to explore alternative arrangements for your care.

II. Uses and Disclosure Beyond Treatment, Payment and Health Care

Operations Permitted Without Authorization or Opportunity to Object.

Federal privacy rules permit us to use or disclose your PHI without your

permission or authorization for a number of reasons including the

following:

A. When Legally Required

We may disclose your PHI when we are required to do so by

any federal, state, or local law. Such instances may include,

without limitation, requests by you to review your own health

information and requests by the Pennsylvania Department of

Health.

B. When There Are Risks to Public Health

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We may disclose your PHI for the following public activities

and purposes:

 To prevent, control or report disease, injury or

disability as permitted or required by law.

 To report vital events such as births or deaths as

permitted or required by law.

 To conduct public health surveillance, investigations

and interventions as permitted or required by law.

 To collect or report adverse events and products

defects, track Food and Drug Administration (“FDA”)

regulated products, enable products recalls, repair or

replacements to the FDA, and to conduct post

marketing surveillance.

 To notify a person who has been exposed to a

communicable disease or who may be at risk of

contracting or spreading a disease, as authorized by

law.

 To report to an employer information about an

individual who is a member of the workforce, as

legally permitted or required.

C. To Report Suspected Abuse, Neglect or Domestic Violence

We may notify government authorities if we believe that a

patient is the victim of abuse, neglect or domestic violence. We

will make the disclosure only when specifically required or

authorized by law or when the patient agrees to the disclosure.

D. To Conduct Health Oversight Activities

We may disclose your PHI to a health oversight agency for

activities including audits, civil, administrative, or criminal

investigations, proceeding(s) or actions, inspections licensure or

disciplinary actions, or other activities necessary for appropriate

oversight as authorized or required by law. We will not disclose

your PHI under this authority if you are the subject of an

investigation and such investigation does not arise out of and is

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not directly related to your receipt of health care or public

benefits.

E. In Connection with Judicial and Administrative Proceedings

We may disclose your PHI in the course of any judicial or

administrative proceeding in response to an order of a court or

administrative tribunal as expressly authorized by such order.

In certain circumstances, we may disclose your PHI in response

to a subpoena, to the extent authorized by state law, if we

receive satisfactory assurances that you have been notified of

the request or that an effort was made to secure a protective

order.

F. For Law Enforcement Purposes

Under certain circumstances, we may release your PHI to assist

law enforcement officials with their law enforcement duties.

Examples of such circumstances include the following:

 As required by law for reporting of certain types of

wounds or other physical injuries.

 Pursuant to court order, court-ordered warrant,

subpoena, summons or similar process.

 For the purpose of identifying or locating a suspect,

fugitive, material witness, or missing person.

 Under certain limited circumstances, when you are the

victim of a crime.

 To law enforcement officials, if the Center has a

suspicion that your health condition was the result of

criminal conduct.

 In an emergency to report a crime.

G. To Coroners, Funeral Directors, and for Organ Donation

We may disclose PHI to a coroner or medical examiner for

identification purposes, to determine cause of death or for the

coroner or medical examiner to perform other duties authorized

by law. We may use or disclose your PHI for purposes of

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communicating to an organization involved in procuring,

banking or transplanting organs and tissues.

H. For Research Purposes

We may use or disclose your PHI for research when the use or

disclosure for research has been approved by an institutional

review board that has reviewed the research proposal and

research protocols, to address the privacy of your PHI.

I. In the Event of a Serious Threat to Health and Safety

We may, consistent with applicable law and ethical standards of

conduct, use or disclose your PHI if we believe, in good faith,

that such use or disclosure is necessary to prevent or lessen a

serious imminent threat to your health or safety or to the health

and safety of the public.

J. For Specified Government Functions

In certain circumstances, federal regulations authorize the

Center to use or disclose your PHI to facilitate specified

government functions relating to military and veterans’

activities, national security and intelligence activities, protective

services for the President and others, medical suitability

determinations, correctional institutions, and law enforcement

custodial situations.

K. For Workers’ Compensation

The Center may release your PHI to comply with workers’

compensation laws or similar programs. For example, we may

release your PHI to your employer if your employer requests

such information and if you were cared for at the Center for a

work related injury.

III. Uses and Disclosures Permitted Without Authorization but with the

Opportunity to Object

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We may disclose your PHI to your family member, close personal friend,

or other person accompanying you to the Center if the information is

directly relevant to the person’s involvement in your care, your recovery

or payment related to your care. We may also disclose your information

in connection with trying to locate or notify family members or others

involved in your care concerning your location, condition or death.

You may object to these disclosures. If you do not object to these

disclosures or if we can infer from the circumstances that you do not

object, or we determine, in the exercise of our professional judgment, that

it is in your best interest for us to make disclosure of information that is

directly relevant to the person’s involvement with your care, we may

disclose your PHI as described. For example and without limitation, if

you are not fully conscious or fully recovered from anesthesia, we may

discuss your post-procedure instructions with the family member or

person taking your home from the Center. Similarly, if you require

transport to a local hospital, we may notify the person accompanying you

to the Center of this fact and the reasons for the hospital care. Notify the

Privacy Officer if you wish to object to any of these types of disclosures.

IV. Uses and Disclosures You Authorize

Other than as stated above, we will not disclose your PHI without your

written authorization, including certain marketing activities, sale of PHI,

and disclosure of psychotherapy notes with some exceptions

. You may

revoke your authorization in writing at any time except to the extent that

we have taken action in reliance upon the authorization.

V. Your Rights

You have the following rights with regard to your PHI:

A. The Right to Inspect and Copy

With certain exceptions, you may inspect and obtain a copy of

your PHI that is contained in a designated record set, for as long

as we maintain the PHI, and you also have the right to receive

this information in an electronic format, but only if it is

contained in an Electronic Health Record (“EHR”). A

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“designated record set” contains medical and billing records

and any other records that your provider and the Center use for

making decisions about you. Under federal law, however, you

may not inspect or copy the following records: information

compiled in reasonable anticipation of, or for use in, a civil, or

criminal, or administrative action or proceeding; and PHI that is

subject to a law that prohibits access to PHI.

We may deny your request to inspect or copy your PHI if, in

our professional judgment, we determine that the access

requested is likely to endanger your life or safety, or that of

another person, or that it is likely to cause substantial harm to

another person references in the information. You have the right

to request a review of this decision.

To inspect and/or copy your PHI, you must submit a written

request to the Privacy Officer whose contact information

provided in Article VIII hereof. If you request a copy of your

PHI, we may charge you a reasonable fee for the costs of

copying, mailing, and/or preparation of a summary or other

expenses incurred by us in complying with your request. Please

contact the Center’s Privacy Officer if you have any questions

about access to your medical record.

B. The Right to Request a Restriction on Uses and Disclosures

You may ask us not to use or disclose certain parts of your PHI

for purposes of treatment, payment or health care operations.

You may also request that we do not disclose your PHI to

family members or friends who may be involved in your care or

for notification purposes as described in this Privacy Notice.

Your request must state the specific restriction requested and to

whom you may want the restriction to apply.

The Center is not required to agree to a restriction you may

request except in the case in which the disclosure is to a health

plan for purposes of carrying out payment or health care

operation, and you request a restriction regarding a health care

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item or service for which you have personally paid the health

care provider out of pocket in full.

We will notify you if we deny your request to a restriction. If

the Center does agree to the requested restriction, we may not

use or disclose your PHI in violation of that restriction unless it

is needed to provide emergency care. Under certain

circumstances, we may terminate our agreement to a restriction.

You may request a restriction by contacting the Privacy Officer.

C. The Right to Request to Receive Confidential Communications

From Us by Alternative Means or at an Alternative Location

You have the right to request that we communicate with you in

an alternative manner or at an alternative location. We will

accommodate reasonable requests. We may condition this

accommodation by asking you for information as to how

payment will be handled or specification of an alternative

address or other method of contact. We will not require you to

provide an explanation for the basis of your request. To make

such a request, you must submit your request in writing to the

Center’s Privacy Officer.

D. The Right to Request Amendments

You may request an amendment to your PHI in a designated

record set for so long as we maintain this information. In order

to request an amendment to your PHI, you must submit your

request in writing to the Center’s Privacy Officer, along with a

description of the reason for your request.

In certain cases, we may deny your request for an amendment.

For example, we may deny your request if the information you

want to amend is accurate and complete or was not created by

the Center. If we deny your request, we will inform you in

writing and you have the right to file a statement of

disagreement.

E. The Rights to Receive an Accounting

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You have the right to request an accounting of certain

disclosures of your PHI made by the Center. This right applies

to disclosures for purposes other than treatment, payment or

health care operations. We are also not required to account for

disclosures you requested, disclosures you agreed to by signing

an authorization form, disclosures to family members and

others involved in your care or certain other disclosures we are

permitted to make without your authorization. The request for

an accounting must be made in writing to our Privacy Officer

and should specify the time period sought for the accounting.

You can request an accounting of disclosures made up to six

years prior to the date of your request. We will provide a first

accounting for your request during any 12-month period

without charge. Subsequent accounting requests may be

subject to a reasonable cost-based fee.

F. The Right to Obtain a Paper Copy of This Notice

Upon request, we will provide a paper copy of this Privacy

Notice, even if you have already received a copy of the Privacy

Notice or have agreed to accept this Privacy Notice

electronically. You can always request a written copy of our

most current version of this Privacy Notice from the Center’s

Privacy Officer. The current version of this Notice of Privacy

Practices is also available on our website at: http://psclg.com

VI. Our Duties

The Center is required by law to maintain the privacy of your PHI, to

provide you with this Privacy Notice of our duties and privacy practices,

and to notify affected individuals following a breach of unsecured PHI.

We must comply with the provisions of this Notice as currently in effect,

although we reserve the right to change the terms of this Privacy Notice

and to make the revised Privacy Notice effective for all future PHI we

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maintain. If the Center amends this Privacy Notice, we will provide a

copy of the revised Privacy Notice by either sending a copy of the

revised Privacy Notice by regular mail or through in-person distribution.

VII. Complaints

You have the right to express complaints to the Center and to the

Secretary of Health and Human Services if you believe that your privacy

rights have been violated.

You may contact the U.S. Department of Health and Human Services at:

Office for Civil Rights

U.S. Department of Health and Human Services

150 S. Independence Mall West

Suite 372, Public Ledger Building

Philadelphia, PA 19106-9111

Phone: (800) 368-1019

Fax: (202) 619-3818

TDD: (800) 537-7697

Email: ocr[email protected]

You may file a complaint with the Center by contacting the Center’s

Privacy Officer in writing, by using the contact information provided in

Article VIII below. We encourage you to express any concerns you may

have regarding the privacy of your PHI

. We will not penalize you for

filing a complaint.

VIII. Contact Persons

At any time, the Center may have one or two individuals who serve as

our “Privacy Officer(s)”. These/this individual(s) serve as the contacts for

all issues regarding patient privacy and your rights under the federal

privacy standards. To exercise any of the rights described in this Privacy

Notice, for more information, or to file a complaint, please contact

Center’s Privacy Official(s):

Physicians’ Surgery Center Lancaster General, LLC

2150 Harrisburg Pike

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Lancaster, PA 17604

Attn: Privacy Officer

The Privacy Officer(s) may be contacted at (717) 735-3993.

IX. Effective Date

This Notice of Privacy Practices becomes effective on October 29, 2020

and replaces all earlier versions.