Review draft — not an adopted public notice. Facility approval and completion are required before publication.
This Notice of Privacy Practices applies to OrthoSurg ASC LLC. It explains the rights you have concerning your health information, the uses and disclosures we may make, and our responsibilities for protecting that information.
Your rights
Get a copy of your medical record
You may ask to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. Ask us how to make the request. We generally respond within 30 days; when the law permits an extension, we will tell you why and when to expect a response. A reasonable, cost-based fee may apply as permitted by law. Some access limits apply; we will explain any denial and available review rights.
Ask us to correct your record
You may ask us to amend information you believe is incorrect or incomplete. We may deny a request in circumstances allowed by law, but will explain the reason in writing, generally within 60 days, and explain how to submit a statement of disagreement.
Request confidential communications
You may ask us to contact you in a specific way or at an alternative location, such as a different mailing address or telephone number. We will accommodate reasonable requests.
Ask us to limit what we use or share
You may ask us not to use or share certain information for treatment, payment or health care operations. We are not required to agree to every request. When you pay for an item or service out of pocket in full and request that we not disclose information about that item or service to your health plan for payment or health care operations, we must honor that restriction unless disclosure is required by law.
Get an accounting of certain disclosures
You may request a list of certain disclosures made during the six years before your request. The list generally does not include disclosures for treatment, payment or health care operations, disclosures made to you or authorized by you, and certain other disclosures excluded by law. One accounting in a 12-month period is free; we may charge a reasonable fee for additional requests after telling you the cost.
Get a paper copy and choose a representative
You may request a paper copy of this notice at any time, even if you agreed to receive it electronically. A person with legally recognized authority, such as an authorized health care representative, may exercise rights for you within that person's authority. We will verify that authority.
Your choices
In appropriate circumstances, you can tell us whether to share relevant information with family, close friends or another person involved in your care or payment, or for disaster relief. When you cannot communicate a preference, we may share information as permitted by law and professional judgment, including when necessary to lessen a serious and imminent threat.
We generally need your written authorization for uses of psychotherapy notes, marketing, sale of health information and other uses or disclosures not described in this notice, except where the law permits otherwise. You may revoke an authorization in writing, except to the extent we have already relied on it or another legal exception applies.
If we contact you for fundraising, you may ask not to be contacted again. Your decision will not affect your treatment or payment.
How we may use and disclose information
Treatment, payment and health care operations
We may use and share information to provide, coordinate or manage your treatment, such as sharing information with your surgeon or anesthesia team. We may use and share information to bill and receive payment, such as sending necessary information to your health plan. We may use and share information for lawful health care operations, such as quality review, staff training, auditing and administration.
Other uses and disclosures permitted or required by law
Subject to applicable legal limits, we may use or disclose information:
- For public health and safety activities, including reporting disease, product recalls, adverse reactions, suspected abuse or neglect, and preventing or reducing a serious and imminent threat.
- For authorized health oversight, audits, investigations and other activities required by law.
- For research when the applicable privacy protections and legal requirements are satisfied.
- To respond to qualifying court or administrative orders, subpoenas and other legal processes, and for law enforcement purposes when the required conditions are met.
- To coroners, medical examiners, funeral directors, and organizations involved in organ, eye or tissue donation.
- For workers' compensation and authorized specialized government functions, including certain military, national security and correctional activities.
- To our business associates that perform services on our behalf and are required to protect the information as applicable.
We follow additional restrictions when federal or Indiana law provides greater protection for particular information. A permitted disclosure under this notice does not override those restrictions.
Special protection for certain substance use disorder records
If we receive or maintain records protected by 42 CFR Part 2, additional restrictions apply. Those records generally cannot be used or disclosed in a civil, criminal, administrative or legislative proceeding or investigation against you without your written consent or a court order accompanied by a subpoena or other legal mandate meeting the applicable requirements.
Before using Part 2 records for fundraising, you must be given clear and conspicuous notice and a choice about receiving fundraising communications as required by law. Other Part 2 confidentiality requirements also continue to apply. Ask our Privacy Officer about protections applicable to your records.
Our responsibilities
We are required by law to maintain the privacy and security of protected health information, provide this notice, and follow the duties and privacy practices described in the notice currently in effect. We will notify affected individuals of a breach of unsecured protected health information when required by law.
We will not use or disclose your information other than as described in this notice unless you provide written authorization or the law otherwise permits or requires it. We may change this notice as allowed by law. Changes may apply to information we already have as well as information received later. The current notice will be available at the center, on this website and on request.
Questions, requests or privacy complaints
Contact the HIPAA Security/Privacy Officer at 812-401-9171, or write to OrthoSurg ASC LLC, Attention: Privacy Officer, 300 Circle Front Dr., Evansville, IN 47715. Ask staff for a secure way to provide information; do not submit records or sensitive details through the general website form.
You may also complain to the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, DC 20201, at 1-800-368-1019 (TDD: 1-800-537-7697), or through the HHS complaint process. We will not retaliate against you for making a complaint.
Ask for a paper copy, language assistance or an appropriate accessible format at no charge.