Notice of Privacy Policy

Your personal medical information is private

Peak One Surgery Center understand how important your personal medical information is to you. We know you are concerned with how that information might be used, the way in which it is disclosed and how you can access that information. That is why we’ve put this document in your hands. It’s why the “Privacy Practices” outlined here are so important and why we want to pledge our commitment, at the outset, to respect your personal medical information.

Our pledge to you

We understand that your medical information is personal & confidential. We create a medical record of the care you receive because it’s our legal obligation, but more importantly because we want to provide you with quality care. Please know we are committed to protecting your personal medical information from any use of which it was not intended.

In short, the law requires us to:

Keep your medical information private.
Notify you of our legal duties & privacy practices with respect to your medical information.
Follow the terms of the most current notice.

What this notice is all about.

The information in this document applies to your medical records. Please understand that a non-Peak One Surgery Center provider may have different polices or notices regarding the use and disclosure of the medical information created in his or her office. This notice will tell you about the specific ways Peak One Surgery Center may use and disclose your medical information. The notice also describes your rights and our duties regarding the use and disclosure of your medical information.

Adhering to privacy practices.

The U.S. Department of Health and Human Services sponsored the Health Insurance Portability and Accountability Act (HIPPA). HIPPA dictates the medical information privacy practices that health care organizations and their partners are obligated to follow. Peak One Surgery provides health care to our patients in partnership with may physicians, advanced practice providers, and other professionals and organizations. This notice describes Peak One Surgery Center’s practices and that of:

Any health care professional who treats you in our center.
All departments of our center.
All employed staff; this includes staff at our sponsor organizations, whom we may share information.
Any business associate or partner whom we share health information.

Be assured that these individuals and organizations understand that the privacy of your medical information is important and are all obligated to follow HIPPA requirements.

IF YOU HAVE ANY QUESTIONS REGARDING THE CONTENTS OF THIS NOTICE OF PRIVACY PRACTICES, PLEASE CONTACT THE CENTER AT THE MAIN NUMBER (970-668-1458) AND ASK FOR THE DESIGNATED PRIVACY OFFICER

How your personal medical information can be used and disclosed.

The following is a list of way in which your personal medical information can be used and disclosed as allowed under HIPPA provisions. Be assured that we will use your information in the most discreet manner.

Disclosure for health care related purposes.

We may use and disclose your medical information for health care related purposed including:

Treatment, such as sending your medical information to a specialist as part of a referral or notifying your provider primarily responsible for your care that you have had an emergency department visit and/or hospital admission, discharge, or transfer.
Obtaining payment for treatment, such as sending billing information to your insurance company or Medicare.
Supporting our health care operations, such as comparing patient data to improve treatment methods.
Communication with business partners so they may help us to do our jobs. These business partners are required by contract and by law to comply with the provision of HIPPA and protect your rights as we do.

Disclosure for public interest and benefit purposes.

Subject to certain requirements, we may give out your medical information to other organizations with out prior authorization for:

Public health purposes.
Research studies.
Serious and imminent threat to a person or the public.
Abuse, neglect, or domestic violence reporting.
Coroner or medical examiner purposes.
Workers’ compensation purposes.
Health oversight audits or inspections.
Requests from law enforcement agencies in special circumstances.
Judicial and administrative orders.
Essential government functions (e.g., national security and intelligence, health and safety of inmates).

Disclosure for contact with you.

We also may use your medical information for contact with you, for:

Appointment reminders
Possible treatment options and alternatives.
Health-related benefits or services that may be of interest to you.

Disclosure when you are a patient.

We may list the following information in our facility directory, unless you tell us otherwise:

Your name.
Your location in the facility

Disclosure to friends, family and others.

We may disclose medical information about you to:

A friend or family member who is involved in your medical care.
Disaster relief authorities to notify your family of your location and condition.

Disclosure in special circumstances.

Most uses and disclosures of psychotherapy notes, uses and disclosures of your medical information for marketing purposes, and disclosures that constitute a sale of your medical information require authorization. In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing your medical information. If you choose to authorize use or disclosure you can later revoke that authorization by notifying us in writing of your decision.

Your Rights.

Can you see a copy of your medical information?

In most cases, you have the right to review and obtain a copy of the medical information we use to make decisions about your care by submitting a written request. If you request a paper or electronic copy, or request a copy be sent to a third party, we may charge a fee for the cost of copying or electronically scanning, and for mailing or other related supplies. If we deny your request to review or obtain a copy you may submit a written request for a review of that decision.

What if you medical records are inaccurate?

If you believe that information in your record is incorrect or if important information is missing, you have the right to request correction of the records by submitting a request in writing along with your reason for requesting the amendment. We could deny your request to amend a record if the information was not created by us; if it is not part of the medical information we maintained; if it is not part of the information you would be permitted to review or copy; or if we determine that the record is accurate. You many appeal, in writing, a decision by us not to amend a record.

Can you know with whom we’ve share your records?

You have the right to a list of those instances where we have disclosed your medical information, other than for treatment, payment, health care operations or where you specifically authorized a disclosure, by submitting a written request. The request must state the time periods desired for the accounting, during the six years prior to the request. You may receive the list in paper or electronic form. The first disclosure list request in a 12-month period is free; other requests will be charged according to our production cost. We will inform you of the cost before you incur any expenses.

Can you specify the way in which we communicate your medical records to you?

You have the right to request that your medical information be communicated to you in a confidential manner, such as sending mail to an address other than your home. Your request must specify how or where you wish to be contacted. We will attempt to honor all reasonable requests.

Can you request your medical information only be released with your permission?

You may request in writing that we not use or disclose your medical information for treatment, payment and health care operations, or to persons involved in your care except when specifically authorized by your or when required by law or in an emergency. Unless your request is to restrict disclosing your medical information to your health plan for health care services for which you pay out of pocket in full, we will consider your request but are not legally required to agree to it. We will inform you of our decision on your request.

Will you be notified if there has been a breach of your medical information?

You have the right to, and will be notified following a breach that compromises the security or privacy of your personal medical information.

If you’ve received this notice electronically, can you receive a paper copy?

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may view or print a copy of the notice at our website, peakoneasc.com

Where can you express a concern?

If you are concerned that your privacy rights may have been violated or disagree with a decision we made about access to your records, you may contact Peak One at 970-668-1458. You may also send a written complaint to the U.S. Department of Health and Human Services Office for Civil Rights. Under not circumstance will you be penalized or retaliated against for filing a complaint.

Will the policies in this notice change?

We may change our polices at any time. Changes will apply to medical information we already hold, as well as new information after the change occurs. When we make a significant change to our polices, we will change this notice and post the current notice in our facility and on our website. The notice will contain the effective date. In addition, you will be offered a copy of the current notice each time you register at the center.