MAE Physicians Surgery Center, LLC

Privacy Notice

PATIENT 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 READ IT CAREFULLY.

I.YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.

Your health record is the physical property of MAE Physicians Surgery Center, LLC. The information contained in the record, however, belongs to you. You have the right to:

  1. Request a restriction or limitation on the medical information we use or disclose about you for your treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your requested restrictions. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
     
  2. Obtain a copy of this Notice by requesting one from the manager or administrator of the surgery center.
     
  3. Inspect and obtain a copy of your health care record by submitting a request in writing to the business office manager or medical records clerk of the surgery center.
     
  4. Amend your healthcare record, if you feel that the medical information that we have about you is incorrect or incomplete by requesting, in writing, that an amendment be made. You must provide a reason that supports your request.
     
  5. Obtain a report of all the disclosures of your health information that we have made.
     
  6. Request that we communicate with you about your medical information in a certain way or at a certain location within reasonable limits.
     
  7. Revoke your authorization to use and disclose medical information about you, except to the extent that we have already used or disclosed your medical information.

II.OUR RESPONSIBLITIES REGARDING YOUR MEDICAL INFORMATION

We are required by law to:

  1. Maintain the privacy of your health information.
     
  2. Provide you with this Notice which describes our legal duties and privacy practices with respect to information we collect about you.
     
  3. Abide by the terms of this Notice.
     
  4. Notify you if we are unable to agree to a requested restriction.
     
  5. Accommodate reasonable requests that you have made to have us communicate your health information to you in a certain way or certain location.

WE RESERVE THE RIGHT TO CHANGE THIS NOTICE. We reserve the right to make the revised and changed notice effective for medical information that we already have about you, as well as any information we receive in the future. We will post a copy of the current notice in the surgery center. The notice will contain the effective date on the first page. Each time you register at the surgery center for health care services, we will offer you a copy of the current notice in effect.

III.HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.

Each time you visit us, a record of your visit is made. We may use or disclose the health information contained in this record if you have signed a consent allowing us to do so. The following categories describe the different ways that we may use and disclose your medical information.

  1. Treatment: We may use medical information about you to provide you with medical treatment and services. We may disclose medical information about you to doctors, nurses, technicians, or other surgery center personnel who are involved in taking care of you at the surgery center.

    For example, information obtained by a nurse, physician, or other members of your healthcare team will be recorded in your medical record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health team. Members of your healthcare team will then record the actions that they took and their observations. By reading your medical record, the physician will know how you are responding to treatment.
     
  2. Payment: We may use and disclose medical information about you so that the treatment and services you receive at the surgery center may be billed to and payment may be collected from you, an insurance company, or third party.

    For example, we may need to give your insurance company information about services you received at the surgery center so that the insurance company will pay us or reimburse you for the surgery.
     
  3. Health Care Operations: We may use and disclose medical information about you for the operations of the surgery center.

    For example, members of the medical staff, risk management, or quality improvement may use information in your health record to assess the care and outcome of your case and others like it. This information will be used in a way to improve the quality and effectiveness of the healthcare and services that we provide.
     
  4. Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the surgery center.
     
  5. Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
     
  6. Health Related Benefits and Services: We may use and disclose medical information to inform you about health-related benefits or services that may be of interest to you.
     
  7. Individuals Involved in Your Care or Payment for Your Care: We may release medical information about you to a friend or family member who is involved in your medical care or who helps pay for your care.
     
  8. As Required by Law. We will disclose medical information about you when required to do so by federal, state or local law.
     
  9. Emergency: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. The surgery center, however, would only disclose the information to someone able to prevent the threat.
     
  10. Organ and Tissue Donation: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and/or transplant.

IV. OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us, will be made upon a specific written authorization you provide to us, that is different from the consent you have signed, which allows the surgery center to use your medical information for the purposes listed above. If you provide us authorization to use or disclose medical information about you, you may revoke this authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. The revocation, however, will not have any effect on any action the surgery center took before it received the revocation.

V. QUESTIONS OR COMPLAINTS

If you have questions and would like additional information, you may contact Carla Glaze, Administrator or Angel Skinner, Business Office Manager at 601-968-1790 at MAE Physicians Surgery Center, LLC.

If you believe your privacy rights have been violated, you can submit a written complaint describing the circumstances surrounding the violation to Carla Glaze, Administrator of MAE Physicians Surgery Center, LLC, 1190 North State Street Suite 102, Jackson, MS 39202.


Everyone gave me exceptional service.

L.C.