Coastal Surgical Specialists, P.C. 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 1. Uses and Disclosure: The health care providers at Coastal Surgical Specialists, P.C. (CSS) are permitted by law to disclose the minimum necessary personal health information of each patient to carry out treatment, payment and health care operations, of the providers at CSS. For treatment purposes, such disclosures may be made to physicians and other health care providers as necessary to effectuate the appropriate treatment and care of patients. Personal health information may be disclosed to the government or other third party payors for the purpose of obtaining payment for services provided. Health Care Providers at CSS may also use personal health information to carry out CSS’s day to day operations such as scheduling, quality review and appointment reminders. A list of other examples of disclosures can be obtained from the Privacy Officer upon request. 2. Required Authorizations: Health Care Providers for CSS will not disclose any patient’s personal health information for any purpose aside from payment, treatment and health care operations, without patient’s authorized consent to such disclosure. Upon request for such authorization, patient shall have the right to refuse and/or revoke any disclosure of patient’s personal health information. 3. Privacy Compliance: In accordance with the privacy regulations promulgated under the Health Insurance Portability and Accountability Act (HIPAA), 45 CTR Parts 160 and 164 (the “Privacy Regulation”). Health Care Providers at CSS have adopted privacy policies regarding usage of patients’ right to privacy. 4. Additional Information: For additional information regarding the Health Care Providers at CSS privacy policy or for a copy of this notice, please contact our Security Officer. The Health Care Providers at CSS reserves the right to change this notice and to make the revised and changed notice effective for medical information that the Health Care Provider at CSS already has about you, as well as any information the Health Care Providers at CSS receives in the future. We will post a copy of the current notice that will contain the effective date. 5. Process for Lodging Complaints: It is the right of the patient to initiate a complaint when they believe that their PHI has not been handled in a reasonably safe and secure method. The patient may contact the Security Officer for CSS and/or contact the Health ad Human Services Office for Civil Rights, Region III at their Hotline (800) 368-1019. Come Visit Us! First Colonial Road Office: 1120 First Colonial Rd., Suite 203 Virginia Beach, VA 23454 Independence Boulevard Office: 1020 Independence Blvd., Suite 212 Virginia Beach, VA 23455 Providence Road Office: 5320 Providence Rd., Suite 204 Virginia Beach, VA 23464
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