Patient Health Information
Under federal law, your patient health information is protected and confidential. Patient health information includes information about your symptoms, test results, diagnosis, treatment, and related medical information. Your health information also includes payment, billing, and insurance information. Your information may be stored electronically and if so is subject to electronic disclosure.
How We Use & Disclose Your Patient Health Information
Treatment: We will use and disclose your health information to provide you with medical treatment or services. For example, nurses, physicians, and other members of your treatment team will record information in your record and use it to determine the most appropriate course of care. We may also disclose the information to other health care providers who are participating in your treatment, to pharmacists who are filling your prescriptions, and to family members who are helping with your care.
Payment: We will use and disclose your health information for payment purposes. For example, we may need to obtain authorization from your insurance company before providing certain types of treatment or disclose your information to payors to determine whether you are enrolled or eligible for benefits. We will submit bills and maintain records of payments from your health plan.
Health Care Operations: We will use and disclose your health information to conduct our standard internal operations, including proper administration of records, evaluation of the quality of treatment, arranging for legal services and to assess the care and outcomes of your case and others like it.
Special Uses and Disclosures
Following a procedure, we will disclose your discharge instructions and information related to your care to the individual who is driving you home from the center or who is otherwise identified as assisting in your post-procedure care. We may also disclose relevant health information to a family member, friend or others involved in your care or payment for your care and disclose information to those assisting in disaster relief efforts.
Other Uses and Disclosures
We may be required or permitted to use or disclose the information even without your permission as described below:
Required by Law: We may be required by law to disclose your information, such as to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.
Research: We may use or disclose information for approved medical research.
Public Health Activities: We may disclose vital statistics, diseases, information related to recalls of dangerous products, and similar information to public health authorities.
Health oversight: We may disclose information to assist in investigations and audits, eligibility for government programs, and similar activities.
Judicial and administrative proceedings: We may disclose information in response to an appropriate subpoena, discovery request or court order.
Law enforcement purposes: We may disclose information needed or requested by law enforcement officials or to report a crime on our premises.
Deaths: We may disclose information regarding deaths to coroners, medical examiners, funeral directors, and organ donation agencies.
Serious threat to health or safety: We may use and disclose information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Military and Special Government Functions: If you are a member of the armed forces, we may release information as required by military command authorities. We may also disclose information to correctional institutions or for national security purposes.
Workers Compensation: We may release information about you for workers compensation or similar programs providing benefits for work-related injuries or illness.
Business Associates: We may disclose your health information to business associates (individuals or entities that perform functions on our behalf) provided they agree to safeguard the information.
Messages: We may contact you to provide appointment reminders or for billing or collections and may leave messages on your answering machine, voicemail or through other methods.
In any other situation, we will ask for your written authorization before using or disclosing identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures. Subject to compliance with limited exceptions, we will not use or disclose psychotherapy notes, use or disclose your health information for marketing purposes or sell your health information, unless you have signed an authorization.
Our Legal Duty
We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices regarding protected health information, and to abide by the terms of the Notice currently in effect. We are required to notify affected individuals in the event of a breach involving unsecured protected health information.
Changes in Privacy Practices
We may change this Notice at any time and make the new terms effective for all health information we hold. If we change our Notice, we will post the new Notice in the waiting area. For more information about our privacy practices, contact the Center Leader.
Every Patient is responsible:
For providing to the health care provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications and other matters relating to his or her health.
For reporting unexpected changes in his or her condition to the health care provider.
For reporting to the health care provider whether he or she comprehends a contemplated course of action and what is expected of him or her.
For following the treatment plan recommended by the health care provider.
For keeping appointments and when he or she is unable to do so for any reason, for notifying the practice.
For his or her actions if he or she is refusing treatment or does not follow the health care provider's instructions.
For assuring that the financial obligations of his or her health care are fulfilled as promptly as possible.
For following Practice rules and regulations affecting patient care and conduct.
For consideration and respect of the Practice staff and property.
For asking what to expect regarding pain and pain management.
For providing a responsible adult to provide transportation home and to remain with them as directed by the health care provider or as indicated on discharge instructions, when receiving sedation.
Complaints and Grievances
Please contact us if you have a question or concern about your rights or responsibilities. You can ask any of our staff to help you contact the Administrator of the facility or you can call Cindy, Administrator, at (941)373-9808.
We want to provide you with excellent service, including answering your questions and responding to your concerns.
You may also choose to contact the licensing agency of the state, the Agency for Health Care Administration:
2727 Mahan Dr., Tallahassee, FL 32308
(888)419-3456 or (850)245-4339
If you are covered by Medicare, you may choose to contact the Medicare Ombudsman at (800)633-4227 or online at Http://www.medicare.gov/claims-and-appeals/medicare-rights/get-help/ombudsman.html
The role of the Medicare Beneficiary Ombudsman is to ensure that Medicare beneficiaries receive the information and help needed to understand Medicare options and to apply your Medicare rights and protections.
Complaints and grievances can also be filed with the Accreditation Association for Ambulatory Health Care (AAAHC) at (847)853-6060 or firstname.lastname@example.org
Notice of Nondiscrimination
Discrimination is Against the Law
Bayview Surgery Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
Bayview Surgery Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Bayview Surgery Center:
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
Qualified sign language interpreters
Written information in other formats (large print, audio, accessible electronic formats)
Provides free language services to people whose primary language is not English, such as:
Information written in other languages
If you need these services, contact the Center Director.
If you believe that Bayview Surgery Center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with:
2800 Bahia Vista Street Suite 300
(TTY: (941) 373-9808)
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Center Director is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at: https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue SW., Room 509F,
HHH Building, Washington, DC 20201
1-800-868-1019, 800-537-7697 (TDD).
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
Source: HHS Office for Civil Rights
LANGUAGE ASSISTANCE SERVICES are available to you at Bayview Surgery Center free of charge. To obtain services, call (941) 373-9806.
Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (941) 373-9806 (TTY: (941) 373-9806) .
Chinese: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 (941) 373-9806 (TTY: (941) 373-9806) .
Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (941) 373-9806 (TTY: (941) 373-9806) .
French Creole: ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele (941) 373-9806 (TTY: (941) 373-9806) .
French: ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le (941) 373-9806 (ATS : (941) 373-9806).
Korean: 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. (941) 373-9806 (TTY: (941) 373-9806) 번으로 전화해 주십시오.
German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (941) 373-9806
Italian: ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (941) 373-9806 (TTY: (941) 373-9806) .
Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (941) 373-9806 (телетайп: (941) 373-9806).
Tagalog-Filipino: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (941) 373-9806 (TTY: (941) 373-9806) .
Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer (941) 373-9806 (TTY: (941) 373-9806) .
Portuguese: ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para (941) 373-9806 (TTY: (941) 373-9806) .
Japanese: 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。(941) 373-9806(TTY: (941) 373-9806) まで、お電話にてご連絡ください。
Hindi: ध्यान दें: यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। (941) 373-9806 (TTY: (941) 373-9806) पर कॉल करें।
Punjabi: ਧਿਆਨ ਦਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਦੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ ਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਧ ਹੈ। (941) 373-9806 (TTY: (941) 373-9806) 'ਤੇ ਕਾਲ ਕਰੋ।