Tri-City Regional Surgery Center, LLC
Privacy Practices Notice

This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information.

Uses and Disclosures

Your medical information will be used by the Tri-City Regional Surgery Center, on your behalf, to enable treatment, obtain payment for services, and in the healthcare operations of the Tri City Regional Surgery Center, including quality assurance. The Tri-City Regional Surgery Center may leave messages for patient's concerning their health care prior to and after surgery has been performed.

Other uses and disclosures of your information will be made only with your authorization, which you may revoke at any time by providing us with written notice of the revocation.

You have the following rights with respect to your medical information:

• The right to inspect and copy protected health information;
• The right to request that your protected health information be amended;
• The right to receive an accounting of protected health information for other than treatment, payment, or operations purposes (referred to as non-routine disclosures);
• The right to request restrictions on certain uses and disclosures of protected health information, which we shall review to make a determination as to whether or not such request will be accepted;

We are required by law, professional ethics, and guidelines to maintain the privacy of your protected health information. We are also required by law to provide you with this legal notice of our duties and privacy practices with respect to your medical information.

Complaints

If you believe that your privacy rights have been violated, you may file a complaint with the Tri-City Regional Surgery Center and to the Secretary of Health and Human Services. The complaint must be in writing.

The Tri-City Regional Surgery Center as a matter of law, professional ethics, and guidelines shall not retaliate in any manner against you for filing such a complaint.

Contact Information

For additional information or clarification of the Tri City Regional Surgery Center's privacy policies and procedures or about filing a complaint please contact:

HIPAA Compliance and Privacy Officer at 509-943-9700

The effective date of this notice is September 6, 2002 the date of its original publication, distribution, and use.

Source: Lemaster and Daniels PLLC