CAMPUS SURGERY CENTER LP
901 Campus Drive, Suite 102 ♦ Daly City, California 94015 ♦ (650) 991-2000 ♦ FAX (650) 755-8638
G:\Administrative\CSC\Forms\masterforms\Privacy Notice.doc
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.
This Privacy Notice is being provided to you as a requirement of a federal law, the
Health Insurance Portability and Accountability Act (HIPAA). This Privacy Notice
describes how we may use and disclose your protected health information to carry
out treatment, payment or health care operations and for other purposes that are
permitted or required by law. It also describes your rights to access and control
your protected health information in some cases. Your "protected health
information" means any written and oral health information about you, including
demographic data that can be used to identify you. This is health information that
is created or received by your health care provider, and that relates to your past,
present or future physical or mental health or condition.
I.
Uses and Disclosures of Protected Health Information
Campus Surgery Center may use your protected health information for purposes of
providing treatment, obtaining payment for treatment, and conducting health care
operations. Your protected health information may be used or disclosed only for these
purposes unless the facility and/or Organized Health Care Arrangement (OHCA) has
obtained your authorization or the use or disclosure is otherwise permitted by the HIPAA
privacy regulations or state law. Disclosures of your protected health information for the
purposes described in this Privacy Notice may be made in writing, orally, or by facsimile.
A.
Treatment. We will use and disclose your protected health information to
provide, coordinate, or manage your health care and any related services. This includes
the coordination or management