Notice of Privacy Practices

This notice describes how medical information about you may be disclosed and how you can get access to this information. Please review it carefully. We are committed to maintaining the confidentiality, integrity and security of personal information entrusted to us by current and prospective patients. This document is intended to inform you how we protect your information and how we use it to service your health needs. We hope you will take a moment to review our Policy.

Your Right to Know

You have a right to know what we do with the personal and confidential information we collect about you in the normal course of our practice of caring for your specific needs and billing/collecting fees from third party payers for services provided to you.

We are required by law to:

  • Make sure that medical information that identifies you is kept private;
  • Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
  • Follow the terms of this notice that are currently in effect.

Because we value the integrity of our patient relationships, we want to assure you that we are properly safeguarding the information you share with us.

Personal Information We Collect

We need accurate and current health information about you so that we can determine what your health care needs are, provide you with quality care and comply with certain legal requirements. We may use and disclose medical information about you so that the treatment, services and/or procedures received at our ASC or other site may be billed to and collected from your insurance company, a third party or you.

We collect personal, health and other information from you on interview or application forms and during medical interviews and examinations. We may obtain additional information from third party payers and other physicians who may have referred you.

Information We May Disclose

We may share your personal health information on a confidential basis with only authorized employees, referring physicians or other physicians who may have an interest in the results of examinations /procedures we may perform on you and third parties whose services are required to assure the highest level of services to you. These include Connecticut GI, PC and Hospital personnel and your immediate family members, unless otherwise directed by you.

We will not disclose any non-public personal information about you to anyone except as authorized by law as described in the Privacy Notice or otherwise communicated by you. We will notify you if we make any material change in this Privacy Notice.

Protection of Your Information

Reasonable care will be taken to keep pertinent records current, complete and accurate. If you see any inaccuracy in any communication from us, we would appreciate your assistance in making the necessary corrections by contacting us.

We will protect all information collected about you and we will restrict access to your non-public personal information by maintaining physical, electronic and procedural safeguards. We will restrict access to protected data to individuals who must use it in the performance of their job related duties or as required by law. Employees who violate our Privacy Policy will be subject to disciplinary action, which may include termination.

You have the right to inspect and copy medical information we have about you by making a written request to the Administrator, 234A Bank Street, 4 th Floor, New London, CT 06320. You also have the right to identify incorrect or incomplete information we have about you by requesting a specific amendment in writing. You have the right to request a list of disclosures we have made of medical information about you.

You must make a request in writing for this including a specific time period no longer than 6 years and not before April 13, 2003. The first list you request in a 12 month period will be free. Additional lists will not be free. We will notify you of the cost involved and you may choose to withdraw your request before any costs are incurred.

You must sign a consent form in order for us to transfer or share information with other healthcare providers.

We May Contact You

We do provide appointment reminders by phone. Your physician may also contact you with test results and/or alternate treatment or diagnostic tests, usually by telephone.

Complaints

If you believe your privacy rights have been violated, you may file a written complaint with our Privacy Officer/Administrator or with the Department of Health & Human Services.

Above all, we value your trust and your confidence in our ability to manage and protect your important personal information. If you have any concerns or questions about our Privacy Policy, please contact us at the address and phone number listed below.

The effective date of this Policy is 4/13/2003.