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NOTICE OF PRIVACY PRACTICES

If you have any questions about this notice, please contact our office:

Canyon Surgical Clinic
Lance R. Bryce, MD, PC
974 South Medical Drive, Suite 2
Brigham City, Utah 84302

Who Will Follow This Notice

Our Pledge Regarding Medical Information

• Make sure that medical information that identifies you is kept private;
• Make available to you this Notice of our legal duties and privacy practices with respect to medical information about you; and
• Follow the terms of the Notice that is currently in effect.
  This Notice may change, in the manner described below under "Changes to This Notice".

How We May Use and Disclose Medical Information About You

• For Treatment We may use your PHI to provide you with medical treatment or other medical services. We may disclose medical information about you to doctors, nurses, physician assistants, nurse practitioner, technicians, medical or nursing students, office staff, or other ancillary personnel who are involved in your medical care.
   
• For Payment: We may use and disclose medical information about you so that the treatment and services you receive from your provider may be billed to and payment may be collected from you, an insurance company or health plan or other third party. For example, we may need to give your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may have our bills and payment arrangements outsourced to one or more third party service providers who issue, process and collect bills on our behalf.
   
• For Health Care Operations: We may use and disclose medical information about you for Lance R. Bryce, MD, PC operations. These uses and disclosures are necessary to run Lance R. Bryce, MD, PC and make sure that all of our patients receive quality care. For example, we may use medical information to review services and to evaluate the performance of our staff. We may also combine medical information about many Lance R. Bryce, MD, PC patients to decide what additional services Lance R. Bryce, MD, PC should offer, what services are not needed, and whether certain new services or policies are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other Lance R. Bryce, MD, PC personnel for review and learning purposes. We may also combine the medical information we have with medical information from other health care providers or billing services to compare how we are doing and see where we can make improvement in the care and services we offer. We may remove information that identifies you from this set of medical information, so others may use it to study health care and health care delivery without knowing who the specific patients are.
• Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits options or alternatives that may be of interest to you.
   
• Individuals Involved in Your Care or Payment for Your Care: We may release medical information about you to a friend, family member, spouse, extended family or anyone who is directly involved in your medical care, or someone who helps pay for your care, unless specifically requested otherwise in writing before the time of service. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort, so that your family can be notified about your condition, status and location.
• As Required by Law: We will disclose medical information about you when required to do so by federal, state or local law.
   
• To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
   
• Disclosure Through Statement of Account: It is normal business operations to send family statements. Our practice will use and disclose your PHI on family billing statements.
   
• Disclosures Through Verbal Notification: Lance R. Bryce, MD, PC may call your home or other alternative location and leave a message on voice mail or in person in reference to any items that assist the practice in carrying out TREATMENT, PAYMENT OR OPERATIONS, such as but not limited to appointment reminders, insurance items and any calls pertaining to your clinical care, including laboratory results among others.
   
• Disclosure Through Electronic Notification: Lance R. Bryce, MD, PC may e-mail to your home or other alternative location any items that assist the practice in carrying out TREATMENT, PAYMENT OR OPERATIONS, such as but not limited to appointment reminder cards, insurance items, information pertaining to your clinical care, any test results and patient statements. You have the right to request that Lance R. Bryce, MD, PC restrict how it uses or discloses my PHI to carry out TREATMENT, PAYMENT OR OPERATIONS.
   
• Special Situations. We may also use and disclose medical information about you in the situations described under "Special Situations" below.

Other Uses of Medical Information

Special Situations

Your Rights Regarding Medical Information About You

• Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
  
  You must submit any request to inspect and copy your medical information to: Canyon Surgical Clinic, 984 South Medical Drive, Suite 2, Brigham City, Utah 84302, in writing. (A form for that request is available from that office.) If you request a copy of your information, we may charge a fee for the costs of coping, mailing, or other supplies associated with your request. Also, all medical information requests generally take up to 60 days to process.
  
  Lance R. Bryce, MD, PC is not the legal custodian of any medical chart, report or record other than those involving billing and payment. We will not release any information other than billing and payment information.
  
  We may deny your request in certain circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by Lance R. Bryce, MD, PC will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of that review. Generally, any costs associated with this review will be accessed to the patient.
   
• Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by Canyon Surgical Clinic.
  
  You must submit any request for an amendment to our office at the location noted on the first page of this Notice, in writing. (A form for that request is available from that office.) Your written request must provide a reason that supports your request.
  
  We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.
  • Is not part of the medical information kept by or for Canyon Surgical Clinic
  • Is not part of the information which you are permitted to inspect and copy; or
  • Is accurate and complete
   
• Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of the disclosure we have made of medical information about you, with some exceptions. The exceptions are governed by federal health privacy law, and may include (1) many routine disclosures for treatment, payment and operations, (2) disclosures to you, and (3) disclosures made from any Canyon Surgical Clinic patient directory, as described above.
  
  You must submit any request for an accounting of disclosures to our office at the location noted on the first page of this Notice, in writing with a 60 business day notice. (A form for that request is available from our office.) Your written request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003, when current federal health privacy laws became effective for Lance R. Bryce, MD, PC [Your request should indicate whether you want the report on paper or electronically.] The first report you request within a 12-month period will be free. For additional reports, we may charge you for the costs of providing the report. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
   
• Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. Please note that we are not required to agree to you request. However, if we do agree, we will comply with your request unless the information is needed to provide your emergency treatment.
  
  You must submit any request for restrictions to our office at the address noted on the first page of this Notice, in writing, before the time of service. (A form for that request is available from our office.) Your written request must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply for example, disclosures to your spouse.
   
• Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
  
  You must submit any request for confidential communication to our office at the location noted on the first page of this Notice, in writing prior to service or treatment. (A form for that request is available from that office.) Your written request must tell us how or where you wish to be contacted. We will not ask you the reason for your request. We will accommodate all reasonable requests.
   
• Right to a Paper Copy of This Notice. You may ask us to give you a paper copy of this Notice at any time, even if you have agreed to receive this Notice electronically, by contacting our office at the location noted on the first page of this Notice.

Changes to This Notice

Complaints

Overriding Notice of Privacy Practices