Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.

Use and Disclosures
The medical support services of University Suburban Health Center (Diagnostic Imaging, GI suite, Laboratory, Wright Surgery Center) are permitted to use and disclose your Protected Health Information (PHI) in the following ways:
(We will require your consent for treatment, payment and healthcare operations as mandated by Ohio Privacy Standards.)

1. Treatment - the service provided by a physician or other health care professional, for illness, accident or testing purposes. The results of the treatment may be sent to your primary care physician for follow-up care.
2. Payment - information regarding your visit will be submitted to your insurance plan for claims processing.
3. Health care operations - your health information may be used for the following:
1. Quality assessment and improvement activities
2. Medical review processes
3. Training programs for medical students, residents and new employees
4. Accreditation, certification, licensing or credentialing activities
5. Auditing functions, including fraud and abuse detection and compliance
6. Business management activities, such as customer service, resolution of internal grievances, etc.
7. Appointment reminders and patient follow-up calls.
4. Without patient consent - we are permitted to use or disclose protected health information without consent or authorization as required by law for public health activities for the purpose of:
1. Preventing or controlling disease or injury,
2. Vital events, such as birth or death, and
3. The conduct of public health surveillance.

NOTE: Further disclosures may be made only with the express consent of the patient. Patients have the right to revoke this consent in writing except to the extent that we have taken action in the reliance of the consent.

Patient Rights Regarding PHI
You have the following rights concerning your Protected Health Information (PHI):

Restrictions
To request restricted access to all or part of your PHI. We are not required to grant your request.

Confidential communications
To receive correspondence of confidential information by alternate means or location.

Access
To inspect or receive copies of your PHI. Access can be denied under CLIA (a laboratory certification program) of the Federal Privacy Act.

Amendments
To request that changes be made to your PHI. We are not required to grant your request.

Accounting
To receive an accounting of the disclosures by us of your PHI.

This Notice
To get updates or a reissue of this notice, at your request.

Complaints
To file a complaint with us or the U.S. Department of Health & Human Services, if you feel your privacy rights have been violated. The ancillary services will not retaliate against any individual who files a complaint.

Our Duties
We are required by law to maintain the privacy of your PHI. We must abide by the terms of this notice or any update of this notice.

Privacy Contact
For more information about our privacy practices or to register a complaint with us, please contact: USHC HIPAA Privacy Officer, 1611 South Green Road, Suite 104, South Euclid, OH, 44121

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