Privacy is so important. And we take the medical and personal information that
you give us very seriously. Read through our Privacy Policy based on the
Insurance Portability and Accountability Act (
HIPAA). This is the standard by which all
of your health care providers use to protect your personal health information.
At the office of Premier Surgical Group, we are committed to treating and using
protected health information about you responsibly. This Notice of Privacy Policy
describes the personal information we collect, and how and when we use or disclose
that information. It also describes your rights as they relate to your protected health
information (PHI). This Notice is effective October 1, 2003 and applies to all
protected health information as defined by federal regulations.

We maintain protocols to ensure the security and confidentiality of your personal
information. We have physical security in our building, passwords to protect
databases, compliance audits, and virus/intrusion detection software. Within our
practice, access to your information is limited to those who need it to perform their

Understanding Your Health Record
Each time you visit Premier Surgical Group, a record of your visit is made. Typically,
this record contains your symptoms, examinations, test results, diagnosis,
treatment, and plan for future care or treatment. This information, often referred to
as your health or medical record serves as a:
  • Basis for planning your care and treatment
  • Means of communication among the many health professionals who contribute
    to your care
  • Legal document describing the care you received
  • A tool in educating health care professionals
  • A source of information for public health officials charged with improving the
    health of the state and the nation
  • A source of data for Premier Surgical Group for planning and marketing
  • A tool by which we can assess and continually work to improve the care we
    render and outcomes we achieve

Understanding what is in your record and how your health information is used helps
you to ensure its accuracy; better understand who, what, when, where, and why
others may access your health information; and make more informed decisions when
authorizing disclosure to others.

Your Health Information Rights
Although your health record is the physical property of Premier Surgical Group, the
information belongs to you. You have the right to:
  • Obtain a paper copy of this Notice of Privacy Policy upon request
  • Inspect and obtain a copy of your health record
  • Amend your health record
  • Obtain an accounting of disclosures to your protected health information
  • Request confidential communications of your protected health information
  • Request a restriction of certain uses and disclosures of your protected health

Our Responsibilities
Premier Surgical Group is required to:
  • Maintain the privacy of your health information
  • Provide you with this Notice as your legal duties and privacy practices with
    respect to information we collect and maintain about you
  • Abide by the terms of this Notice
  • Notify you if we are unable to agree to a requested restriction
  • Accommodate reasonable requests you may have to communicate health

We reserve the right to change our practices and to make the new provisions
effective for all protected health information we maintain. Each time you visit our
facility for treatment you may obtain a copy of the current Notice in effect upon

We will not use or disclose your health information in a manner other than described
in the section regarding Examples of Disclosures for Treatment, Payment, and Health
Operations, without your written authorization, which you may revoke except to the
extent that action has already been taken.

For More Information or to Report A Problem
If you have questions and would like additional information, you may contact the
practice's Privacy Officer at (803) 779-3222.

If you believe your privacy rights have been violated, you can either file a complaint
with the practice's Privacy Officer or with the Office of Civil Rights, U.S. Department of
Health and Human Services (OCR). There will be no retaliation for filing a complaint
with either the practice or the Privacy Officer of the OCR. The address for the OCR
regional office for South Carolina is as follows:

    Office for Civil Rights
    U.S. Department of Health and Human Services
    Atlanta Federal Center, Suite #3B70
    61 Forsyth Street, SW
    Atlanta, GA 30303-8909

Examples of Disclosures For Treatment, Payment, And Health Operations
We will use your health information for treatment
We may provide medical information about you to health care providers, our practice
personnel, or third parties who are involved in the provision, management, or
coordination of your care.

    Information obtained by a nurse, physician or other member of your health
    care team will be recorded in your record and used to determine the course of
    treatment that should work best for you. Your medical information will be
    shared among health care professionals involved in your care.

    We will also provide other physician(s) or subsequent health care provider(s)
    (when applicable) with copies of various reports that should assist them in
    treating you.

    We will use your health care information for payment.
    We may disclose your information so that we can collect or make payment for
    the health care services you receive.

    If you participate in a health insurance plan, we will disclose necessary
    information to that plan to obtain payment for your care.

    We will use your health information for regular health operations.
    We may disclose your health information for our routine operations. These
    uses are necessary for certain administrative, financial, legal, and quality
    improvement activities that are necessary to run the practice and support core

    Members of the quality improvement team may use information in your health
    record to assess the care and outcomes in your case and others like it. This
    information will then be used in an effort to continually improve the quality
    and effectiveness of the health care and service we provide and to reduce
    health care costs.

Appointment Reminders
We may disclose medical information to provide appointment reminders (i.e.,
contacting you at the phone number you have provided to us and leaving a
message as an appointment reminder).

Consistent with applicable law, we may disclose health information to a coroner,
medical examiner, or funeral director.

Workers Compensation
We may disclose health information to the extent authorized by and necessary to
comply with laws relating to workers compensation or other similar programs
established by law.

Public Health
As required by law, we may disclose your health information to public health or legal
authorities charged with preventing or controlling disease, injury, or disability.

We may disclose information to researchers when their research has been approved
and the researcher has obtained a required waiver from the Institutional Review
Board / Privacy Board, who has reviewed the research proposal.

As Required By Law
We may disclose health information as required by law. This may include reporting a
crime, responding to a court order, grand jury subpoena, warrant, discovery
request, or other legal process, or complying with health oversight activities, such as
audits, investigations, and inspections, necessary to ensure compliance with
government regulation and civil rights.

Specialized Government Functions
We may disclose health information for military and veterans affairs or national
security and intelligence activities.

Business Associates
There are some services provided in our organization through contacts with
business associates. Due to the nature of business associates' services, they must
receive your health information in order to perform the jobs we've asked them to do.
To protect your health information however, when these services are contracted we
require the business associate to appropriately safeguard your information.

Practice Marketing
We may contact you to provide information about treatment alternatives or other
health-related benefits and services that may be of interest to your (i.e., to notify
you of any new tests or services we may be offering).

Food and Drug Administration (FDA)
We may disclose to the FDA health information relative to adverse events with
respect to food, supplements, products and product defects, or post marketing
surveillance information to enable product recalls, repairs, or replacement.

Personal Representative
We may use or disclose information to your personal representative (person legally
responsible for your care and authorized to act on your behalf in making decisions
related to your health care).

To Avert a Serious Threat to Health / Safety
We may disclose your information when we believe in good faith that this is
necessary to prevent a serious threat to your safety or that of another person. This
may include cases of abuse, neglect, or domestic violence.

Communication with Family
Unless you object – health professionals using their best judgement may disclose to
a family member or close personal friend health information relevant to that person's
involvement in your care or payment related to your care. We may notify these
individuals of your location and general condition.

Disaster Relief
Unless you object – we may disclose health information about you to an
organization assisting in a disaster relief effort.
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PHONE (803) 779-3222  FAX (803) 779-3223