Associated Medical Specialists, P.A.
d/b/a Coastal Cancer Center

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 IT CAREFULLY

If you have any questions about this Notice, please contact our Privacy Officer.

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or healthcare 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. “Protected health information” (hereinafter referred as PHI), is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health condition and related health care services.

Coastal Cancer Center is required by law to maintain the privacy of your PHI, to provide you with this Notice of Privacy Practices and to abide by the terms of this Notice of Privacy Practices. Coastal Cancer Center treats its chemotherapy and lab patients in a common setting.

As allowed by law, we may change the terms of our notice at any time. The new notice will be effective for all PHI that we maintain at that time. We will post a Notice in a clear and prominent location in our offices and on our Web site at www.coastalcancercenter.com.

Federal law requires that we comply with State laws that are more protective of your PHI. Your PHI may be used and disclosed by your physician, our staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, with or without your written consent or authorization. We may use and disclose your PHI for each of the following purposes: treatment, payment or healthcare operations without your consent or authorization.

Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. An example of this would be your office visit, hospital visits or tests.

Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities, and utilization reviews. An example of this would be sending a bill for your visit to your insurance company for payment.

Health care operations include the business aspects of running our practice, such as conducting quality assessment and improvement activities, auditing functions, cost management analysis, and customer service. An example of this would be an internal quality assurance review.

Other permitted and required uses and disclosures that may be made without your consent, authorization or opportunity to object include: public health authority, communicable diseases, health oversight, abuse and neglect, Food and Drug Administration, legal proceedings, law enforcement, coroners, organ donation, criminal activity, military activity, national security, worker’s compensation and as required by the law.

Any other uses and disclosures will be made only with your written authorization. With your written authorization, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your healthcare. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization.

You have the following rights with respect to your PHI:

• The right to request on certain uses and disclosures of PHI, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you.
• You have the right to request a restriction of your PHI. This means you may ask us not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care. Your request must state the specific restriction requested and to whom you want the restriction to apply.
• Your physician is not required to agree to a restriction that you may request. If your physician believes it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. Please discuss any restriction you wish to request with your physician. You may request a restriction in writing and please allow 10 business days for it to become effective. These restrictions may be terminated if you agree or we notify you that we are terminating the restriction for information created or received after we notify you.
• You have the right to request to receive confidential communications from us by alternative means or at an alternative location.
• You have the right to request that your physician amend your PHI.
• You have the right to obtain a paper copy of this notice from us upon request.

You may complain to us or to the Secretary of Health & Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer without fear of retribution.

If you would like further information, please contact the following:
Coastal Cancer Center – Privacy Officer
8121 Rourk Street
Myrtle Beach, South Carolina 29572
(843) 692-5000

This notice was published and becomes effective on: April 1, 2003.