Preparing for Your Surgery

For your health and safety, some laboratory tests or medical clearance may be required prior to your procedure. Your surgeon or Surgery Center of Raritan Valley Surgery Center may ask you to visit your family doctor to obtain the necessary tests or clearance within 30 days of your procedure.

Within a week of your scheduled procedure a nurse from Raritan Valley Surgery Center will call you to confirm your surgery time. They will ask you questions regarding your past and current medical conditions, allergies and medications you are taking. Please don't hesitate to ask any questions you may have, and be sure to let them know of any special needs.

The nurse will instruct you as to what time you are to stop eating and drinking prior to surgery.

If you take medication for any conditions, ask your doctor and/or the Raritan Valley Surgery Center nurse whether or not to take it the day of your surgery.

For women, if there is a possibility that you are pregnant, please notify your doctor and/or the Raritan Valley Surgery Center nurse.

Leave all valuables at home, including watches, rings, jewelry and wallets.

Please notify your surgeon of any change in your health, such as a cold, fever or sore throat.

For your safety, a responsible adult MUST be available to drive you home after your procedure. Your ride is required to wait at the facility for you until you are discharged.

Children, age 17 years and younger or incapacitated adults must be accompanied by a person with legal guardianship.

You will receive a call for Raritan Valley Surgery Center business office staff regarding your financial information and responsibilities.

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Day of Surgery

Arrive promptly at the time instructed, usually 30-90 minutes prior to your surgery time. This will allow adequate time for all necessary admission procedures.

Please bring your insurance identification cards and photo ID. If special financial arrangements are necessary, please call the Raritan Valley Surgery Center prior to the day of surgery.

Wear loose fitting comfortable clothing. Leave all valuables, at home.

Items to bring with you include but are not limited to: a list of your current medications, prior obtained prescription for pain medication, containers for eye wear, medical equipment you may use or have received prior to your surgery, any important records such as living will or patient advocate forms and any comfort devices such as a pillow for the ride home.

Upon arrival, you will change into a hospital gown and slippers which we provide. You will be asked to remove contact lenses, dentures, jewelry and any prosthesis.

Your care throughout your stay will be closely monitored by our staff for your safety and comfort.

When you are fully awake, members of your family will be able to join you.

Each individual is different however you may expect to be in the recovery area 30 minutes-2 hours.

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At home after surgery

Your surgeon will provide specific instructions for care while recovering at home. In the event of difficulty, please call your surgeon.

For the first 24 hours following surgery, do not engage in strenuous activities, do not drink any alcoholic beverages, drive, or make any critical decisions.

A nurse from Raritan Valley Surgery Center will call you within a day or two to evaluate how you are recovering at home. You will be asked to complete a questionnaire about the care you received. Your comments will enable us to continue to improve our services.

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Patient Responsibilities

Providing accurate and complete information about your present health status and past medical history and reporting any unexpected changes to the appropriate practitioner.

Following the treatment plan recommended by the practitioner involved in your care.

Providing an adult to transport you home after surgery and stay with you as needed.

Indicating that you clearly understand what is expected of you after your surgery/procedure.

Your own actions should you refuse treatment, leave the Facility against medical advice, or choose to purposefully not follow the instructions of your practitioner.

Providing information and/or copies of an Advance Directive such as Living Will or Durable Power of Attorney.

Ask your health professional what to expect for pain management; discuss pain relief options; discuss openly any concerns or fears regarding pain management medications.

 

TO MAKE A PAYMENT ONLINE, PLEASE GO TO:

HTTPS://PATIENTNOTEBOOK.COM/36494

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Advance Directives

An advance directive speaks for you if you are unable to speak and helps to assure that your religious and personal beliefs will be respected. It is a useful document for an adult of any age to plan for future health care needs.



Although Raritan Valley Surgery Center does not honor advance directives in regards to Do Not Resuscitate (DNR), upon request we will provide you with contact information and forms to assist in writing an advance directive.

Information can also be obtained at: (732) 560-1000

You may also contact your local area office on aging.

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Financial Policy

Raritan Valley Surgery Center’s fees cover the use of the facility only, and do not include laboratory, pathology, surgeon or anesthesiologist fee. You will be billed separately for these services.

As a courtesy, we will bill your primary and secondary insurance carriers or governmental agency directly for the Raritan Valley Surgery Center's charges. Be sure to bring your most current insurance, Medicare, or public assistance card with you on the day of your surgery. If you have more than one insurance carrier, we will also need accurate secondary billing information.

Please be aware of any admission policies your insurance plan may have. You or your physicians may have to adhere to certain requirements in order to insure maximum reimbursement. Failure to obtain pre-authorization, physician referral, or a second opinion may greatly reduce or eliminate your benefits.

Be prepared to bring any co-pay or co-insurance amounts on the day of your surgery. Patients who do not have insurance coverage may also be required to pay a portion of their charges in advance. Also, please make sure you bring a photo ID. We will need to see this as part of your insurance validation. We realize, however, that at times you may require special financial arrangements. In these instances, please phone our office prior to your surgery to discuss alternative methods of payment. Raritan Valley Surgery Center accepts cash, cashier's checks, credit cards, and personal checks with a valid I.D.

Please feel free to contact our business office at any time if you have questions or concerns regarding the facility charges, the financial policy, or billing procedures. Call 732-560-1000 for more information.

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Grievance Process

We strive to maintain a professional and compliant atmosphere. However, issues can arise. The Grievance procedure is a means for patients and related parties to inquire into issues raised and identify whether action needs to be taken to resolve identified issues and prevent recurrence. 

The Facility Administrator will record the grievance complaint and conduct a prompt investigation for quick resolution. Any patient and/or support person, visitor, employee, physician, or vendor may lodge a grievance using the Center’s procedure to formally voice complaints, resolve disputes, or to bring attention to possible violations of patient rights.

No person shall be punished or retaliated against for using the Grievance Procedure. Any grievances, comments and complaints are addressed to the Center Administrator. Complete details and a copy of the Center’s Grievance Policy as well as a Grievance form may be obtained by contacting the Center Administrator, Karen Thompson at 732-560-1000.


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Patient Bill of Rights

The facility will observe and respect a patient’s rights and responsibilities without regard to age, race, color, sex, national origin, religion, culture, physical or mental disability, personal values or belief systems. The facility will, prior to the start of the surgical procedure, provide the patient, the patient's representative, or the patient's surrogate with verbal and written notice of the patient's rights

 

Patient Rights:

The patient has the right to:

  • Considerate, respectful and dignified care and respect for personal values, beliefs and preferences.

  • Access to treatment without regard to race, ethnicity, national origin, color, creed/religion, sex, age, mental disability, or physical disability. Any treatment determinations based on a person’s physical status or diagnosis will be made on the basis of medical evidence and treatment capability.

  • Respect of personal privacy.

  • Receive care in a safe and secure environment.

  • Exercise your rights without being subjected to discrimination or reprisal.

  • Know the identity of persons providing care, treatment or services and, upon request, be informed of the credentials of healthcare providers and, if applicable, the lack of malpractice coverage.

  • Expect the center to disclose, when applicable, physician financial interests or ownership in the center.

  • Receive assistance when requesting a change in primary or specialty physicians, dentists or anesthesia providers if other qualified physicians, dentists or anesthesia providers are available.

  • Receive information about health status, diagnosis, the expected prognosis and expected outcomes of care, in terms that can be understood, before a treatment or a procedure is performed.

  • Receive information about unanticipated outcomes of care.

  • Receive information from the physician about any proposed treatment or procedure as needed in order to give or withhold informed consent.

  • Participate in decisions about the care, treatment or services planned and to refuse care, treatment or services, in accordance with law and regulation.

  • Be informed, or when appropriate, your representative be informed (as allowed under state law) of your rights in advance of furnishing or discontinuing patient care whenever possible.

  • Receive information in a manner tailored to your level of understanding, including provision of interpretative assistance or assistive devices.

  • Have family be involved in care, treatment, or services decisions to the extent permitted by the patient or your surrogate decision maker, in accordance with laws and regulations.

  • Appropriate assessment and management of pain, information about pain, pain relief measures and participation in pain management decisions.

  • Give or withhold informed consent to produce or use recordings, film, or other images for purposes other than care, and to request cessation of production of the recordings, films or other images at any time.

  • Be informed of and permit or refuse any human experimentation or other research/educational projects affecting care or treatment.

  • Confidentiality of all information pertaining to care and stay in the center, including medical records and, except as required by law, the right to approve or refuse the release of your medical records.

  • Access to and/or copies of your medical records within a reasonable time frame and the ability to request amendments to your medical records.

  • Obtain information on disclosures of health information within a reasonable time frame.

  • Have an advance directive, such as a living will or durable power of attorney for healthcare, and be informed as to the center’s policy regarding advance directives/living will. Expect the center to provide the state’s official advance directive form if requested and where applicable.

  • Obtain information concerning fees for services rendered and the center’s payment policies.

  • Be free from restraints of any form that are not medically necessary or are used as a means of coercion, discipline, convenience or retaliation by staff.

  • Be free from all forms of abuse or harassment.

  • Expect the center to establish a process for prompt resolution of patients’ grievances and to inform each patient whom to contact to file a grievance. Grievances/complaints and suggestions regarding treatment or care that is (or fails to be) furnished may be expressed at any time. Grievances may be lodged with the state agency directly using the contact information provided on the patient rights poster posted in the center lobby.

  • If a patient is adjudged incompetent under applicable State laws by a court of proper jurisdiction, the rights of the patient are exercised by the person appointed under State law to act on the patient’s behalf.

  • If a State court has not adjudged a patient incompetent, any legal representative or surrogate designated by the patient in accordance with State law may exercise the patient’s rights to the extent allowed by State law.

     

    Patient Responsibilities:

    The Patient is responsible for:

  • Being considerate of other patients and personnel and for assisting in the control of noise, smoking and other distractions.

  • Respecting the property of others and the center.

  • Identifying any patient safety concerns.

  • Observing prescribed rules of the center during your stay and treatment.

  • Providing a responsible adult to transport you home from the center and remain with you for 24 hours if required by their provider.

  • Reporting whether you clearly understand the planned course of treatment and what is expected of you and asking questions when you do not understand their care, treatment, or service or what you are expected to do. 

  • Keeping appointments and, when unable to do so for any reason, notifying the center and physician.

  • Providing caregivers with the most accurate and complete information regarding present complaints, past illnesses and hospitalizations, medications—including over-the-counter products and dietary supplements, and any allergies or sensitivities, unexpected changes in your condition or any other patient health matters.

  • Promptly fulfilling your financial obligations to the center, including charges not covered by insurance.

  • Payment to center for copies of the medical records they may request.

  • Informing your providers about any living will, medical power of attorney, or other advance directive that could affect your care.

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HIPAA Compliance Policy

The Facility has established a compliance policy to ensure compliance with the Standards for Privacy of Individually Identifiable Health Information (the “Privacy Regulations”) promulgated under the Health Insurance Portability and Accounting Act of 1996 (“HIPAA”).

This compliance policy is not intended to be a comprehensive explanation of the Privacy Regulations, nor will it provide answers to every possible issue that may arise under the Privacy Regulations. Rather, it is intended to provide guidelines with respect to the steps that the Facility must take in order to achieve compliance with the Privacy Regulations and to sensitize the Facility to potential problems that may arise under the Privacy Regulations. The Facility expects full compliance with the guidelines set forth in this policy statement, and encourages the Facility to seek any further necessary information or clarification prior to engaging in any potentially sensitive actions or activities. See HIPAA Notebook for complete HIPAA policies and forms.

This compliance policy is divided into two main sections: (1) an overview of the Privacy Regulations; and (2) specific compliance guidelines. This policy requires the Facility to:
- Appoint a Privacy/Security Official;
- Inform Patients of the Facility’s Privacy Polices and Procedures by disseminating handouts and posting a disclosure notice;
- Use a Business Associates agreement;
- Clarify discipline for employees and vendors who violate the Privacy Rules and Privacy Policies and Procedures;
- Update the Privacy Policies and Procedures as needed;
- Hold all-employee educational meetings;
- Discuss adoption of the Privacy Policies and Procedures at a Board Meeting; and
- Develop safe guards to protect and de-identify Protected Health Information (as defined in the regulations).

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Ownership Disclosure

We the Physician Owners of Raritan Valley Surgery Center, and want say thank you for your trust in us for your surgical procedure.  We recognize that you have the right to choose the provider of your healthcare services. We are pleased that you have chosen Raritan Valley Surgery Center.

David Bortniker, MD 

242 East Main Street

Somerville, NJ 08876


William Chen, MD 

561 Cranbury Road

East Brunswick, NJ 08816


James Chimenti, MD 

1952 RT.22 East Suite 210

Bound Brook, NJ 08805


Tony Di Stefano, DPM 

234 Stelton Road

Piscataway, NJ 08854


Bruce Edelman, MD 

B3 Cornwall Drive

East Brunswick, NJ 08816


Ali El-Saheli, DPM 

234 Stelton Road

Piscataway, NJ 08854


Ronald Francesco, DPM 

234 Stelton Road

Piscataway, NJ 08854

 

Adrianna Hekiert, MD 

245 US Hywy 22 West

Bridgewater, NJ 08807

 

Edward Krisiloff, MD 

515 Church Street

Bound Brook, NJ 08805


Amy Lazar, MD 

245 US Hywy 22 West

Bridgewater, NJ 08807


Jay More, MD 

1952 RT.22 East Suite 210

Bound Brook, NJ 08805


Sudha Nahar, MD 

49 Veronica Avenue #207

Somerset, NJ 08873


Shail Patel, DPM 

234 Stelton Road

Piscataway, NJ 08854

 

Steven Sabin, MD 

B3 Cornwall Drive

East Brunswick, NJ 08816


Stephen Schneider, MD 

515 Church Street

Bound Brook, NJ 08805

 

Thangamani Seenivasan, MD 

30 Rehill Ave Suite 3400

Somerville, NJ 08876


Marco Ucciferri, DPM 

234 Stelton Road

Piscataway, NJ 08854


Peter Wishnie, DPM 

12 Wills Way

Piscataway, NJ 08854

 

Rae Aranas, MD 

350 Grove St.

Bridgewater, NJ 08807

Surgical Care Affiliates

 

 

 

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Notice of Privacy Practices

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.

 

At Surgical Care Affiliates (“SCA”), we understand that medical information about you and your health is personal, and we are committed to protecting that information. This Notice of Privacy Practices describes how we and the medical staff and personnel who provide you with care or services at this facility may use and disclose your Protected Health Information (“PHI”) 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 PHI, which is information about you, including demographic information that may identify you and that relates to your past, present or future physical or mental health or condition and related healthcare services. We are required by law to maintain the privacy of your PHI, to provide notice of our legal duties and privacy practices with respect to your PHI, to notify affected individuals following a breach of unsecured PHI, and to abide by the terms of this Notice of Privacy Practices.

 

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. Upon your request, you can receive any revised Notice of Privacy Practices by accessing our website www.scasurgery.com, contacting the facility where you received services, or by contacting the Privacy Officer: privacy.officer@scasurgery.com.

 

1. How We May Use and Disclose Your PHI.

We may use or disclose your PHI as described in this section. The following are examples of the types of uses and disclosures of your PHI that SCA is permitted to make without your specific authorization. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our facility.  Where State or federal law restricts one of the described uses or disclosures, SCA will follow the requirements of such State or federal law.  The following are general descriptions only.  They do not cover every example of disclosure within a category.  However, all of the ways SCA is permitted to use and disclose your PHI will fall within one of the categories in this Notice of Privacy Practices. 

 

Treatment. We may use PHI about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students or other personnel who are involved in your care to, for example, plan a course of treatment for you. We also may disclose PHI about you to individuals outside of SCA who may be involved in your medical care, such as family members or others we use to provide services that are part of your care.

 

Payment. Your PHI will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and undertaking utilization review activities. For example, obtaining approval for a surgery may require that your relevant PHI be disclosed to your health plan.

 

Healthcare Operations. We may use or disclose your PHI as needed to support our business activities. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other healthcare operations.  For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel and others to:

 

• Evaluate the performance of our staff;

• Assess the quality of care and outcomes in your case and similar cases;

• Learn how to improve our facilities and services; or

• Determine how to continually improve the quality and effectiveness of the health care we provide.

 

In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your healthcare provider is ready to see you. We may use or disclose your PHI, as necessary, to contact you to remind you of your appointment.

 

We will share your PHI with third party “business associates” that may perform various activities (e.g., billing or transcription services) for SCA. Whenever an arrangement between our facility and a business associate involves the use or disclosure of your PHI, we will require the business associate to appropriately safeguard it.

 

2. Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or Opportunity to Object. You have the opportunity to authorize or object to the use or disclosure of all or part of your PHI. You may revoke your authorization at any time, but your revocation will only be effective for future uses and disclosures and will not affect any use or disclosure made in reliance on your authorization.  If you are not present or able to authorize or object to the use or disclosure of the PHI, then your healthcare provider may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your healthcare will be disclosed. We may use and disclose your PHI in the following instances.  Other uses and disclosures not described in this Notice of Privacy Practices will be made only with your written authorization.   

 

Facility Directories. Unless you object, we will use and disclose in our facility directory your name, the location at which you are receiving care, your condition (in general terms) and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name. Members of the clergy will be told of your religious affiliation.

 

Others Involved in Your Healthcare. Unless you object, 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. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, about your general condition or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare.

 

In addition, with few exceptions, unless you provide written authorization, we will not use or disclose your PHI for marketing purposes and we will not sell your PHI. 

 

3. Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object. We may use or disclose your PHI without your authorization in the following situations:

 

Required By Law. We may use or disclose your PHI to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.

 

Public Health. We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your PHI, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

 

Communicable Diseases. We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

 

Health Oversight. We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws.

 

Abuse or Neglect. We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI to the governmental entity or agency authorized to receive such information if we believe that you have been a victim of abuse, neglect or domestic violence. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

 

Food and Drug Administration (“FDA”). We may disclose your PHI to a person or company required by the FDA to report information such as adverse events and product defects, to enable product recalls, to make repairs or replacements, or to conduct post marketing surveillance.

 

Legal Proceedings. We may disclose PHI in response to a court or administrative order. We may also disclose PHI in response to a subpoena, discovery request, or other lawful process, but only if a reasonable effort has been made to tell you about the request or to obtain an order protecting the information requested.

 

Law Enforcement. We may release PHI for certain law enforcement purposes including, for example, reports required by law, to comply with a court order or warrant, or to report or answer questions about a crime.

 

Coroners, Funeral Directors and Organ Donation. We may disclose PHI to a coroner, funeral director or medical examiner as necessary to permit them to carry out their duties.

 

Research. We may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.

 

Criminal Activity. Consistent with applicable federal and state laws, we may disclose your PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.

 

Military Activity and National Security. When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President of the United States or other officials.

 

Workers’ Compensation. Your PHI may be disclosed by us as authorized to comply with workers compensation laws and other similar legally established programs.

 

Required Uses and Disclosures. Under the law, we must make disclosures to you and to the U.S. Department of Health and Human Services when required to determine our compliance with the requirements of the Federal Privacy Standards.

 

4. Your Rights. Following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights. We have the right to deny your request in certain circumstances. We will inform you if your request is denied.

 

Right to Access Your PHI. You may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as we maintain the PHI. A “designated record set” contains medical and billing records and any other records that your healthcare provider and SCA use for making decisions about you. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative action or proceeding; and, PHI that is subject to law that prohibits access to PHI. Depending on the circumstances, a decision to deny access may be reviewable.  If the information you request is maintained electronically, and you request an electronic copy, we will provide a copy In the electronic form and format you request, if the information can be readily produced in that form and format.  If the information cannot be readily produced in that form and format, we will work with you to come to an agreement on form and format. 

 

Please contact the facility’s Medical Records Department if you have questions about access to your PHI. If you request a copy of the information, we may charge a fee for the costs of retrieving, copying, mailing and any other supplies associated with your request. Your records remain the property of SCA.

 

Right to Request a Restriction on the Use or Disclosure of Your PHI. 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 or for notification purposes as described in the Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.  Except as provided in the following paragraph, we are not required to agree to your request.  However, if we do agree to the request, we will honor the restriction until you revoke it or we notify you.

 

We will comply with any restriction request if (1) except as otherwise required by law, the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment); and (2) the PHI pertains solely to a health care item or service for which the health care provider involved has been paid out-of-pocket in full.  SCA is not responsible for notifying subsequent health care providers of your request for restrictions on disclosures to health plans for those items and services, so you will need to notify other providers if you want them to abide by the same restriction.

 

To request restrictions, you must make your request in writing to SCA.  In your request, you 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 to Receive Confidential Communications From Us. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will attempt to accommodate reasonable requests. We will not request an explanation from you as to the basis for the request. Please make this request in writing to the facility’s Medical Records Department.

 

Right to Request Amendment. If you think that the PHI we have about you is wrong or incomplete, you may ask us to amend the information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact the facility’s Medical Records Department if you have a question about amending your medical record.

 

Right to Request an Accounting of Certain Disclosures. You may request a list of our disclosures of your PHI, subject to several exceptions and limitations. For example, this right does not apply to disclosures for purposes other than treatment, payment or healthcare operations, and it excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures.  To request this list or accounting of disclosures, you must submit your request in writing to SCA's Privacy Officer.  Your request must state a time period that may not be longer than six years prior to the request date and may not include dates before April 14, 2003.  The first list you request within a 12-month period will be free.  For additional lists during the same 12-month period, we may charge you for the cost of providing the list.  We will notify you of the cost Involved and you may choose to withdraw or modify your request at the time before any costs are incurred.

 

Right to Be Notified of a Breach.  You have a right to be notified in the event that we discover a breach of unsecured PHI, as defined under federal law.

 

Right to Obtain a Paper Copy of This Notice. You have the right to obtain a paper copy of this notice, even if you agreed to receive such notice electronically. You may ask us to give you a copy of this notice at any time. To request a copy of this notice, you can make your request in writing to SCA’s Privacy Officer (contact information is below).

 

5. Questions and Complaints.

You may file a complaint with us or with the Secretary of the Department of Health and 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 of your complaint. We will not retaliate against you for filing a complaint. For further information about the complaint process, or to make any requests or inquiries, you may contact our Privacy Officer at:

 

Privacy Officer

Surgical Care Affiliates

569 Brookwood Village Suite 901

Birmingham, AL 35209

Telephone: (205) 545-2713

E-mail: privacy.officer@scasurgery.com

 

This notice was effective on April 14, 2003 and revised on April 28, 2015.

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Anti-Discrimination

 Raritan Valley Surgery Center complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.  Raritan Valley Surgery Center does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

            Raritan Valley Surgery Center:

            • Provides free aids and services to people with disabilities to communicate effectively with us, such as:

                        ○ Qualified sign language interpreters

            ○ Written information in other formats (large print, audio, accessible electronic formats, other formats)

            • Provides free language services to people whose primary language is not English, such as:

                        ○ Qualified interpreters

                        ○ Information written in other languages

If you need these services, contact Karen Thompson.

If you believe that Raritan Valley Surgery Center has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with Karen Thompson, Administrator, 100 Franklin Square Dr. Suite 100, Somerset, NJ 08873, Phone- (732) 560-1000, Fax (732) 560-9990, Email Karen.Thompson@scasurgery.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Karen Thompson, Administrator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Español

ATENCIÓN:  si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.  Llame al 1-877-286-9235 (TTY: 1-866-827-7028).

繁體中文

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電1-877-286-9235TTY1-866-827-7028

한국어

주의:  한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.  1-877-286-9235 (TTY: 1-866-827-7028)번으로 전화해 주십시오.

Português

ATENÇÃO:  Se fala português, encontram-se disponíveis serviços linguísticos, grátis.  Ligue para 1-877-286-9235 (TTY: 1-866-827-7028).

ગુજરાતી

સુચના: જો તમે ગુજરાતી બોલતા હો, તો નિ:શુલ્ક ભાષા સહાય સેવાઓ તમારા માટે ઉપલબ્ધ છે. ફોન કરો  1-877-286-9235 (TTY: 1-866-827-7028).

 

Polski

UWAGA:  Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej.  Zadzwoń pod numer 1-877-286-9235 (TTY: 1-866-827-7028).

Italiano

ATTENZIONE:  In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti.  Chiamare il numero 1-877-286-9235 (TTY: 1-866-827-7028).

العربية

ملحوظة:  إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان.  اتصل برقم 1-5329-682-778 (رقم هاتف الصم والبكم: 1-8207-728-668)

Tagalog

PAUNAWA:  Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.  Tumawag sa 1-877-286-9235 (TTY: 1-866-827-7028).

Русский

ВНИМАНИЕ:  Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода.  Звоните 1-877-286-9235 (телетайп: 1-866-827-7028).

Kreyòl Ayisyen

ATANSYON:  Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou.  Rele 1-877-286-9235 (TTY: 1-866-827-7028).

हिंदी

ध्यान दें:  यदि आप हिंदी बोलते हैं तो आपके लिए मुफ्त में भाषा सहायता सेवाएं उपलब्ध हैं। 1-877-286-9235 (TTY: 1-866-827-7028) पर कॉल करें।

Tiếng Việt

CHÚ Ý:  Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.  Gọi số 1-877-286-9235 (TTY: 1-866-827-7028).

Français

ATTENTION :  Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement.  Appelez le 1-877-286-9235 (ATS : 1-866-827-7028).

اُردُو

خبردار: اگر آپ اردو بولتے ہیں، تو آپ کو زبان کی مدد کی خدمات مفت میں دستیاب ہیں ۔ کال

1-877-286-9235 (TTY: 1-866-827-7028).

 

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