Allegheny Regional Surgical Associates Notice of Privacy Practices


Effective April 14, 2003
Revised: August 31, 2012

If you have any questions about this Notice, please contact our office at 889-7500.

This Notice of Privacy Practices applies to Allegheny Regional Surgical Associates. (to include both outpatient and inpatients.)

When this Notice refers to "we" or "us", it is referring to your physician, our office staff and others outside of our offices that are involved in your care and treatment. This Notice applies only to protected health information created or obtained in connection with medical care we provided to you.


We recognize that medical information about you and your health is personal. As a provider of healthcare services, we are committed to maintaining the privacy of the medical information that we create, receive, and maintain on behalf of our patients. This notice will tell you how we may use and disclose medical information about you. We may, in the future, revise or amend this Notice of Privacy Practices. If we do, any revision or amendment to this Notice will be effective for all of your records that we maintain, as well as for any future records that we may create or maintain. You will be offered a copy of the current notice when you present to the office for treatment. You will be asked to acknowledge in writing your receipt of this Notice. The Notice is posted on our website, which may be accessed at www.alleghenyregionalsurgical.com.


There are a number of instances in which we will need to use and to disclose your medical information. For some uses and disclosures, we will need your permission to release the information. In general, for routine uses of your health information for treatment, payment, and regular office operational purposes, your permission is not required. The following categories describe some of the ways that we may use and disclose medical information without obtaining your prior authorization. These circumstances include:


We may use medical information about you in order to diagnose illness and to provide you with medical treatment and services. In order to provide you with care, we may disclose medical information about you to the doctors, nurses, technicians, medical and nursing students and other hospital personnel or healthcare providers who are involved in taking care of you. We may also share information with physicians or other providers of care who take care of you. For example, your family physician may need to review some of your records in order to provide care for you.

In addition, different departments of the hospital may share medical information about you in order to coordinate the different services you may need, such as lab work, X-rays or other types of testing. It is our practice to provide test results to the physician who ordered the test. We may also disclose medical information about you to people outside of the hospital, such as nursing homes, home health agencies, or rehab facilities for purposes of coordinating your care upon discharge.


We may use and disclose medical information about you so that the treatment and services you receive may be appropriately billed to and that payment may be collected from your insurance provider or from you. For example, we may need to give your health plan information about surgery you received so that your health plan will pay for the surgery. Depending on the requirements of your health coverage, we may need to disclose medical information in order to receive prior approval for planned treatment. For example, many health plans require pre-authorization for MRI studies.

There may be other instances in which we will need to communicate with your health insurer in order to determine whether your treatment will be covered. In situations where money is owed and patients have not made prior arrangements with us, we do use collection agencies to assist us in attempting to recover payment for services provided.

We may also disclose medical information about you to other healthcare providers in order to assist them in appropriately billing for care and treatment that has been provided to you.


We may use and disclose medical information about you for routine office operations. These uses and disclosures are necessary to operate the office and to make sure our patients receive cost-effective, quality care.

In addition, we may contact you for appointment reminders, to contact you for scheduled services or to gather pre-office information. We may want to inform you about possible treatment options, alternatives, health-related benefits or services that may be of interest to you.


We may use or disclose medical information about you without your prior authorization for a number of other purposes, which may include:

To Communicate with Your Family. Unless you object, our staff, using their best judgment, may disclose to a member of your family, to a relative or a close friend, or to any other person you identify, health information relevant to that person's involvement in your care or payment related to your care. We may also disclose information to any of these people in an attempt to notify or to assist in notifying them of your location and general condition in the case of an emergency.

To Our Business Associates. We provide some services through contracts with business associates. Examples of some of our business associates include: answering service, record storage, legal services, consultant services, accreditation and many others. When we contract with business associates, we may disclose your health information to the business associate so that they can perform the function that we have contracted with them to do. In order to protect your health information, we require the business associate to appropriately safeguard any information to which we give them access.

When Legally Required. The office will disclose your health information when it is required to do so by any Federal, State, or local law or in response to a valid subpoena or court order.

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

To Report to the Food & Drug Administration (FDA). We may disclose to the FDA health information related to adverse effects or events with respect to food, drugs, supplements, products, devices, or post-marketing surveillance information to enable product or device recall, repairs or replacements.

To Report Abuse or Neglect. The office is required to notify appropriate authorities if the hospital believes that a child or other care-dependent patient is a victim of abuse or neglect. We are also required to report injuries that are a result of criminal conduct.

To Conduct Health Oversight Activities. The office may disclose your health information to a health oversight agency for activities including audits, civil, administrative or criminal investigations, inspections, licensure, or disciplinary actions.

For Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transplantation.

To Coroners and Medical Examiners. We may disclose your health information to coroners and medical examiners for purposes of determining a cause of death or for other purposes related to their official duties as authorized by law.

To Funeral Directors. We may disclose your health information to funeral directors as necessary to carry out their duties.

For Worker's Compensation. The office may disclose your health information to the extent authorized by and to the extent necessary to comply with the laws related to worker's compensation or similar programs that provide benefits for work-related injuries or illness.

When a Crime is Committed at the Office. If we believe that you have committed or if you threaten to commit a crime at the office, on office property, or against office staff, we will disclose relevant health information to the proper law enforcement authorities.

In the Event of a Serious Threat to Health or Safety. The office may, consistent with applicable law and ethical standards of conduct, disclose your health information if we, in good faith, believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health or safety of the public.

For Specified Government Functions. In certain circumstances, the law authorizes the office to use or disclose your health information to facilitate specified governmental functions relating to military and national security, intelligence activities, protective services for the President and others, and medical suitability determinations. We must also disclose information to the Department of Health and Human Services (DHHS) as necessary for them to determine our compliance with the law.


You have the following rights in connection with the medical information we maintain about you.


You have the right to review and/or to request a copy of your medical information. We require that you make these requests in writing. Our office has Authorization forms that you must complete to let us know what records you wish to look at or to have a copy of. The completed Authorization forms should be given to the office who will then process your request. You may be charged a fee to cover the cost of copying the records that you request.

In certain very limited circumstances, we may deny your request. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by our office 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 the review.


If you believe that information in your medical record is incorrect or if you find that important information is missing, you have the right to request that we correct the records by submitting a request in writing that provides your reason for requesting the amendment. Forms for making such requests are available in our office. 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; if it is not part of the medical information kept by us; or if we determine that the record is accurate. You may appeal, in writing, a decision by us not to amend a record.


You have the right to receive a list of those instances where we have disclosed medical information about you. (These requests must be in writing and on the appropriate form. The first disclosure list you request in a 12-month period is free. Other requests will be charged according to our cost of producing the list.) This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices. The right to receive this is subject to certain exceptions, restriction and limitations.


You have a right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare 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. These requests must be submitted in writing at the time of or prior to your visit. Upon request, the staff registering you will provide you with the appropriate form and will process your request. We will consider your request, but we are not required to agree to it. We will inform you of our decision on your request. If we do agree, we will comply with your request unless we need to use or disclose the information in order to provide you with emergency treatment.


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 may ask that we send medical information to an address other than your home address. We will attempt to accommodate all reasonable requests, but are not required by law to accommodate every request made. We prefer that these requests be made at the time of registration or admission. We will need an address and phone number where we are able to send you information and contact you. If you have an answering machine, it is our general practice to leave a very limited message that directs you to return the call.


You have the right to receive from us a paper copy of this Notice. Copies will be available upon request by contacting the office at (814) 889-7500.


If you are concerned that your privacy rights may have been violated, you may contact the office by phone at (814) 889-7500 and ask for the Privacy Officer; by mail to 620 Howard Avenue, Suite 3F, Altoona, PA 16601. In addition, you may file a written complaint with the Secretary of the Department of Health and Human Services, Office of Civil Rights. Under no circumstances will you be penalized or retaliated against for filing a complaint.