Patient Rights and Responsibilities
As a patient at Millennium Surgical Center, the patient has the following rights:
1. To be informed of these rights, as evidenced by the patient’s written acknowledgement, or by documentation by staff in the medical record, that the patient was offered a written copy of these rights and given a written or verbal explanation of these rights, in terms the patient could understand. The facility shall have a means to notify patients of any rules and regulations it has adopted governing patient conduct in the facility.
2. To be informed of services available in the facility, of the names and professional status of the personnel providing and/or responsible for the patient’s care, and of fees and related charges, including the payment, fee, deposit, and refund policy of the facility and any charges for services not covered by sources of third party payment or not covered by the facility’s basic rate;
3. To be informed if facility has authorized other health care and educational institutions to participate in the patient’s treatment. The patient also shall have the right to know the identity and function of these institutions, and to refuse to allow their participation in the patient’s treatment;
4. To receive from the patient’s physician(s) or clinical practitioner(s), in terms that the patient understands, an explanation of his or her complete medical/health condition or diagnosis, recommended treatment, treatment options, including the option of no treatment, risk(s) of treatment, and expected results(s). If this information would be detrimental to the patient’s health, or if the patient is not capable of understanding the information, the explanation shall be provided to the patient’s next of kin or guardian. This release of information to the next of kin or guardian along with the reason for not informing the patient directly, shall be documented in the patient’s medical record;
5. To participate in the planning of the patient’s care and treatment, and to refuse medication and treatment. Such refusal shall be documented in the patient’s medical record;
6. To be included in experimental research only when the patient gives informed, written consent to such participation, or when a guardian gives such consent for an incompetent patient in accordance with law, rule and regulation. The patient may refuse to participate in experimental research, including the investigation of new drugs and medical devices;
7. To voice grievances or recommend changes in policies and services to facility personnel, the governing authority, and/or outside representatives of the patient’s choice either individually or as a group, and free from restraint, interference, coercion, discrimination or reprisal;
8. To be free from mental and physical abuse, free from exploitation, and free from use of restraints unless they are authorized by a physician for a limited period of time to protect the patient or others from injury. Drugs and other medications shall not be used for discipline of patients or for convenience of facility personnel;
9. To be treated with courtesy, consideration, respect and recognition of the patient’s dignity, individuality, and right to privacy, including but not limited to, auditory and visual privacy. The patients privacy shall be respected when facility personnel are discussing the patient:
10. To confidential treatment of information about the patient. Information in the patients medical record shall not be released to anyone outside the facility without the patients approval, unless another healthcare facility to which the patient was transferred required the information, or unless the release of the information is required and permitted by law, a third-party payment contract, or a peer review, or unless the information is needed by the New Jersey Sate Department of Health for statutorily authorized purposes. The facility may release data about the patient for studies containing aggregated statistics when the patients identity is masked;
11. To not be required to perform work for the facility unless the work is part of the patient’s treatment and is performed voluntarily by the patient. Such work shall be in accordance with Local, State and Federal laws and rules;
12. To exercise civil and religious liberties, including the right to independent personnel decisions. No religious belief or practices; or any attendance at religious services, shall be imposed upon the patient;
13. To not be discriminated against because of age, race, religion, sex, nationality, or ability to pay, or deprived of any constitutional, civil, and/or legal rights solely because of receiving services from the facility; and
14. To expect and receive assessment, management and treatment of pain as an integral component of that person’s care in accordance with NJAC 8:43E-6.
As a patient at Millennium Surgical Center, the patient has the following responsibilities:
1. Patients and families, as appropriate, must provide, to the best of their knowledge, accurate and complete information about present complaints, past illnesses, hospitalization, medications, and other matters relating to their health. Patients and their families must report perceived risks in unexpected changes in their condition. They can help the organization understand their environment by providing feedback about service needs and expectations.
2. Patients and families, as appropriate, must ask questions when they do not understand their care, treatment, and service or what they are expected to do.
3. Patients and their families must follow the care, treatment, and service plan developed. They should express any concerns about their ability to follow the proposed care plan or course of care, treatment, and services. The organization makes every effort to adapt the plan to the specific needs and limitations of the patients. When such adaptations to the care, treatment, and service plan are not recommended, patients and their families are informed of the consequences of the care, treatment, and service alternatives and not following the proposed course.
4. Patients and their families are responsible for the outcomes if they do not follow the care, treatment, and service plan.
5. Patients and their families must follow the organization’s rules and regulations.
6. Patients and their families must be considerate of the organization’s staff and property, as well as other patients and their property.
7. Patients and their families should promptly meet any financial obligation agreed to with the organization.
Complaints with regard to the quality of care & service rendered by this
facility can be lodged at:
New Jersey Department of Health and Senior Services
Division of Health Facilities Evaluation and Licensing
PO Box 367
Trenton, NJ 08625-0367
Office of the Medicare Beneficiary Ombudsman
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.
Who Presents This Notice
This Notice describes the privacy practices of Millennium Surgical Center (the "Center") and members of its workforce, as well as the physician members of the medical staff and allied health professionals who practice at the Center. The Center and the individual health care providers together are sometimes called "the Center and Health Professionals" in this Notice. While the Center and Health Professionals engage in many joint activities and provide services in a clinically integrated care setting, the Center and Health Professionals each are separate legal entities. This Notice applies to services furnished to you at Millennium Surgical Center, 2090 Springdale Road, Suite A, Cherry Hill, NJ 08003 as a Center outpatient or any other services provided to you in a Center-affiliated program involving the use or disclosure of your health information.
The Center and Health Professionals each are required by law to maintain the privacy of your health information ("Protected Health Information" or "PHI") and to provide you with this Notice of legal duties and privacy practices with respect to your Protected Health Information. The Center and Health Professionals use computerized systems that may subject your Protected Health Information to electronic disclosure for purposes of treatment, payment and/or health care operations as described below. When the Center and Health Professionals use or disclose your Protected Health Information, the Center and Health Professionals are required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure).
Permissible Uses and Disclosures Without Your Written Authorization
In certain situations your written authorization must be obtained in order to use and/or disclose your PHI. However, the Center and Health Professionals do not need any type of authorization from you for the following uses and disclosures:
Uses and Disclosures for Treatment, Payment and Health Care Operations. Your PHI, may be used and disclosed to treat you, obtain payment for services provided to you and conduct "health care operations" as detailed below:
- Treatment. Your PHI may be used and disclosed to provide treatment and other services to you–for example, to diagnose and treat your injury or illness. In addition, you may be contacted to provide you appointment reminders or information about treatment alternatives or other health–related benefits and services that may be of interest to you. Your PHI may also be disclosed to other providers involved in your treatment. For example, a doctor treating you for a broken leg may need to know if you have diabetes because if you do, this may impact your recovery.
- Payment. Your PHI may be used and disclosed to obtain payment for services provided to you–for example, disclosures to claim and obtain payment from your health insurer, HMO, or other company that arranges or pays the cost of some or all of your health care ("Your Payor") to verify that Your Payor will pay for health care. The physician who reads your x–ray may need to bill you or your Payor for reading of your x-ray therefore your billing information may be shared with the physician who read your x–ray.
- Health Care Operations. Your PHI may be used and disclosed for health care operations, which include internal administration and planning and various activities that improve the quality and cost effectiveness of the care delivered to you. For example, PHI may be used to evaluate the quality and competence of physicians, nurses and other health care workers. PHI may be disclosed to the Center Compliance & Privacy Office in order to resolve any complaints you may have and ensure that you have a comfortable visit. Your PHI may be provided to various governmental or accreditation entities such as the Joint Commission on Accreditation of Healthcare Organizations to maintain our license and accreditation. In addition, PHI may be shared with business associates who perform treatment, payment and health care operations services on behalf of the Center and Health Professionals.
Disclosure to Relatives, Close Friends and Other Caregivers. Your PHI may be disclosed to a family member, other relative, a close personal friend or any other person identified by you who is involved in your health care or helps pay for your care. If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of your incapacity or an emergency circumstance, the Center and/or Health Professionals may exercise professional judgment to determine whether a disclosure is in your best interests. If information is disclosed to a family member, other relative or a close personal friend, the Center and/or Health Professionals would disclose only information believed to be directly relevant to the person’s involvement with your health care or payment related to your health care. Your PHI also may be disclosed in order to notify (or assist in notifying) such persons of your location or general condition.
Public Health Activities. Your PHI may be disclosed for the following public health activities: (1) to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; (2) to report child abuse and neglect to public health authorities or other government authorities authorized by law to receive such reports; (3) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; (4) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and (5) to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance.
Victims of Abuse, Neglect or Domestic Violence. Your PHI may be disclosed to a governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse, neglect, or domestic violence if there is a reasonable belief that you are a victim of abuse, neglect or domestic violence.
Health Oversight Activities. Your PHI may be disclosed to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid.
Judicial and Administrative Proceedings.Your PHI may be disclosed in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
Law Enforcement Officials. Your PHI may be disclosed to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena. For example, your PHI may be disclosed to identify or locate a suspect, fugitive, material witness, or missing person or to report a crime or criminal conduct at the facility.
Correctional Institution. Your PHI may be disclosed to a correctional institution if you are an inmate in a correctional institution and if the correctional institution or law enforcement authority makes certain requests to us.
Business Associates Your PHI may be disclosed to business associates or third parties that the Center and Health Professionals have contracted with to perform agreed upon services.
Decedents. Your PHI may be disclosed to a coroner or medical examiner as authorized by law.
Organ and Tissue Procurement. Your PHI may be disclosed to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
Research Your PHI may be used or disclosed without your consent or authorization if an Institutional Review Board approves a waiver of authorization for disclosure.
Health or Safety. Your PHI may be used or disclosed to prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety.
Specialized Government Functions. Your PHI may be disclosed to units of the government with special functions, such as the U.S. military, the U.S. Department of State under certain circumstances such as the Secret Service or NSA to protect, for example, the country or the President.
Workers’ Compensation. Your PHI may be disclosed as authorized by and to the extent necessary to comply with state law relating to workers’ compensation or other similar programs.
As Required by Law. Your PHI may be used and disclosed when required to do so by any other law not already referred to in the preceding categories; such as required by the FDA, to monitor the safety of a medical device.
Appointment Reminders. Your PHI may be used to tell or remind you about appointments.
Fundraising. Your PHI may be used to contact you as a part of fundraising efforts, unless you elect not to receive this type of information.
USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
Use or Disclosure with Your Authorization. For any purpose other than the ones described above, your PHI may be used or disclosed only when you provide your written authorization on an authorization form ("Your Authorization"). For instance, you will need to execute an authorization form before your PHI can be sent to your life insurance company or to the attorney representing the other party in litigation in which you are involved.
Marketing. Your written authorization ("Your Marketing Authorization") also must be obtained prior to using your PHI to send you any marketing materials. (However, marketing materials can be provided to you in a face-to-face encounter without obtaining Your Marketing Authorization. The Center and/or Health Professionals are also permitted to give you a promotional gift of nominal value, if they so choose, without obtaining Your Marketing Authorization). The Center and/or Health Professionals may communicate with you in a face-to-face encounter about products or services relating to your treatment, case management or care coordination, or alternative treatments, therapies, providers or care settings without Your Marketing Authorization.
In addition, the Center and/or Health Professionals may send you treatment communications, unless you elect not to receive this type of communication, for which the Center and/or Health Professionals may receive financial remuneration.
Sale of PHI The Center and Health Professionals will not disclose your PHI without your authorization in exchange for direct or indirect payment except in limited circumstances permitted by law. These circumstances include public health activities; research; treatment of the individual; sale, transfer, merger or consolidation of the Center; services provided by a business associate, pursuant to a business associate agreement; providing an individual with a copy of their PHI; and other purposes deemed necessary and appropriate by Health and Human Services (HHS).
Uses and Disclosures of Your Highly Confidential Information. In addition, federal and state law require special privacy protections for certain highly confidential information about you ("Highly Confidential Information"), including the subset of your PHI that: (1) is maintained in psychotherapy notes; (2) is about mental illness, mental retardation and developmental disabilities; (3) is about alcohol or drug abuse or addiction; (4) is about HIV/AIDS testing, diagnosis or treatment; (5) is about communicable disease(s), including venereal disease(s); (6) is about genetic testing; (7) is about child abuse and neglect; (8) is about domestic abuse of an adult; or (9) is about sexual assault. In order for your Highly Confidential Information to be disclosed for a purpose other than those permitted by law, your written authorization is required.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
Right to Request Additional Restrictions. You may request restrictions on the use and disclosure of your PHI (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved with your care or with payment related to your care, or (3) to notify or assist in the notification of such individuals regarding your location and general condition. While all requests for additional restrictions will be carefully considered, the Center and Health Professionals are not required to agree to these requested restrictions.
You may also request to restrict disclosures of your PHI to your health plan for payment and healthcare operations purposes (and not for treatment) if the disclosure pertains to a healthcare item or service for which you paid out-of-pocket in full. The Center and Health Professionals must agree to abide by the restriction to your health plan EXCEPT when the disclosure is required by law.
If you wish to request additional restrictions, please obtain a request form from the Center’s Management Office and submit the completed form to the Center’s Management Office. A written response will be sent to you.
Right to Receive Confidential Communications. You may request, and the Center and Health Professionals will accommodate, any reasonable written request for you to receive your PHI by alternative means of communication or at alternative locations.
Right to Revoke Your Authorization. You may revoke Your Authorization, Your Marketing Authorization or any written authorization obtained in connection with your PHI, except to the extent that the Center and/or Health Professionals have taken action in reliance upon it, by delivering a written revocation statement to the Center’s Management Office identified below.
Right to Inspect and Copy Your Health Information. You may request access to your medical record file and billing records maintained by the Center and Health Professionals in order to inspect and request copies of the records. Under limited circumstances, you may be denied access to a portion of your records. If you desire access to your records, please obtain a record request form from the Center’s Management Office and submit the completed form to the Center’s Management Office. If you request copies of paper records, you will be charged in accordance with federal and state law. To the extent the request for records includes portions of records which are not in paper form (e.g., x-ray films), you will be charge the reasonable cost of the copies. You also will be charged for the postage costs, if you request that the copies be mailed to you. However, you will not be charged for copies that are requested in order to make or complete an application for a federal or state disability benefits program.
Right to Amend Your Records. You have the right to request that PHI maintained in your medical record file or billing records be amended. If you desire to amend your records, please obtain an amendment request form from the Center’s Management Office and submit the completed form to the Center’s Management Office. Your request will be accommodated unless the Center and/or Health Professionals believe that the information that would be amended is accurate and complete or other special circumstances apply.
Right to Receive an Accounting of Disclosures. Upon request, you may obtain an accounting of certain disclosures of your PHI made during any period of time prior to the date of your request provided such period does not exceed six years and does not apply to disclosures that occurred prior to April 14, 2003. If you request an accounting more than once during a twelve (12) month period, you will be charged for the accounting statement.
Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Notice, even if you have agreed to receive such notice electronically.
For Further Information or Complaints. If you desire further information about your privacy rights, are concerned that your privacy rights have been violated or disagree with a decision made about access to your PHI, you may contact the Center. You may also file written complaints with the Office for Civil Rights of the U.S. Department of Health and Human Services or online at https://www.hhs.gov/ocr/complaints/index.html. Upon request, the Center will provide you with the correct address for the Office for Civil Rights of the U.S. Department of Health and Human Services. The Center and Health Professionals will not retaliate against you if you file a complaint with the Center or the Director.
Effective Date and Duration of This Notice
Effective Date. This Notice is effective on 05/03/2016
Right to Change Terms of this Notice. The terms of this Notice may be changed at any time. If this Notice is changed, the new notice terms may be made effective for all PHI that the Center and Health Professionals maintain, including any information created or received prior to issuing the new notice. If this Notice is changed, the new notice will be posted in waiting areas around the Center and on our Internet site at www.mscsurgery.com. You also may obtain any new notice by contacting the Center.
Millennium Surgical Center
Attn: Administrator / Privacy Officer
2090 Springdale Road, Suite A
Cherry Hill, NJ 08003
Telephone Number: 856-751-4555
E-mail: [email protected]
Corporate Compliance & Privacy Office
United Surgical Partners International
15305 Dallas Parkway, Suite 1600
Addison, Texas 75001
Compliance Hotline: 1-800-8-ETHICS
Advance Directive Policy
Millennium Surgical Center is an outpatient facility, where only elective surgery and/or procedures are performed. Therefore all patients shall be presumed as having consented to cardiopulmonary resuscitation (CPR) when signing the consent for surgery.
CPR shall be defined as: the administering of any means or device to restore or support resuscitative functions in a patient, whether by mechanical devices, chest compressions, mouth-to-mouth resuscitation, cardiac massage, tracheal intubation, manual or mechanical ventilators or respirators, defibrillation, the administrations of drugs and/or chemical agents intended to restore cardiac and/or respiratory functions in a patient where cardiac or respiratory arrest has occurred or is believed to be imminent.
The following policies, in accordance with State law, have been instituted by Millennium Surgical Center due to the nature of the services provided by the facility:
- Patients are not required to have an Advance Directive
- Do not resuscitate (DNR) orders contained in Advance Directives are not acknowledged by the center
- In the event of a life-threatening emergency, patients are resuscitated, treated, stabilized, & transported to a higher level of care, as necessary
The official State of NJ advance directive form is available and can be downloaded from our forms tab.
Please be aware that the physician that refers you to the Millennium Surgical Center may have a beneficial equity interest in the facility. These physicians have a personal stake in maintaining its reputation, high quality of care, and success in the medical marketplace. As always, you have the option to seek treatment at a health care service provider of your own choice. A listing of alternative health care service providers can be found in the classified section of your telephone directory under the appropriate heading.
At Millennium Surgical Center we are constantly negotiating with insurance carriers to make access to our facility as easy as possible for our patients. Please be aware that services associated with your referral may be reimbursed at an out-of-network level by your insurance carrier or other third party payer.
Please let us know if you have any questions.