Patient Privacy Information

UTAH CANCER SPECIALISTS, P.C.
NOTICE OF PRIVACY PRACTICES
Effective Date: June 30, 2013

THIS NOTICE OF PRIVACY PRACTICES (“NOTICE”) DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

Our Commitment to Privacy. Utah Cancer Specialists, P.C. (“UCS”) is a highly specialized medical practice dedicated to the diagnosis, treatment and management of all forms of cancer and blood-related diseases. In addition to providing you with the information, care and support you need, UCS is committed to protecting the privacy of your personal health information. As part of our commitment, we have developed this Notice to inform you about our privacy practices.

UCS is required by state and federal laws to protect the privacy of your personal health
information. We are also required by law to provide you with this Notice. Any time we use or disclose your personal health information, we must follow the terms of this Notice currently in effect. The remainder of this Notice provides you with information about how we may use and disclose your personal health information in different circumstances, the choices and rights you have about how your personal health information may be used and disclosed, and our obligations to protect the privacy of your personal health information. After reading this Notice, if you have any questions about its contents, please contact our Contact Person at the telephone number or address provided below.

How We Use And Disclose Your Personal Health Information.

  • Uses and Disclosures for Treatment, Payment and Health Care Operations. UCS
    may use or disclose your personal health information to provide your treatment, to obtain payment for your treatment and for our own health care operations, referred to in this Notice as our “health care operations.” Examples of how UCS may use your personal health information include the following:

    1. Uses and Disclosures for Treatment. UCS keeps record of care and services
      provided to you. We use these records to plan, provide and coordinate your health care services. For example, various members of UCS’ medical staff may view your personal health information as necessary to provide the best care for you. Or, we may provide your personal health information to another health care provider who, at the request of your UCS physician, is needed to assist with providing a diagnosis or in treating you.
    2. Uses and Disclosures of Payment. We may use and disclose your personal
      health information to obtain payment for health care services we have provided to you. For example, a bill for services provided may be sent to you or to your insurance company that includes information that identifies you and provides information about your treatment. Or, we may forward additional information about you to your insurance company or to a government agency to substantiate the medical necessity of the care we provided in order to obtain payment for our services.
    3. Uses and Disclosures for Health Care Operations. We may use or disclose your personal health information for our health care operations. For example, we may use or disclose your personal health information to perform risk assessments and other administrative tasks to monitor the quality of care that we provide. Also, we may contact you to provide appointment reminders or information about treatment alternatives or to tell you about health-related benefits and services that may be of interest to you.
    4. Other Uses of Your Health Information. We may also use your personal health information in order to:
      • Recommend treatment alternatives;
      • Tell you about health services and products that may benefit you;
      • Share information with family or friends involved in your care or payment
        for your care, when appropriate;
      • Share information with third parties who assist us with treatment,
        payment, and health care operations. We require such business
        associates of UCS to appropriately safeguard your information in
        accordance with applicable state and federal law;
      • Remind you of an appointment; or
      • Contact you or provide you with our education materials such as newsletters or research participation requests.

In some situations, state and federal laws may further restrict how we use or disclose your information for treatment, payment and health care operations. For example, certain treatment records, test results, conversations with mental health professionals, or information about minors may have additional restrictions on the use or disclosure of such information. In such situations, UCS will make sure it complies fully with such laws.

  • Uses and Disclosures without an Authorization. There are other limited situations
    where UCS may use or disclose your personal health information without obtaining your authorization. Those situations include the following:

    1. For public health purposes, such as reporting communicable diseases, work-related illnesses, or other diseases and injuries as permitted by law; reporting births and deaths; and reporting reactions to drugs and problems with medical devices;
    2. To protect victims of abuse, neglect, or domestic violence;
    3. For health oversight activities such as investigations, audits, and inspections;
    4. For law enforcement purposes;
    5. For lawsuits and similar proceedings;
    6. When requested by law enforcement as required by law or court order;
    7. To coroners, medical examiners, and funeral directors;
    8. For organ and tissue donation;
    9. For research under strict federal guidelines;
    10. To reduce or prevent a serious threat to public health and safety;
    11. For workers’ compensation or other similar programs if you are injured at work;
    12. For specialized government functions such as intelligence and national security;
    13. For accreditation purposes; and
    14. When otherwise required by law.

UCS may also submit your personal health information to the Medicaid eligibility database, the Children’s Health Insurance Program eligibility database, and/or other shared clinical databases or health information exchanges.

  • Uses and Disclosures with Your Authorization. For all other uses and disclosures of your personal health information, UCS will receive your prior written authorization. Please know that you have the right to revoke any authorization you previously granted. If you have any questions about authorizations, or how to revoke them, please contact our Contact Person at
    the telephone number or address provided below.

Your Individual Rights. You have the right to:

  • Request restrictions on how we use and share your health information. We will consider all requests for restrictions carefully, but are not required to agree to any restriction;
  • Request that we use a specific telephone number or address to communicate with you;
  • *Request to inspect and copy your health information, including an electronic copy of electronic medical records. Usually this includes medical and billing records, but does not include psychotherapy notes, if applicable. Fees may apply. Under limited circumstances, we may deny you access to a portion of your health information and you may request a review of the denial;
  • *Request corrections, amendment or additions to your health information;
  • *Request an accounting of certain disclosures of your health information made by us. The accounting does not include disclosures made for treatment, payment, and health care operations and some disclosures required by law. Your request must state the period of time desired for the accounting, which period is limited by law. The first accounting is free, but a fee will apply if more than one request is made in any 12-month period;
  • *Request that we restrict the disclosure of certain health information to a health plan if the disclosure is for payment or health care operations and pertains to a health care item or service for which you have paid out of pocket in full; and

Request a paper copy of this Notice even if you agree to receive it electronically.
Requests marked with a star (*) above must be made in writing. Contact the Contact Person, listed below, for the appropriate form for your request.

Privacy Responsibilities. UCS is required by law to:

  • Maintain the privacy of your health information;</li>
  • Provide this Notice that describes the ways we may use and share your health
    information;
  • Accommodate reasonable requests to communicate your health information by
    alternative means or at alternative locations;
  • Notify you of any reportable breach or security incident of your unsecured health
    information; and
  • Follow the terms of the Notice currently in effect.

Changes to Notice. We reserve the right to make changes to this Notice at any time, and to make any new privacy practices effective for all information we maintain. Current Notices will be posted in our facilities and on our website, www.utahcancer.com. You may also request a copy of any Notice from the Contact Person listed below.

Contact Person. Questions about our privacy practices, your rights, our obligations to protect your personal health information, and requests for access to your medical records should be addressed to the following:

Utah Cancer Specialists, P.C.
Director of Administrative Services
3838 South 700 East, Suite 100
Salt Lake City, UT 84107
(801) 269-0231

Medical records are kept in the office where the patient is seen. After 2 years of inactivity, medical records are archived but are still accessible. After 10 years of inactivity, medical records are destroyed.

Right to File a Complaint. UCS will investigate all complaints regarding your privacy, and will not retaliate against you for filing a complaint. In addition to filing a complaint with the UCS Contact Person listed above in this Notice, you may also file a written complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services.

Our Organization. This Notice describes the privacy practices of UCS. UCS includes
physicians, employees and volunteers. This Notice also describes the privacy practices of affiliated providers while they are performing services on behalf of UCS. unless they provide to you a notice of their specific privacy practices. Affiliated providers are not employed by UCS but are authorized to provide services to UCS patients. Affiliated providers may have different privacy practices from those described in this Notice. For more information about the privacy practices of affiliated providers, please contact them directly.

Effective Date. This notice is effective as of June 30, 2013. For new UCS patients after that date, the effective date is the first date of service as noted in the patient’s medical record.

1238204-4