Effective Date: April 14, 2003

To our Patients and their Families:

1.) This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information.  Please review it carefully.

2.) This Privacy Notice is being provided to you as a requirement of a federal law, the Health Insurance Portability and Accountability Act (HIPAA).  This privacy notice describes how we may use and disclose your protected heath information (PHI) to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law.  It also describes your rights to access and control your protected health information in some cases.  Your “protected health information” (PHI) means any written and oral health information about you, including demographic data that can be used to identify you.  This is health information that is created or received by your health care provider, and that relates to your past, present or future physical or mental health or condition.

Uses and Disclosures of Protected Health Information

Central Anesthesia Service Exchange Medical Group, Inc. (C.A.S.E. Medical Group) may use patient protected health information for purposes of providing treatment, obtaining payment for treatment and for conducting health care operations.  Protected Health Information (PHI) may be used or disclosed only for these purposes unless C.A.S.E. Medical Group has obtained patient authorization or the use of disclosure is otherwise permitted by the HIPAA privacy regulations or state law.  Disclosures of PHI for the purposes described in this Privacy Notice may be made in writing, orally, or by facsimile.
What type of information will Central Anesthesia Service Exchange Medical Group, Inc. collect from patients?
 Some of the information that is collected consists of names, addresses, telephone numbers, dates of birth, and Social Security Numbers.  This also can include information about health, diagnosis, health insurance, employer and medication use.
How is this information obtained?
 This information is obtained from patients, referring physicians, the healthcare facilities where             patients receive services, insurance carriers and pharmacies.
How do we use the information collected?
Treatment and evaluation in the facilities where patients receive our services.

Calling in or confirming prescriptions to pharmacies
To discuss diagnosis and t
reatment with patient families or guardians or if you are an inmate, with a correctional institution or law enforcement official.
In order to refer the patient for further diagnostic studies.
Collection agency use.
Sending patient medical records to attorneys and Workers Compensation Adjusters.
For dictation and transcription.
Sending information to other persons or companies where patients have signed a valid Release of Information.
How do we store this information?
The information is stored on paper and computers in the office of our chronic pain practice as well as at the billing office of C.A.S.E. Medical Group.
How do we supply this information to others?
It is shared by fax, email, telephone, US Postal Service, Internet and personal communications. We share only the minimum information necessary for treatment, payment and healthcare operations.
Do we sell this information to any one?
Central Anesthesia Service Exchange Medical Group, Inc. does not sell, provide or market the information to any one.

With whom can we share the information?
The reports generated by our chronic pain practice office, such as initial consultation, follow up visits, test results (ordered by us) during the patient’s  treatment  are routinely sent to the patient’s  referring physician and in the case of workers compensation, to the adjuster, and to our  billing office.  For all of our patients we forward the necessary reports to insurance companies in order for them to make payments or to obtain authorization for further treatment with us.
How do we keep track of the disclosure of information?
As of April 14, 2003, a disclosure history will be kept in the patient’s file of all non-routine disclosures.  Non-routine disclosure consists of supplying information for reasons other than treatment, payment and healthcare operations.  For instance, a separate authorization is required for disclosure for marketing or research purposes.
How secure is the information?
Our computers are password protected. Our computer uses firewall and we continually back up the system. Our staff training includes privacy and security rules.
Can patients change any information?
Yes, they have the right to request an amendment to their healthcare information.  For security, we back up the data on our system and that backup information cannot be updated.  Their request may be denied if not submitted in writing, or if it is submitted without a reason supporting the request for change.  Also we may deny your request for change if the information did not originate with us.  
Can patients obtain a copy of their medical records?
Yes, with a completed written request available from our office. Upon receipt of the request and the appropriate fee we will process your request.  It can take up to four business days for the copies to be ready.
What is the fee to obtain copies of medical records? 
The fee for copies of medical records is $15 at our pain physician office.  We supply information to other treating doctors as a courtesy. 
What medical records do we copy?
Billing records consist of an itemized statement.  Anesthesia records may be obtained from the facility where the patient received services.  The Chronic Pain practice office supplies only those records generated at that office.  These reports are procedure reports and results of any diagnostic tests ordered by the office.  Data in the patient file from the patient’s other providers is not included

Changes to our Privacy Policy

Modifications, additions or other changes may occur periodically.  The changes will be posted in our Notice of Privacy Practices here or a paper copy can be obtained from our office. 


If there are questions about the Privacy Practices of this office, please contact the Privacy Officer at the following address.
Central Anesthesia Service Exchange
Medical Group, Inc.

Attn: Privacy Officer
P.O. Box 660910
Sacramento, CA  95866-0910
916.481.0777 x210
If you believe your privacy rights have been violated by us you have the right to file a complaint or if you disagree with a decision we made concerning your rights as listed above.  All complaints must be submitted in writing within 180 days of the incident that caused the complaint, or the date that you first became aware of the incident
You may also contact the Department of Health and Human Services.