Patient Information

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.

This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law.

TeamMD Surgery Center is an Out of Network facility. The Center accepts Commercial Insurance with Out-Of-Network (OON) Benefits, Auto Insurance and Workers Compensation Insurance (subject to pre-approval). The Center does not participate in Managed Care or Medicaid plans. TeamMD Surgery Center participates with Medicare.

TeamMD Surgery Center LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Under Section 1557 of the Affordable Care Act (ACA), covered entities are required to post notices of non-discrimination and taglines that alert individuals with limited English proficiency (LEP) to the availability of language assistance services.

TeamMD Surgery Center is dedicated to providing the best healthcare services possible. To help accomplish this mission, TeamMD Surgery Center believes that all patients should know their rights and responsibilities.

Patient Rights:
1. The right to exercise these rights without regard to age, sex, economic status, educational background, race, color, religion,s.

• Your time of arrival will be confirmed with you the day before your procedure.
• If you are getting sedation or general anesthesia, do not eat or drink at least 8 hours prior to your procedure, including water, gum, and candy. If you are getting ONLY local anesthesia with no sedation, you can eat a light meal, no caffeine.
• ASTHMA: if necessary, take 2 puffs of your inhaler before you come to the center. Bring any emergency inhalers with you.

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

What is “balance billing” (sometimes called “surprise billing”)?

973-567-4162

1167 McBride Ave, Ste 4
Woodland Park, NJ 07424

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HIPAA Notice of Privacy Practices

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