About HIPAA

Gramercy Surgery Center understands that our patients’ medical information is personal and private.

Please read the following HIPAA forms carefully to understand how Gramercy Surgery Center may use your healthcare information and how you can obtain access to this information.

HIPAA stands for the Health Insurance Portability and Accountability Act. It provides all people the right of privacy with regard to private healthcare information (PHI). This includes information that is collected in the process of providing healthcare, and may include your name, address, phone number, hospital record number, reason for providing healthcare, and the type of treatment you receive.

To read more, review the links below:

Advance Directive

Notice of Privacy Practices

Patient Rights and Responsibilities



Pre-Admission Testing Questionnaire

  • Part 1


  • Part 2


  • Patients answering "YES" to any questions in Part 2 require Pre-OP Nursing Call


  • Part 3


  • Patients answering "YES" to any questions in Part 3 require Pre-OP Nursing Call


  • Part 4

  • Patients answering "YES" to two or more questions in Part 4 require Pre-OP Nursing Call