NOTICE OF OUR PRIVACY
PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THAT INFORMATION.
PLEASE REVIEW THIS NOTICE
CAREFULLY.
This Practice is committed to maintaining the privacy of your protected
health information ("PHI"), which includes information about your health
condition and the care and treatment you receive from the Practice. The
creation of a record detailing the care and services you receive helps
this office to provide you with quality health care. This Notice details
how your PHI may be used and disclosed to third parties. This Notice
also details your rights regarding your PHI. The privacy of PHI in
patient files will be protected when the files are taken to and from the
Practice by placing the files in a box or brief case and kept within the
custody of a doctor or employee of the Practice authorized to remove the
files from the Practice’s office. It may be necessary to take patient
files to a facility where a patient is confined or to a patient’s home
where the patient is to be examined or treated.
NO CONSENT REQUIRED
1. The Practice may use and/or disclose your PHI for the purposes of:
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(a) Treatment - In
order to provide you with the health care you require, the Practice
will provide your PHI to those health care professionals, whether on
the Practice's staff or not, directly involved in your care so that
they may understand your health condition and needs. For example, a
physician treating you for a condition or disease may need to know
the results of your latest physician examination by this office.
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(b) Payment - In
order to get paid for services provided to you, the Practice will
provide your PHI, directly or through a billing service, to
appropriate third party payors, pursuant to their billing and
payment requirements. For example, the Practice may need to provide
the Medicare program with information about health care services
that you received from the Practice so that the Practice can be
properly reimbursed. The Practice may also need to tell your
insurance plan about treatment you are going to receive so that it
can determine whether or not it will cover the treatment expense.
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(c) Health Care
Operations - In order for the Practice to operate in accordance with
applicable law and insurance requirements and in order for the
Practice to continue to provide quality and efficient care, it may
be necessary for the Practice to compile, use and/or disclose your
PHI. For example, the Practice may use your PHI in order to evaluate
the performance of the Practice's personnel in providing care to
you.
2. The Practice may use and/or disclose your PHI, without a written
Consent from you, in the following additional instances:
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(a) De-identified
Information - Information that does not identify you and, even
without your name, cannot be used to identify you.
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(b) Business
Associate - To a business associate if the Practice obtains
satisfactory written assurance, in accordance with applicable law,
that the business associate will appropriately safeguard your PHI. A
business associate is an entity that assists the Practice in
undertaking some essential function, such as a billing company that
assists the office in submitting claims for payment to insurance
companies or other payers.
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(c) Personal
Representative -To a person who, under applicable law, has the
authority to represent you in making decisions related to your
health care
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(d) Emergency
Situations -
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(i) for the purpose of obtaining or rendering emergency
treatment to you provided that the Practice attempts to obtain
your Consent as soon as possible; or
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(ii) to a public or private entity authorized by law or by its
charter to assist in disaster relief efforts, for the purpose of
coordinating your care with such entities in an emergency
situation.
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(e) Communication
Barriers - If, due to substantial communication barriers or
inability to communicate, the Practice has been unable to obtain
your Consent and the Practice determines, in the exercise of its
professional judgment, that your Consent to receive treatment is
clearly inferred from the circumstances.
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(f) Public Health
Activities - Such activities include, for example, information
collected by a public health authority, as authorized by law, to
prevent or control disease and that does not identify you and, even
without your name, cannot be used to identify you.
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(g) Abuse, Neglect or
Domestic Violence - To a government authority if the Practice is
required by law to make such disclosure; if the Practice is
authorized by law to make such a disclosure, it will do so if it
believes that the disclosure is necessary to prevent serious harm
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(h) Health Oversight
Activities - Such activities, which must be required by law, involve
government agencies and may include, for example, criminal
investigations, disciplinary actions, or general oversight
activities relating to the community's health care system.
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(i) Judicial and
Administrative Proceeding - For example, the Practice may be
required to disclose your PHI in response to a court order or a
lawfully issued subpoena.
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(j) Law Enforcement
Purposes - In certain instances, your PHI may have to be disclosed
to a law enforcement official. For example, your PHI may be the
subject of a grand jury subpoena. Or, the Practice may disclose your
PHI if the Practice believes that your death was the result of
criminal conduct.
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(k) Coroner or
Medical Examiner - The Practice may disclose your PHI to a coroner
or medical examiner for the purpose of identifying you or
determining your cause of death.
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(l) Organ, Eye or
Tissue Donation - If you are an organ donor, the Practice may
disclose your PHI to the entity to whom you have agreed to donate
your organs.
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(m) Research - If the
Practice is involved in research activities, your PHI may be used,
but such use is subject to numerous governmental requirements
intended to protect the privacy of your PHI and that does not
identify you and, even without your name, cannot be used to identify
you.
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(n) Avert a Threat to
Health or Safety - The Practice may disclose your PHI if it believes
that such disclosure is necessary to prevent or lessen a serious and
imminent threat to the health or safety of a person or the public
and the disclosure is to an individual who is reasonably able to
prevent or lessen the threat.
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(o) Workers'
Compensation - If you are involved in a Workers' Compensation claim,
the Practice may be required to disclose your PHI to an individual
or entity that is part of the Workers' Compensation system.
APPOINTMENT REMINDER
The Practice may, from time to time, contact you to provide appointment
reminders or information about treatment alternatives or other
health-related benefits and services that may be of interest to you. The
following appointment reminders are used by the Practice:
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(a) a postcard mailed
to you at the address provided by you; and
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(b) telephoning your
home and leaving a message on your answering machine or with the
individual answering the phone.
SIGN-IN LOG
The Practice maintains a sign-in log for individuals seeking care and
treatment in the office. The sign-in log is located in a position where
staff can readily see who is seeking care in the office, as well as the
individual's location within the Practice's office suite. This
information may be seen by, and is accessible to,others who are seeking
care or services in the Practice's offices.
FAMILY/FRIENDS
The Practice may disclose to your family member, other relative, a close
personal friend, or any other person identified by you, your PHI
directly relevant to such person's involvement with your care or the
payment for your care. The Practice may also use or disclose your PHI to
notify or assist in the notification (including identifying or locating)
a family member, a personal representative, or another person
responsible for your care, of your location, general condition or death.
However, in both cases, the following conditions will apply:
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(a) If you are
present at or prior to the use or disclosure of your PHI, the
Practice may use or disclose your PHI if you agree, or if the
Practice can reasonably infer from the circumstances, based on the
exercise of its professional judgment, that you do not object to the
use or disclosure.
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(b) If you are not
present, the Practice will, in the exercise of professional
judgment, determine whether the use or disclosure is in your best
interests and, if so, disclose only the PHI that is directly
relevant to the person's involvement with your care.
AUTHORIZATION
Uses and/or disclosures, other than those described above, will be made
only with your written authorization.
YOUR RIGHTS
1. You have the right to:
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(a) Revoke any
Authorization and/or Consent, in writing, at any time and to request
a revocation, you must submit a written request to the Practice's
COMPLIANCE OFFICER.
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(b) Request
restrictions on certain use and/or disclosure of your PHI as
provided by law, however, the Practice is not obligated to agree to
any requested restrictions. To request restrictions, you must submit
a written request to the Practice's COMPLIANCE OFFICER. In your
written request, you must inform the Practice of what information
you want to limit, whether you want to limit the Practice's use or
disclosure, or both, and to whom you want the limits to apply. If
the Practice agrees to your request, the Practice will comply with
your request unless the information is needed in order to provide
you with emergency treatment
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(c) Receive
confidential communications or PHI by alternative means or at
alternative locations; you must make your request in writing to the
Practice's COMPLIANCE OFFICER. The Practice will accommodate all
reasonable requests.
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(d) Inspect and
obtain a copy of your PHI as provided by law. To inspect and copy
your PHI, you are requested to submit a written request to the
Practice's COMPLIANCE OFFICER. The Practice can charge you a fee for
the cost of copying, mailing or other supplies associated with your
request
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(e) Amend your PHI as
provided by law. To request an amendment, you must submit a written
request to the Practice's COMPLIANCE OFFICER. You must provide a
reason that supports your request. The Practice may deny your
request if it is not in writing, if you do not provide a reason in
support of your request, if the information to be amended was not
created by the Practice (unless the individual or entity that
created the information is no longer available), if the information
is not part of your PHI maintained by the Practice, if the
information is not part of the information you would be permitted to
inspect and copy, and/or if the information is accurate and
complete. If you disagree with the Practice's denial, you will have
the right to submit a written statement of disagreement.
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(f) Receive an
accounting of disclosures of your PHI as provided by law. The
request should indicate in what form you want the list (such as a
paper or electronic copy)
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(g) Receive a paper
copy of this Privacy Notice from the Practice upon request to the
Practice's COMPLIANCE OFFICER.
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(h) Complain to the
Practice or to the Office of Civil Rights, U.S. Department of Health
and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH
Building, Washington, D.C. 20201, 202/619-0257, email:
ocrmail@hhs.gov
or to the Florida Attorney General, Office of the Attorney General,
PL-01 The Capitol, Tallahassee, FL 32399-1050, 850/414-3300, if you
believe your privacy rights have been violated. To file a complaint
with the Practice, you must contact the Practice's COMPLIANCE
OFFICER. All complaints must be in writing.
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(i) To obtain more
information on, or have your questions about your rights answered,
you may contact the Practice's COMPLIANCE OFFICER, Benjamin F.
Bates, Ph.D., at 850-472-0360 or via email at
drbates@scenichealth.com.
PRACTICE'S REQUIREMENTS
1. The Practice:
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(a) Is required by
federal law to maintain the privacy of your PHI and to provide you
with this Privacy Notice detailing the Practice's legal duties and
privacy practices with respect to your PHI.
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(b) Is required by
State law to maintain a higher level of confidentiality with respect
to certain portions of your medical information that is provided for
under federal law. In particular, the Practice is required to comply
with the following State statutes: Section 381.004 relating to HIV
testing, Chapter 384 relating to sexually transmitted diseases and
Section 456.057 relating to patient records ownership, control and
disclosure.
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(c) Is required to
abide by the terms of this Privacy Notice.
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(d) Reserves the
right to change the terms of this Privacy Notice and to make the new
Privacy Notice provisions effective for all of your PHI that it
maintains.
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(e) Will distribute
any revised Privacy Notice to you prior to implementation.
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(f) Will not
retaliate against you for filing a complaint.
QUESTIONS AND COMPLAINTS
You may obtain additional information about our privacy practices or
express concerns or complaints to the person identified below who is the
COMPLIANCE OFFICER and Contact person appointed for this practice. The
COMPLIANCE OFFICER is Benjamin F. Bates, Ph.D.
You may file a complaint with the COMPLIANCE OFFICER if you believe that
your privacy rights have been violated relating to release of your
protected health information. You may, also, submit a complaint to the
Department of Health and Human Services the address of which will be
provided to you by the COMPLIANCE OFFICER. We will not retaliate against
you in any way if you file a complaint.
EFFECTIVE DATE
This Notice is in effect as of January 1st, 2003. |