Notice of Privacy Practices
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.
We are required by law to maintain the privacy of your protected health information, to notify you of our legal duties and privacy practices with respect to your health information, and to notify affected individuals following a breach of unsecured health information. This notice summarizes our duties and your rights concerning your information. Our duties and your rights are set forth more fully in 45 CFR Part 164. We are required to abide by the terms of our notice that is currently in effect.
1. Uses and Disclosures We May Make Without Written Authorization. We may use or disclose your health information for certain purposes without your written authorization, including the following:
Treatment. We may use or disclose your information for purposes of treating you. For example, we may disclose your information to another health care provider so they may treat you; to provide appointment reminders; or to provide information about treatment alternatives or services we offer.
Payment. We may use or disclose your information to obtain payment for services provided to you. For example, we may disclose information to your health insurance company or other payer to obtain payment for treatment.
Healthcare Operations. We may use or disclose your information for certain activities that are necessary to operate our practice and ensure that our patients receive quality care. For example, we may use information to train or review the performance of our staff or make decisions affecting the practice.
Other Uses or Disclosures. We may also use or disclose your information for certain other purposes allowed by 45 CFR §164.512 or other applicable laws and regulations, including the following:
To avoid a serious threat to your health or safety or the health or safety of others.
As required by state or federal law such as reporting abuse, neglect or certain other events.
As allowed by workers compensation laws for use in workers compensation proceedings.
For certain public health activities such as reporting certain diseases.
For certain public health oversight activities such as audits, investigations, or licensure actions.
In response to a court order, warrant or subpoena in judicial or administrative proceedings.
In response to certain requests by law enforcement to locate a fugitive, victim
or witness, or to report deaths or certain crimes.
To coroners, funeral directors, or organ procurement organizations as necessary to allow them to carry out their duties.
We participate in one or more Health Information Exchanges (HIE) which allows disclosure of your electronic health record via electronic transfer to other facilities and providers for your treatment purposes. Your information and basic identifying information regarding your visits to our facilities may be shared with the HIEs for the purposes of diagnosis and treatment.
We communicate all immunizations administered to the Florida Shots System. If you would like to opt-out of this program, please contact the Florida Immunization Program by phone at 877.888.7468.
2 Uses and Disclosures with Your Written Authorization. Other uses and disclosures not described in this notice will be made only with your written authorization, including most uses or disclosures of psychotherapy notes; for most marketing purposes. You may revoke your authorization by submitting a written notice to Office Manager. The revocation will not be effective to the extent we have already taken action in reliance on the authorization.
3 Your Rights Concerning Your Protected Health Information. You have the following rights concerning your health information. To exercise any of these rights, you must submit a written request to the Office Manager. You may inspect and obtain a copy of records that are used to make decisions about your care or payment for your care. We may charge you a reasonable cost-based fee for providing the records. We may deny your request under limited circumstances, e.g., if we determine that disclosure may result in harm to you or others or if we determine that the record is accurate and complete.
4 Changes to This Notice. We reserve the right to change the terms of this notice at any time, and to make the new notice effective for all protected health information that we maintain. If we materially change our privacy practices, we will post a copy of the current notice in our reception area and on our website. You may obtain a copy of the operative notice from our receptionist or office manager.
5 Complaints. You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our Office Manager. All complaints must be in writing. We will not retaliate against you for filing a complaint.
6 Effective Date. This Notice is effective June 28, 2021.