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 to carryout 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 information. "Protected Health information" (PHI) is information about you that may identify you and that relates to your past, present or future physical, mental health and/or any condition related to your health care services.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms in our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time.We wil provide you with any revised Notice of Privacy Practices upon request. This may be done by accessing our website, calling our office and requesting that a revised copy be sent to you in the mail or by asking for one at the time of your appointment.
protected health information (PHI) may be used and disclosed by your
provider, our office staff and others outside of our office who are
involved in your care and treatment for the purpose of providing
health care services to you. Your PHI may also be used and
disclosed to pay your health care bills and to support the operation
of your provider's practice.
The following are some examples of the types of uses and disclosures of your PHI that your providers office is permitted to make and may be made by our office.
We will use and disclose your PHI to provide, coordinate or manage
your health care and any related services. This includes the
coordination or management
of you health care with another provider. For example, we would
your PHI, as necessary to a home health agency that provides care to
will also disclose PHI to other physicians who may be treating you.
Your PHI may
be provided to a physician to whom you have been referred to ensure
that the physician
has the necessary information to diagnose or treat you.
In addition, we may disclose your PHI from time to time to another physician or health care provider (i.e. a speciaist) who, at the request of your provider, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your provider.
Your PHI will be used and disclosed, as needed, to obtain payment
for your health care services provided by us or by another provider.
This may include certain activities that your health insurance plan
may undertake before it approves or pays for the health care services
for you such as making a determination of eligibility or coverage
for insurance benefits, reviewing services provided to you for
necessity, and undertaking utilization review activities.
For example, obtaining approval for a hospital stay may require that your relevant PHI be disclosed to the health plan to obtain approval for the hospital admission.
Care Operations: As needed, we may use or disclose, your PHI in
order to support the business activities of your provider's practice.
These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, fundraising activities, and conducting or arranging for other business activities.
will share your protected health information with third party
business associates that perform various activities (i.e. billing or
transcription services) for our practice. Wherever an arrangement
between our office and a business associate involves
the use or disdosure of your protected heath information, we will
enter a contract that contains terms that will protect the privacy of
your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. You may contact our Compliance Officer to request that these materials not be sent to you.
By Law: We may use or disclose your PHI to the extent that the use or
disclosure is required by law. The use or
disclosure will be made in complance with
the law and will be limited to the relevant requirements of the law. You will be
notified, if required by law, of any such uses or disclosures.
Public Health: We may disclose your PHI for public health activities and purposes
to a public health authority that is permitted by law to collect or receive the information. For example, a disclosure may be made for the purpose of preventing
or controlling disease, injury or disability.
Communicable Diseases: We may disclose your PHI, if authorized by law; to a
person who may have been exposed to a communicable disease or may otherwise
be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefits programs, other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the
requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your PHI information to a person
or company required by the Food and Drug Admnistration for the purpose of quality, safety, or effectiveness of FDA-regulated products or activities including to report adverse events, product defects or problems, biologic product deviations, to track products, to enable product recalls, to make repairs and replacements or to conduct post marketing survellance as required.
Research: We may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal
and established protocols to ensure the privacy of your PHI.
Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized) or in certain conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose PHI, so long as applicable legal requirements are met for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of our practice and (6) medical emergency (not on our practice's premises) and it is likely that a crime has occurred.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your PHI, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities, (2) for the purpose of a determination by the Department of Veteran Affairs of your eligibility for benefits or (3) to foreign military authority if you are a member of that foreign military service. We may also disclose your PHI to autiorized federal officials for concluding national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Workers' Compensation: We may disclose your PHI as authorized to comply with workers compensation laws and other similar legally-established programs.
Others Involved in Your Health Care or Payment for your Care: Unless you object, we may disdose to a member of your family, a relative, a close friend or any other person you identify your PHI that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgement. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals in your health care.
uses and disclosures of your protected health information (PHI) will
be made only with your written authorization, unless otherwise
permitted or required by law as described below. You may revoke this
in writing at anytime. If you revoke your authorization, we will no
longer use or disclose your PHI for the reasons covered by your
written authorization. Please understand that we are unable to take
back any disclosures already made with your authorization.
Other Permitted and Required Users and Disclosures That Require Providing You the Opportunity to Agree or Object: We may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, then your provider may, using professional judgment, determine whether the disclosure is in your best interest.
Facility Directories: Unless you object, we will use and disclose in our facility directory your name, the location at which you are receiving care, your general condition (such as fair or stable), and your religious affiliation. All of this information may be disclosed to people that ask for you by name.
have the right to inspect and copy your protected health information: You
may inspect and obtain a copy of PHI
about you for so long as we maintain the PHI.
You may obtain your medical record that contains medical and billing records and
any other records that the practice uses for making decisions about your treatment.
As permitted by federal law, we may charge you a reasonable copy fee for a copy of your records.
Under federal law, you may not inspect or copy the following records: Psychotherapy notes, information compiled in a reasonable anticipation of, or use
in, a civil, criminal, or administrative action or proceeding; and laboratory results that are subject to law that prohibit access to PHI. Depending on the circumstances, a decision to deny access may be reviewable. Please contact our Compliance Officer
if you have questions about access to your medical record.
You have the right to request a restriction of your PHI: You may ask us not to use or disclose any part of your PHI for the purposes of treatrnent, payment or health
care operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for Notification purposes as described in this Notice of Privacy Practices. Your request must be
written and must state the specific restriction requested and to whom you want the restrictions to apply. This must be deivered to our office and directed to the Compliance Officer.
You have the right to file a complaint: You may file a complaint with us by notifying our Compliance Officer or to the Secretary of Health and Human Services if you
believe your privacy rights have been violated. We will not retaliate against you for
filing a complaint.
You have the right to a paper copy. You have the right to obtain a paper copy of
this notice from us, upon request, even if you have agreed to accept this notice electronically.
have the right to request to receive confidential communications
by alternative means or at
We will accommodate reasonable requests. We may
also condition this accommodation by
asking you for information as to how payment will be handled or
specification of an alternative address or other method
of contact. We will not request an explanation from you as to the
basis for the request. Please make this request
in writing and deliver to our Compliance Office.
You may have the right to have your provider amend your PHI: This means you may request an amendment of PHI about you in a designated record set for so long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Compliance Officer if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we may have made, if any, of your PHI: This right applies to disclosures for purposed other than treatment, payment of heath care operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you if you authorized us to make the disclosure, for a facility directory, to family members or friends involved in your care, or for notification purposes, for national security or intelligence, to law enforcement (as provided in the privacy rule) or correctional facilities, as part of a limited data set disclosure. The right to receive this information is subject to certain exceptions, restrictions. and limitations.
Your provider is not required to agree to a restriction that you may request: If your provider does agree to the requested restriction, we may not use or disclose your PHI in violation of that restnction unless it is needed to provide emergency treatment. With this in mind, please discuss any restrictions you wish to request with your provider.
Phone: (888) 729-1282
FAX: (904) 800-2592
Address: 10175 Fortune Parkway, Suite 903, Jacksonville, FL 32256
This notice was published and becomes effective on: August 20, 2018