A. OUR COMMITMENT TO YOUR PRIVACY
Our practice is dedicated to
maintaining the privacy of your protected health information (PHI). In
conducting our business, we will create
records regarding you and the treatment and services we provide to you.
We are required by law to maintain the confidentiality of health information
that identifies you as well as your health status. We also are required by law
to provide you with this notice of our legal duties and the privacy practices
that we maintain in our practice concerning your PHI. By federal and state law,
we must follow the terms of the notice of privacy practices that we have in
effect at the time.
We
realize that these laws may seem complicated, but we must provide you with the
following important information:
· How we may use and disclose your protected health information (PHI)
· Your privacy rights regarding your PHI
· Our obligations concerning the use and
disclosure of your PHI
The terms of this notice apply to all records containing
your PHI that are created or retained by our practice. We reserve the right to revise or amend this
Notice of Privacy Practices to allow for additional uses or disclosures of
PHI. Any revision or amendment to this
notice will be effective for all of your records that our practice has created or maintained
in the past, and for any of your records that we may create or maintain in the
future. Our practice will post a copy of our current Notice in our offices in a
visible location at all times, and you may
request a copy of our most current Notice at any time.
IF
YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT: Privacy Officer, Central Florida Pulmonary Group, P.A., 26 North Mills
Avenue; Orlando, Florida 32803
C. WE MAY USE AND
DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) IN THE FOLLOWING WAYS
The following categories describe the different ways in which we may
use and disclose our PHI.
1.
Treatment. Our practice may use and disclose your PHI to provide, treat,
coordinate, and/or manage your health care and any related services.
Common treatment activities
include, but are not limited to: We may order laboratory tests, diagnostic
tests, procedural and surgical types of
service for you (such as, but not limited to, blood tests, x-rays). We may use
the results of services ordered to help us reach a diagnosis or to treat your
medical condition(s). We might use your PHI in order to write a prescription
for you, or we might disclose your PHI to a pharmacy when we order a
prescription for you. Many of the people who work for our practice – including,
but not limited to, our doctors and nurses – may use or disclose your PHI in order
to treat you or to assist others in your treatment. For example, your PHI may be
provided to a physician to whom we have referred you to ensure that the
physician has the necessary information to diagnose or treat you. Additionally,
we may disclose your PHI to others who are involved in your care or may assist
in your care, such as, but not limited to, a hospital, outpatient facility,
durable medical equipment company, home health agency, nursing facility, or hospice agency.
2.
Payment. Our practice may use and disclose your PHI in order to bill and
collect payment for the services and items you may receive from us. Common
payment activities include, but are not limited to: We may submit a claim to
your insurance company that identifies you as well as your diagnosis,
procedures, and supplies used. We may contact your health insurer to certify
that you are eligible for benefits (and for what range of benefits), and we may
provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay
for, your treatment. For example, obtaining approval for a hospital stay, or
other hospital outpatient service, may require that relevant PHI be disclosed
to the health plan for approval for the hospital admission. We may contact your
insurance company in order to review a claim or to appeal a claim. We also may
use and disclose your PHI to obtain payment from third parties that may be
responsible for such costs which could include family members. We may use your
PHI to bill you directly for services and items. We may use and disclose
specified information to consumer reporting agencies, such as, but not limited
to, a collection agency.
3.
Health Care Operations. Our practice may use and disclose your PHI to operate
our business. Operational activities include, but are not limited to,
quality assessment
activities, employee review activities, training of medical students in our
office, licensing, and conducting or arranging for other business activities
such as, but not limited to, medical review, legal, accounting and
auditing services.
Other
examples of use and disclosure of PHI for operations include, but are not
limited to:
·
We may use a sign in sheet at the registration desk where you will be
asked to sign your name and indicate the physician or other practitioner who
will be seeing you.
·
We may also call you, by name, from the waiting room when your physician
or other employee is ready to see you.
·
We may have conversations and communications with you that we reasonably
attempt to safeguard from incidental disclosure to others. Such incidental disclosures are not a
violation of the law, and we encourage you to communicate with us using a
lowered tone of voice.
·
We may send you results of testing in the mail utilizing our
professional business name and logo.
·
We may send you a reminder in the mail of your next appointment or the
need to schedule an appointment utilizing our
professional business name and logo.
·
We may leave a message on your telephone answering machine/service,
utilizing your name, as a reminder of an appointment or to contact our
office
insurance/billing department.
·
We may share your PHI with third party "business associates"
(such as, but not limited to, an answering service, transcription service) used
by the practice. Whenever an arrangement between our office and a business associate involves the use or
disclosure of your PHI, we will have a written contract that contains terms
that will protect the privacy of your PHI.
·
We may communicate with you regarding information about our practice or
to inform you of potential treatment options or
alternatives, or health related benefits that may be of interest to you.
NOTE: Uses and disclosures of your PHI as listed
above, or in the areas listed below, may be made using standard communications
such as, but not limited to, telephone, direct mail, and facsimile. Every
reasonable effort is made in our communications to ensure the accuracy and
security of the information used in performing standard
communications.
4. Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a
relative, a close friend or any other person you identify, your protected health
information 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 judgment. We may use or disclose protected
health information 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 protected health information to an
authorized public or private entity to assist in disaster relief efforts and to coordinate uses and
disclosures to family or other individuals involved in your health care.
D.
USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION (PHI) IN CERTAIN
SPECIAL CIRCUMSTANCES
The
following categories describe unique scenarios in which we may use or disclose
your protected health information:
Required By Law: We may use or disclose your protected health information to the extent that the use or
disclosure is required by law. The use
or disclosure will be made in compliance 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 protected health information for public
health activities and purposes to a public health authority that is permitted
by law to collect or receive the information. The disclosure will be made in
accordance with state law for the purpose of controlling disease, injury or
disability. We may also disclose your protected health information, if directed by the public health
authority, to a foreign government agency that is collaborating with the public
health authority.
Communicable Diseases: We may disclose your protected health information,
according to state 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 protected health information 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 benefit programs, other government
regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a
public health authority that is authorized by law to receive reports of child
abuse or neglect. In addition, we may disclose your protected health
information 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 under law. 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 protected health information
to a person or company required by the Food and Drug Administration to report
adverse events, product defects or problems, biologic product deviations,
track products, to enable product
recalls, to make repairs or replacements.
Legal Proceedings: We may disclose protected health information 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), in certain conditions in response to a subpoena, discovery request
or other lawful process.
Law Enforcement: We may also disclose protected health information, 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 the
practice, and (6) medical emergency (not on the Practice’s premises) and it is
likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose protected
health information to a coroner or medical examiner for identification
purposes, determining cause of death or for the coroner or medical examiner to
perform other duties authorized by law. We may also disclose protected
health information to a
funeral director, as authorized by law, in order to permit the funeral director
to carry out their duties. We may disclose such information in reasonable anticipation of death.
Protected health information may be used and disclosed for cadaveric organ, eye
or tissue donation and transplantation
purposes.
Research: We may disclose your protected health information 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 protected health information.
Criminal Activity: Consistent with applicable federal and state laws, we
may disclose your protected health information, 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 protected health
information 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 Veterans Affairs of your eligibility for benefits, or (3) to foreign military
authority if you are a member of that foreign military services. We may also
disclose your protected health information to authorized federal officials for
conducting national security and intelligence activities, including for
the provision of protective
services to the President or others legally authorized.
Workers’ Compensation: Your protected health information may be disclosed
by us as authorized to comply with workers’ compensation laws and other similar
legally-established programs.
Inmates: We may use or disclose your protected health information if you
are an inmate of a correctional facility and your physician created or received
your protected health information in the course of providing care to you.
E. RIGHT TO
PROVIDE AN AUTHORIZATION FOR OTHER USES AND DISCLOSURES.
Our
practice will obtain your written authorization for uses and disclosures that
are not identified by this notice or permitted by applicable law. Any authorization you provide
to us regarding the use and disclosure of your protected health information
(PHI) may be revoked at any time in writing. After you revoke your authorization, we will no longer use or
disclose your PHI for the reasons described in the authorization except to the
extent that your physician or the practice has taken action in reliance on the
use or disclosure indicated in the
authorization.
Confidential Communications. You
have the right to request that our practice communicate with you about your
health and related issues in a particular manner or at a certain
location. For instance, you may ask that
we contact you at home, rather than work. In order to request a type of
confidential communication,
you must make a written request to the: Privacy Officer of Central Florida Pulmonary Group, P.A. specifying the requested method of
contact, or the location where you wish to be contacted. Our practice will
accommodate reasonable requests.
Requesting Restrictions.
You have the right to request a restriction in our use or disclosure of
your PHI for treatment, payment, or health care operations. We are not required
to agree to your request; however, if we do agree, we are bound by our
agreement except when otherwise required by law, in emergencies, or when the
information is necessary to treat you. We reserve the unilateral right to
revoke any voluntary agreement to restrict the use or disclosure of your PHI
that we may enter into. In order to request a restriction in our use or
disclosure of your PHI, you must make your request in writing to the Privacy Officer. Your request must describe in a clear and
concise fashion:
the information you wish restricted;
whether you are requesting to limit our practice’s use, disclosure or both;
and
to whom you want the limits to apply.
Inspection
and Copies. You have the right to
inspect and obtain a copy of the PHI that may be used to make decisions about
you, including patient medical records and billing records, but not Including
psychotherapy notes. In order to inspect
and/or obtain a copy of your PHI, you must submit your request in
writing to the Privacy Officer. Our practice may charge a fee for the costs of copying, mailing, labor
and supplies associated with your request. Our practice may deny your request
to inspect and/or copy in certain limited circumstances; however, under certain
circumstances, you may request a review of our denial. Another licensed health
care professional chosen by us will conduct reviews.
Amendment. You may ask us to amend your health
information if you believe it is incorrect or incomplete, and you may request
an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to the Privacy Officer. You must provide us with a reason that supports your request for
amendment. Our practice will deny your request if you fail to submit your
request (and the reason
supporting your request) in writing. Also, we may deny your request if
you ask us to amend information that is in our opinion: (a) accurate and
complete; (b) not part of the PHI kept by or for the practice; (c) not part of
the PHI which you would be permitted to inspect and copy; or (d) not created by
our practice, unless the individual or entity that created the information is
not available to amend the information.
Accounting
of Disclosures. All of our patients have
the right to request an “accounting of
disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our
practice has made of your PHI for non-treatment or operations purposes. Use of
your PHI as part of the routine patient care in our practice is not required to
be documented in the disclosure.
Examples might include, but are not limited to, the doctor sharing
information with the nurse; or the billing department using your information to
file your insurance claim. Also excluded from the accounting disclosures are records
related to an authorization made by yourself. In order to obtain an accounting
of disclosures, you must
submit your request in writing to the Privacy Officer. All requests for an “accounting of disclosures” must state a time
period, which may not be longer than six (6) years from the date of disclosure
and may not include dates before April 14, 2003. The first list you request within a 12-month
period is free of charge, but our practice may charge you for additional lists
within the same 12-month period. Our practice will notify you of the costs
involved with additional requests, and you may withdraw your request before you
incur any costs.
Right to
a Paper Copy of This Notice. You are
entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this
notice at any time. To obtain a paper copy of this notice, contact the Privacy Officer.
Right to File a Complaint. If you
believe your privacy rights have been violated, you may file a complaint with
our practice or with the Office for Civil Rights, U.S. Department of Health and
Human Services. To file a complaint with our practice, contact:
Privacy Officer
Central Florida Pulmonary Group, P.A.
326 North Mills Avenue
Orlando, Florida 32803
To file a complaint with the Office for Civil
Rights:
Office for Civil Rights
U.S. Department of Health & Human
Services
200 Independence Avenue, S.W., Room
509F
Washington, D.C. 20201
All complaints must be submitted in
writing. You will not be penalized or retaliated against for filing a complaint.