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.
Our Privacy Obligations
We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information.
We are required by law to maintain the privacy of protected health information, to provide you with this Notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information.
How We May Use and Disclose Your Health Information:
Permissible Uses and Disclosures Without Your Written Authorization
Treatment. We use medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, information obtained by a staff member will be recorded in your medical record and used to determine the best course of treatment for you.
Payment. We use and disclose medical information about you to obtain payment for the services we provide. For example, a bill may be sent to you or to your health insurer or other company that arranges or pays the cost of some or all of your health care. The bill may contain information that identifies you, your diagnosis, or supplies used during treatment.
Health Care Operations. We may use and disclose health information about you for our health care operations. Your health information may be disclosed to our medical staff members or quality improvement personnel who may be involved in the internal administration and planning of various activities that improve the quality and effectiveness of the health care that we provide to you. For example, we may use and disclose health information about you to evaluate the quality and competence of our physicians, nurses and other health care workers. We may disclose your health information to our Privacy Officer in order to resolve any complaints you may have and ensure that you have a pleasant visit with us. We may also disclose your health information to your other health care providers when such health information is required for them to treat you. We may use or disclose your health information as necessary to contact you by telephone or by mail to remind you of an appointment or to communicate minimal medical information. We will only use your designated telephone contact number(s) as listed on your patient authorization.
Required By Law. We may use and disclose your health information when required by law. For example, we may disclose information for the following purposes:
For Judicial and Administrative Proceedings in response to a legal order or other lawful process;
To report information related to victims of abuse, neglect or domestic violence;
To assist law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena;
To report information as required by law about product defects, product recalls, repairs or replacements under the jurisdiction of the Food and Drug Administration.
Public Health. Your health information may be used and disclosed to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; reporting child, elder or dependent adult abuse or neglect; reporting domestic violence; reporting to the FDA problems with products and reactions to medications; and reporting disease or infection exposure.
Public Safety. We may disclose your health information to prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety pursuant to applicable laws.
Health Oversight Activities. We may disclose your health information to health oversight agencies during the course of audits, investigations, inspections, licensure and other proceedings, subject to the limitations imposed by law.
Coroners. We may disclose your health information to a coroner or medical examiner as authorized by law.
Marketing. Provided we do not receive any payment for making these communications, we may contact you to give you information about products or services related to your treatment, case management or care coordination, or to direct or recommend other treatments, therapies, health care providers or settings of care that may be of interest to you. We may describe products or services provided by this practice and tell you which health plans this practice participates in. We can provide you with marketing materials in a face-to-face encounter, or give you a promotional gift of nominal value without obtaining your Authorization. We may use your information to identify health-related services and products that may be beneficial to your health and then contact you about the products or services relating to your treatment options and other health-related topics. We will not otherwise use or disclose your medical information for marketing purposes or accept any payment for other marketing communications without your prior written authorization.
Sale of Health Information. We will not sell your health information without your prior written authorization.
Organ and Tissue Procurement. If you are an organ donor, we may disclose your health information to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
Research. We may use or disclose your health information without your consent or authorization if an Institutional Review Board/Privacy Board approves a waiver of authorization for disclosure.
Specialized Government Functions. We may disclose your health information for military or national security purposes or to correctional institutions or law enforcement officers that have you in their lawful custody.
Workers’ Compensation. We may disclose your health information as necessary to comply with workers’ compensation laws.
Proof of Immunization. We will disclose proof of immunization to a school that is required to have it before admitting a student where you have agreed to the disclosure on behalf of yourself or your dependent.
Change of Ownership. In the event that this medical practice is sold or merged with another organization, your health information/record will become the property of the new owner, although you will maintain the right to request that copies of your health information be transferred to another physician or medical group.
Breach Notification. In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have provided us with a current e-mail address, we may use e-mail to communicate information related to the breach. In some circumstances our business associate may provide the notification. We may also provide notification by other methods as appropriate. E-mail will not contain PHI and will not disclose inappropriate information.
Use and Disclosures Requiring Your Written Authorization
Use or Disclosure with Your Authorization. Except as described in this Notice of Privacy Practices, this medical practice will, consistent with its legal obligations, not use or disclose health information which identifies you without your written authorization. If you do authorize this medical practice to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
Your Health Information Rights
Right to Request Special Privacy Protections. You have the right to request restrictions on certain uses and disclosure of your health information by a written request specifying what information you want to limit, and what limitations on our use or disclosure of that information you wish to have imposed. If you tell us not to disclose information to your commercial health plan concerning health care items or services for which you paid for in full out-of-pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons. We reserve the right to accept or reject any other request, and will notify you of our decision.
Right to Request Confidential Communications. You have the right to request that you receive your health information in a specific way or at a specific location.
Right to Inspect and Copy. You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and if you want a copy, your preferred form and format. We will provide
copies in your requested form and format if it is readily producible, or we will provide you with an alternative format you find acceptable, or if we can’t agree and we maintain the record in an electronic format, your choice of a readable
electronic or hardcopy format. We will also send a copy to any other person you designate in writing. We will charge a reasonable fee which covers our costs for labor, supplies and postage.
Right to Amend or Supplement. You have a right to request that we amend your health information that you believe is incorrect or incomplete. You must make a request to amend in writing, and include the reasons you believe the information is inaccurate or incomplete.
Right to an Accounting of Disclosures. You have a right to receive an accounting of disclosures of your health information made by this medical practice as provided by 45 CFR § 164.528.
Right to a Paper or Electronic Copy of this Notice. You have a right to notice of our legal duties and privacy practices with respect to your health information, including a right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by e-mail.
Changes to this Notice of Privacy Practices. We reserve the right to amend this Notice at any time in the future. Until such amendment is made, we are required by law to comply with the terms of this Notice currently in effect. After an amendment is made, the revised Notice will apply to all protected health information that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception area, and a copy will be available at each appointment. The Notice will also be available on our website, www.floridaabortion.com.
Effective Date - This Notice is effective on September 23, 2013
Complaints. Complaints about this notice of Privacy Practices or how we handle your health information should be directed to our Privacy Officer. If you are not satisfied with the manner in which we handle a complaint, you may submit a formal complaint to DHHS Office of Civil Rights if you believe your privacy rights have been violated. You will not be penalized in any way for filing a complaint.
I have read this privacy notice and I have been given ample time to ask questions regarding the information it contains. I understand the Center will hold my record to the highest standard of privacy and confidentiality and will only release my personal health information when so authorized by me in writing, or when required by law to do so.