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NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003
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.
This Notice of Privacy Practices describes
how we (including other healthcare providers affiliated with us) may use
and release protected health information about you that we maintain.
Permitted and Required Disclosures of
Protected Health Information:
Treatment, Payment and Healthcare
Operations. As one of your healthcare providers, we may use and
disclose protected health information ("PHI") about you for
treatment, payment and healthcare operations without your authorization.
Some examples of these types of uses/disclosures are:
· Treatment.
We may use or disclose PHI about you to provide your prescribed products,
equipment or services. We may consult and coordinate with your physician.
We may remind you of medication or supply refills and scheduled visits/appointments.
We may provide you information about treatment alternatives or other
health benefits and services that may be of interest to you through
newsletters or other means. We may also disclose your PHI to other healthcare
providers (such as physicians and pharmacies) involved in your treatment.
· Payment.
We may use or disclose your PHI to bill and collect payment for the
products, equipment or services we provide you. We may contact your
insurer or other payor to obtain eligibility and coverage information.
We may also disclose your PHI to health plans, healthcare clearinghouses
or other healthcare providers involved in your care for their payment
activities.
· Healthcare
Operations. We may use or disclose your PHI for quality assessment
activities, evaluation of our employees’ performance, business
planning and development, and management and general administrative
purposes. We may disclose your PHI to health plans or other healthcare
providers for their quality assessment, employee evaluation or healthcare
compliance activities.
We also engage consultants and contractors
to perform certain services for us. When the nature of these services
involves PHI disclosure, the consultants/contractors are required to appropriately
safeguard the PHI they receive.
Other Permitted and Required Uses and
Disclosures. We may use or disclose your PHI for the following
reasons without your consent:
Persons Involved in Care/Payment.
We may disclose relevant parts of your PHI to family members or other
persons involved in your care and its payment. We may notify such persons
or public or private entities involved in disaster relief efforts of
your location, general condition or death.
Limited Marketing Purposes.
From time to time, we may also provide promotional items of nominal
value or marketing information communicated to you in person (face to
face).
Health Oversight Activities.
We may disclose parts of your PHI to regulatory authorities for purposes
of monitoring the healthcare system and compliance with civil rights
laws and government regulations and healthcare program requirements.
Health or Safety.
We may use or disclose parts of your PHI if we believe it is necessary
to prevent or lessen a serious and imminent threat to your health and
safety or the health and safety of another person or the public. In
certain circumstances, this may include disclosing parts or your PHI
to local utility companies or emergency services so that they may provide
appropriate assistance in the event of an emergency or power outage.
Abuse, Neglect or Domestic Violence.
We may disclose parts of your PHI to appropriate governmental agencies
if we believe you may be a victim of abuse, neglect or domestic violence
and such disclosure is authorized by applicable law or regulation.
Public Health Activities.
We may disclose parts of your PHI to public health authorities for purposes
of controlling disease, injury or disability. We may also release parts
of your PHI to the Food and Drug Administration to report adverse events,
track products, enable recalls, conduct post-marketing surveillance
and other activities in connection with its regulation of the quality,
safety and effectiveness of certain products or activities.
Research. Subject to certain
restrictions, we may disclose parts of your PHI to facilitate research
when an individual authorization waiver is approved by an institutional
review or privacy board.
De-Identified Information.
We may use or disclose parts of your PHI that do not personally identify
you or reveal who you are.
Workers
Compensation. To the extent
authorized by applicable law, we may disclose your PHI to workers compensation
or similar programs that provide benefits for work-related injuries
or illnesses.
Correctional Institutions.
If you are incarcerated or otherwise in the custody of law enforcement
officials, we may disclose certain of your PHI to the correctional institution
or facility or its authorized personnel.
Legal Proceedings.
We may disclose parts of your PHI in any judicial or administrative
proceeding pursuant to court order or to meet other legal requirements.
Law Enforcement. We
may disclose parts of your PHI to locate or identify a suspect, fugitive,
material witness or missing person; to comply with laws such as those
requiring reporting of certain injuries or death or to report certain
crimes.
Coroners, Medical Examiners and Funeral
Directors. We may disclose parts of your PHI to coroners
and medical examiners for identification purposes, to determine cause
of death or as otherwise required by law. We may also disclose, consistent
with applicable law, parts of your PHI to funeral directors to permit
them to carry out their duties.
Organ or Tissue Donation Purposes.
We may disclose parts of your PHI to organ procurement organizations
or other entities to facilitate organ or tissue procurement, banking
or transplantation.
Specialized Government Functions.
Under certain circumstances, we may disclose parts of your PHI to Armed
Forces personnel and to Department of State and other federal officials
in connection with specialized governmental functions (including military
missions, national security and protective services).
Governmental Agencies. We
may disclose parts of your PHI to governmental authorities entitled
to receive such information, including the Secretary of Health and Human
Services.
Required or Permitted by Law.
We may disclose parts of your PHI in other situations not mentioned
above when required or permitted by law.
Other Disclosures:
Except as provided by our Notice of Privacy Practices, we will not use
or disclose protected health information about you without your written
authorization.
Your Rights:
The following is a statement of your rights regarding your PHI and a brief
description of how you may exercise these rights:
Access. You have
the right to inspect and copy the PHI we maintain about you except for:
psychotherapy notes, information complied in anticipation of a legal
proceeding or other PHI to which your access is limited by federal law.
Requests to inspect and copy records must be in writing directed to
our Privacy Officer and provide specific information to assist us in
fulfilling your request. We may charge a reasonable fee for copying
and mailing copies. If we deny your request for access, under most circumstances,
you have the right to have the denial reviewed. Please contact our Privacy
Officer if you have questions concerning your right to inspect and copy
your records.
Confidential Communications.
You have the right to request that PHI be sent to you by alternate means
or at alternative locations. For instance, you can ask that we send
mail to a post office box rather than to your home address. We will
accommodate all reasonable requests. Please make this request in writing
to our Privacy Officer.
Restrictions. You
have the right to request restrictions on how we use or disclose your
PHI for our treatment, payment and healthcare operations activities.
You also have the right to request that we not release any part of your
PHI to family members or others who may be involved in your care. Your
request must be in writing to our Privacy Officer and must specify what
parts of your PHI you do not want released and to whom you do not want
it released.
We are not required to agree to your request
and only our Privacy Officer is authorized to agree to such requests.
If we agree to your request, we will abide by the restriction unless
the restricted PHI is needed to provide you emergency treatment.
Amendment. You have
the right to request that we amend the PHI we maintain about you. Requests
for amendment must be in writing directed to our Privacy Officer and
provide a reason to support your requested amendment. If we deny your
request for amendment, you may file a written statement of disagreement
with our Privacy Officer and we will include it in your PHI when used
and disclosed.
Accounting. You have
the right to receive an accounting of certain disclosures of PHI made
by us. Your request for accounting must be in writing directed to our
Privacy Officer and must not request an accounting for more than six
years. Certain disclosures are not required to be included in the accounting
including: disclosures for our treatment, payment and healthcare operations
activities, incidental disclosures, disclosures for national security,
disclosures to correctional institutions, certain disclosures of PHI
without personally identifying information; and any disclosures made
prior to April 14, 2003.
Copy of Notice of Privacy Practices.
You have the right to receive a paper copy of our Notice of Privacy
Practices even if you agreed to receive our Notice of Privacy Practices
electronically. You may obtain a copy from your local service center
or by contacting our Privacy Officer and requesting a copy by mail.
Our Responsibilities:
We are required by law to maintain the privacy of protected health information
and to provide you notice of our legal duties and privacy practices with
respect to protected health information.
We are required to abide by the terms of
our Notice of Privacy Practices or applicable state laws which provide
for more restrictions on the use and disclosure of your PHI.
Changes to Notice of Privacy Practices:
We may change the terms of our Notice of Privacy Practices at any time.
The new Notice of Privacy Practices will apply to all PHI that we maintain
on or after the effective date of the new Notice of Privacy Practices.
Upon request to your local service center, we will give you a copy of
a new Notice of Privacy Practices. You may also obtain this information
by calling our Privacy Officer and requesting a copy by mail.
Complaints:
If you believe your privacy rights have been violated, you may lodge a
complaint by contacting our Privacy Officer. You may also complain to
the Secretary of Health and Human Services. We will not retaliate against
you for filing a complaint.
Additional Information:
If you need additional information about our Privacy Practices, please
contact our Privacy Officer at:
Privacy Officer
19387 U.S. 19 North
Clearwater, FL 33764
Telephone: 800/435-7436
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Privacy
Practices