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THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAYBE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.
PLEASE READ CAREFULLY
A. OUR COMMITMENT TO YOUR PRIVACY:
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI). 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. 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 IIHI. By Federal and State law, we must follow the terms of the Notice of Privacy Practices that we have in effect at this time.
The terms of this notice apply to all records containing your IIHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. 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 office in a visible location at all times, and you may request a copy of our most current Notice at any time.
B. IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
The Practice Manager, Dianne Carusi at 954-989-5854.
C. WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS:
The following categories describe the different ways in which we may use and disclose your IIHI.
1. Treatment: Our practice may use your IIHI to treat you. We may ask you to have laboratory tests, and we may use the results to help us reach a diagnosis. We may also use your IIHI to prescribe medication and to communicate with your pharmacy. Our staff, including but not limited to our doctors and nurses may use or disclose your IIHI in order to treat you or to assist others in your treatment. Additionally, we may disclose your IIHI to others who may assist in your care, such as your spouse, children or parents.
2. Disclosures Required By Law: Our practice will use and disclose your IIHI when required to do so by Federal, State or Local Law.
Our practice may disclose your IIHI to a health oversight agency for activities authorized by law. Oversight activities include, investigations, inspections, audits, surveys, licensure and disciplinary actions, civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
Our practice may use and disclose your IIHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your IIHI in response to a discovery request, subpoena, or other lawful process by another part involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
D. USE AND DISCLOSURE OF YOUR (IIHI) IN SPECIAL CIRCUMSTANCES:
1. Public Health Risks: Our practice may disclose your IIHI to public health authorities that are authorized by law to collect information for the purpose of:
• Maintaining vital records, such as births and deaths.
• Reporting child abuse or neglect.
• Preventing or controlling disease, injury or disability.
• Notifying a person regarding potential exposure to a communicable disease.
• Notifying a person regarding a potential risk for spreading or contracting a disease or condition.
• Reporting reactions to drugs or problems with products or devices.
• Notifying individuals if a product or device they may be using has been recalled.
• Notifying appropriate government agencies and authorities regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
• Notifying your employer under limited circumstances related primarily to workplace injury, illness or medical surveillance.
2. Law Enforcement: We may release IIHI if asked to do so by a law enforcement official:
• Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement.
• Concerning a death we believe has resulted from criminal conduct.
• Regarding criminal conduct at our offices.
• In response to a warrant, summons, court order, subpoena or similar legal process.
• To identify/locate a suspect, material witness, fugitive or missing person.
• In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator).
3. Deceased Patients: Our practice may release IIHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death.
4. National Security: Our practice may disclose your IIHI to Federal officials for intelligence and National security activities authorized by law. We also may disclose your IIHI to Federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
E. YOUR RIGHTS REGARDING YOUR IIHI:
1. Confidential Communications: In order to request a type of confidential communication, you must make a written request to the practice manager, specifying the requested method of contract, or the location where you wish to be contacted regarding your health and related issues. Our practice will make every effort to accommodate reasonable requests.
You have the right to request that we restrict our disclosure of your IIHI to only certain individuals such as family members and friends. We are not required to agree to your request. 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. In order to request a restriction in our use or disclosure of your IIHI, you must make your request in writing to the practice manager. Your request must be describe in a clear and concise manner. Requests must include the information you want restricted, the time frame of the restriction and to whom the limits apply.
2. Inspection and Copies: You have the right to inspect and obtain a copy of the IIHI. You must submit your request in writing. Our practice may charge for copies of medical records.
3. Amendment: You may ask us to amend your health information if you believe it is incorrect or incomplete. You may request an amendment for as long as the information is kept by our practice. Amendments must be requested in writing and submitted to the practice manager. You must provide us with a reason that supports your request for the amendment. 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 IIHI kept by or for the practice, (c) not part of the IIHI 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.
4. Accounting of Disclosures/ Right of Accounting of Non-TPO Disclosures: In order to obtain an accounting of disclosures, you must submit your request in writing to the practice manager. 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.
5. 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 Secretary of the Department of Health and Human Services. To file a complaint with our practice, contact the practice manager. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
6. Right to Provide an Authorization for Other Uses and Disclosures: Any authorization you provide to us regarding the use and disclosure of your IIHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your IIHI for the reasons described in the authorization. Please note, we are required to retain records of your care.
If you have any questions regarding this notice or our health information privacy policies, please contact the practice manager.