PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice,
please contact our Privacy Officer at 352-567-0188.
Florida Medical Clinic understands your privacy is important. This
Privacy Notice describes how we may use and disclose your protected
health information to carry out treatment, payment or health care
operations and for other purposes that are permitted or required by law.
It also describes your rights to control your protected health
information. Protected health information is information about you,
including demographic information, that may identify you and that
relates to your past, present or future physical or mental health
condition or payment.
Understanding Your Health Record/Information
Each time you visit a hospital, physician, or other healthcare provider,
a record of your visit is made. Typically, this record contains personal
demographic information, your symptoms, examination and test results,
diagnoses, treatment, and a plan for future care or treatment. This
information, often referred to as your health or medical record, serves
as a:
Basis for planning your care and treatment;
Means of communication among the many health professionals who
contribute to your care;
Legal document describing the care you received;
Means by which you or a third party payer can verify that services
billed were actually provided;
A tool in educating health professionals;
A source of data for medical research;
A source of information for public health officials charged with
improving the health of the nation;
A source of data for facility planning and marketing; and A tool with
which we can assess and continually work to improve the care we render
and the outcomes we achieve.
Understanding what is in your record and how your health information is
used helps you to:
Ensure its accuracy;
Better understand who, what, when, where and why others may access your
health information;
Make more informed decisions when authorizing disclosure to others.
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Your Health Information Rights:
Although your health record is the physical property of the healthcare
practitioner or facility that compiled it, the information belongs to
you. You have the right to:
Request a restriction on certain uses and disclosures of your
information as provided by 45 CFR 164.522. However, we are
not required to agree to the restriction;
Inspect and copy your health record as provided for in 45CFR
164.524 and Florida law. Usually this includes medical and
billing records, but does not include psychotherapy notes.
If you request a copy of the information, we may charge
a fee for the costs of copying, mailing or other supplies
associated with your request.
Amend your health record as provided in 45 CFR 164.526.
To request an amendment, your request must be in
writing and must provide a reason that supports your
request. We may deny your equest if you ask to amend
information that:
- Was not created by us;
- Is not part of the medical information kept by FMC;
- Is not part of the information which you would be
permitted to inspect or copy; or
- Is accurate or complete.
Obtain an accounting of disclosures of your health information
as provided in 45 CFR 164.528. To request this list or accounting
of disclosures, your request must be in writing and must state
the time period which may not be longer than six years and
may not include dates before April 13, 2003. The first list you
request within a 12 month period will be free. For additional
lists, we may charge you for the costs of providing the list.
Request communications of your health informaton by
alternative means orat alternative locations;
Receive confidential communications of protected health
information as provided in 45 CFR 164.522 (b), as applicable;
Revoke your authorization to use or disclose health information
except to the extent that action has already been taken.
Copies of the regulations cited above may be requested from the Privacy
Officer by calling 352-567-0188.
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Our Responsibilities:
Florida Medical Clinic is required to:
Maintain the privacy of your health information;
Provide you with a notice as to our legal duties and
privacy practices with respect to information we
collect and maintain about you;
Abide by the terms of this notice;
Notify you if we are unable to agree to a requested restriction;
Accommodate reasonable requests you may have to
communicate health information by alternative
means or at alternative locations.
We reserve the right to change our practices and to make the new
provisions effective for all protected health information we maintain.
Should our information practices change significantly, we will post the
new notice in each FMC location as well as on our Web site:
www.floridamedicalclinic.com. You can also request a copy of our notice
at any time.
We will not use or disclose your health information without your
authorization, except as described in this notice.
Back For More Information or to Report a Problem
If have questions and would like additional information, you may contact
FMC's Privacy Officer at (352) 567-0188.
If you believe your privacy rights have been violated, you can file a
complaint by contacting FMC's Privacy Officer at 352-567-0188 or you may
send a written complaint to the Secretary, US Department of Health and
Human Services. FMC's Privacy Officer can provide you with the
appropriate address upon request. There will be no retaliation for
filing a complaint.
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and Health Care Operations
We will use your health information for treatment. For example,
information obtained by a nurse, physician or other member of your
healthcare team will be recorded in your record and used to determine
the course of treatment that should work best for you. Different
departments within Florida Medical Clinic may share medical information
about you in order to coordinate different services you need, such as
prescriptions, lab work and X-rays. We may also disclose medical
information about you to people outside FMC who may be involved in your
medical care, such as hospitals, long-term care facilities, ambulatory
surgery centers or home health agencies.
We will also provide a referring physician or a subsequent healthcare
provider with copies of various reports that should assist him/her in
treating you.
We will use your health information for payment. For example, a bill may
be sent to you or an insurance company (third party payer). The
information on or accompanying the bill may include information that
identifies you, as well as your diagnosis, procedures and supplies used.
We may also tell your health plan about a treatment you are going to
receive to obtain prior approval or to determine whether your plan will
cover the treatment.
We will use your health information for regular healthcare operations.
For example, in day-to-day business practices, trained staff may handle
your physical medical record in order to have the record assembled or
for filing reports into your record. Certain data elements are entered
into our
computer system that processes most billing, schedules your appointments
and for statistical reporting. As part of our improvement efforts to
provide the most effective services, your record may be reviewed by
professional staff to assure accuracy, completeness and organization.
This information may be shared by facsimile transmission.
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Other Uses or Disclosures
Business Associates: There are some services provided in our
organization through contacts with business associates. Examples include
our using an outside transcription service to type physicians' dictated
notes or a copy service we may use when making copies of your health
record. When these services are contracted, we may disclose your health
information to our business associates so that they can perform the job
we've asked them to do. So that your health information is protected,
however, we require the business associate to agree in writing to
appropriately safeguard your information.
Communication with Family: Health professionals, using their best
judgment, may disclose to a family member, other relative, close
personal friend or any other person you identify, health information
relevant to that person's involvement in your care or payment related to
your care.
Research: We may disclose 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 health information.
Coroners, Medical Examiners and Funeral Directors: We may disclose
health information to a coroner or medical examiner. This may be
necessary, for example, to identify a deceased person or determine the
cause of death. We may also release medical information about patients
to funeral directors consistent with applicable law to carry out their
duties.
Organ Procurement Organizations: If you are an organ donor, we may
disclose health information to organ procurement organizations or other
entities engaged in the procurement, banking, or transplantation of
organs for the purpose of tissue donation and transplant.
Marketing: We may contact you to provide appointment reminders or
information about treatment alternatives or other health related
benefits and services that may be of interest to you.
Food and Drug Administration (FDA): We may disclose to the FDA health
information relative to adverse events with respect to food,
supplements, product and product defects or post marketing surveillance
information to enable product recalls, repairs or replacement.
Workers Compensation: We may disclose health information to the extent
authorized by and to the extent necessary to comply with laws relating
to workers compensation or other similar programs established by law.
These programs provide benefits for work-related injuries or illness.
Public Health: As required by law, we may disclose your health
information to public health or legal authorities for public health
activities. These activities generally include the following:
To prevent or control disease, injury or disability;
To report births or deaths;
To report reactions to medications or problems with products;
To notify people of recalls of products they may be using;
To notify a person who may have been exposed to a disease or
may be at risk for contracting or spreading a disease or
condition;
To notify the appropriate government authority if we believe a
patient has been the victim of abuse, neglect or domestic
violence. We will only make this disclosure when you agree
or when required or authorized by law.
Correctional Institution: If you are an inmate of a correctional
institution or under the custody of a law enforcement official, we may
disclose to the institution or agents thereof, health information
necessary for your health, and the health and safety of other
individuals.
Law Enforcement: We may disclose health information for law enforcement
purposes as required by law
In response to a court order, valid subpoena, warrant, summons
or similar process;
To identify or locate a suspect, fugitive, material witness, or
missing person;
About the victim of a crime if, under certain limited
circumstances, we are unable to obtain the person's agreement;
About a death we believe may be the result of criminal conduct;
About criminal conduct at the Clinic; and
In emergency circumstances to report a crime; the location
of the crime or victims; or the identity, description or location
of the person who committed the crime.
Federal law makes provision for your health information to be released
to an appropriate health oversight agency, public health authority or
attorney, provided that a workforce member or business associate
believes in good faith that we have engaged in unlawful conduct or have
otherwise violated professional or clinical standards and are
potentially endangering one or more patients, workers or the public.
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Other Uses and Disclosures of Your Information by Authorization Only
When you request information to be disclosed to another party or
yourself, we will respond according to federal and state law.
We are required to get your authorization to use or disclose your
protected health information for any use other than treatment, payment
or health care operations, and those specific circumstances outlined
above. We use an Authorization to Use/Disclose form that specifically
states what information will be given to whom, for what purpose, and is
signed by you or your legal representative. You have the ability to
revoke the signed authorization at any time by a written statement given
to us to that effect.
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This Notice of Privacy Practices is effective April 14, 2003. |
