NOTICE
OF PRIVACY PRACTICES
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 is being provided to you as a requirement
of the Health Insurance Portability and Accountability Act (HIPAA).
This Notice of Privacy Practices (“Notice”) describes how
we may use and disclose your Protected Health Information (PHI) to
carry out treatment, payment or health care operations and for other
specified purposes that are permitted or required by law. PHI means
any of your written and oral health information, including demographic
data, that can be used to identify you. The Notice also describes your
rights with respect to PHI about you.
Orlando Neurosurgery is required to follow the terms of this Notice.
We will not use or disclose PHI about you without your written authorization,
except as described in this Notice. We reserve the right to change
our practices and this Notice and make new Notice effective for all
PHI we maintain. Upon request, we will provide any revised Notice to
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Examples of How We May Use and Disclose PHI
The following categories describe and provide examples of different
ways that we use and disclose PHI:
We will use PHI for treatment. We will use and disclose
your PHI to provide, coordinate or manage your health care and any
related services. This includes the coordination or management of your
health care with a third party for treatment purposes. For example,
we may disclose your protected health information to a pharmacy to
fulfill a prescription, to a laboratory to order a blood test; or to
a home health agency that is providing care in your home. We may also
disclose PHI to other physicians who may be treating you or consulting
with your physician with respect to your care. In some cases, we may
also disclose PHI to an outside treatment provider for purposes of
the treatment activities of the other provider.
We will use PHI for payment. Your PHI will be used,
as needed, to obtain payment for the services that we provide. This
may include contacting your insurer to determine whether it will pay
for your treatment and the amount of your co-payment responsibility.
We will bill you or a third-party payor for the cost of treatment provided
for you. For example, if a hospital admission is recommended, we may
need to disclose information to your health insurer to get prior approval
for the hospitalization. The information on or accompanying the bill
may include information that identifies you, as well as the treatment
you are receiving.
We will use PHI for health care operations. We may
use and disclose medical information about you for medical office operations.
These uses and disclosures are necessary to run our office and make
sure that all of our patients receive quality care. For example, we
may use medical information to review our treatment and services and
to evaluate the performance of our staff in caring for you.
Appointment Reminders. We may use and disclose medical
information to contact you as a reminder that you have an appointment.
Family and Friends. Unless you object, we may disclose
your medical information to family members, other relatives or close
personal friends when the medical information is directly relevant
to that person’s involvement with your care.
Notification. Unless you object, we may use or disclose
your medical information to notify a family member, a personal representative
or another person responsible for your care of your location, general
condition or death.
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We are likely to use or disclose PHI for the following purposes:
Business associates: There are some services provided
by us through contracts with business associates. Examples include
billing companies, accounting firms, and law firms. When these services
are contracted for, we may disclose PHI about you to our business associate
so that they can perform the job we have asked them to do. To protect
PHI about you, we require the business associate to appropriately safeguard
the PHI.
Communication with individuals involved in your care or payment
of your care. Health professionals, using their professional
judgment, may disclose to a family member, other relative, close personal
friend or any person you identify, PHI relevant to that person’s
involvement in your care or payment related to your care.
Health-related communications: We may contact you
with 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, or persons under the jurisdiction of the FDA, PHI relative
to adverse events with respect to drugs, foods, supplements, products
and product defects or post marketing surveillance information to enable
product recalls, repairs or replacement.
Workers’ Compensation: We may disclose PHI about
you to the extent authorized by and to the extent necessary to comply
with laws related to Workers’ Compensation or other similar programs
established by law.
Public Health: As required by law, we may disclose
PHI about you to public health or legal authorities charged with preventing
or controlling disease, injury or disability.
Law Enforcement: We may disclose PHI about you for
law enforcement purposes as required by law or in response to a valid
subpoena.
As required by law: We must disclose PHI about you
when required to do so by law.
Health Oversight Activities: We may disclose PHI about
you to an oversight agency for activities authorized by law. These
oversight activities include audits, investigations, and inspections,
as necessary, for our licensure and for the government to monitor the
health care system, government programs, and compliance with civil
rights laws.
Judicial and Administrative Proceedings: If you are
involved in a lawsuit or a dispute, we may disclose PHI about you in
response to a court or administrative order. We may also disclose PHI
about you in response to a subpoena, discovery request, or other lawful
process by someone else involve in the dispute, but only if efforts
have been made to tell you about the request or to obtain an order
protecting the requested PHI.
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We
are permitted to use or disclose PHI about you for the following
purposes:
We will use PHI for treatment. Research: We may
disclose PHI about you 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 information.
Coroners, medical examiners, and funeral directors: We
may release PHI about you 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 disclose PHI to funeral
directors consistent with applicable law to carry out their duties.
To avert a serious threat to health or safety: We
may use and disclose PHI about you when necessary to prevent a
serious threat to your health and safety or the health and safety
of the public or another person.
Military and Veterans: If you are a member of
the Armed Forces, we may release PHI about you as required by Military
Command authorities. We may also release PHI about foreign military
personnel to the appropriate military authority.
National Security and Intelligence Activates: We
may release PHI about you to authorized federal officials for intelligence,
counter-intelligence, and other national security activities authorized
by law.
Protective Services for the President and others: We
may disclose PHI about you to authorized federal officials so they
may provide protection to the President, other authorized or foreign
heads of state or conduct special investigations.
Victims of abuse, neglect, or domestic violence: We
may disclose PHI about you to a government authority, such as a
social service or protective services agency, if we reasonably
believe you are a victim of abuse, neglect or domestic violence.
We will only disclose this type of information to the extent required
by law, if you agree to the disclosure, or if the disclosure is
allowed by law and we believe it is necessary to prevent serious
harm to you or someone else or the law enforcement or public official
that is to receive the report represents that it is necessary and
will not be used against you.
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Your Health Information Rights
You have the following rights with respect to PHI about you:
We will use PHI for treatment. Right to Inspect and
Copy. You have the right to inspect and request a copy of your medical
information that may be used to make decisions about your care. If
you request a copy of the information, we may charge a fee for processing
your request. We may deny your request to inspect and copy in certain
very limited circumstances.
Right to Amend. If you feel that medical information
we have about you is incorrect or incomplete, you may ask us to amend
the information. You have the right to request an amendment for as
long as the information is kept by or for our office. We may approve
or deny your request for an amendment. If we deny your request, you
will be provided with a written explanation of our reasons for denial.
Right to an Accounting of Disclosures. You have the
right to request an “accounting of disclosures”. This is
a list of the disclosures we made of medical information about you
for purposes other than treatment, payment or operations. Your request
must state a time period which may not be longer than six years and
may not include dates before April 14, 2003. The first list you request
within a 12-month period will be provided free of charge, but you may
be charged for the cost of providing additional accountings. We will
notify you of the cost involved and you may choose to withdraw or modify
your request at that time.
Right to Request Restrictions. You have the right
to request a restriction or limitation on the medical information we
use or disclose about you for treatment, payment or health care operations.
You also have the right to ask to restrict disclosures to family members
or to others who are involved in your health care or payment for your
health care. Please note that while we will try to honor your request
and will permit requests consistent with its policies, we are not required
to agree to any restrictions.
Right to Request Confidential Communications. You
have the right to request that we communicate with you about medical
matters in a certain way or at a certain location. For example, you
may request that we contact you about medical matters only in writing
or at a different residence or post office box. Your request must be
in writing and specify how or when you would like to be contacted.
We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice. You have the
right to obtain a paper copy of the Notice upon request. You may request
a copy of the Notice at any time. To obtain a paper copy, contact the
Orlando Neurosurgery Privacy Officer at 1801 Cook Avenue, Orlando,
Florida 32806.
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Other Uses and Disclosures of PHI
Orlando Neurosurgery will obtain your written authorization before
using or disclosing PHI about you for purposes other than those provided
for above or as otherwise permitted or required by law. You may revoke
an authorization in writing at any time. Upon receipt of the written
revocation, we will stop using and disclosing PHI about you, except
to the extent that we have already taken action in reliance on the
authorization.
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For More Information or to Report a Problem
If you have questions or would like additional information about Orlando
Neurosurgery’s privacy practices, you may contact the Orlando
Neurosurgery Privacy Officer at 1801 Cook Avenue, Orlando, Florida
32806 (407-425-7470). If you believe your privacy rights have been
violated, you can file a complaint with the Orlando Neurosurgery Privacy
Officer or with the Secretary of Health and Human Services. There will
be no retaliation for filing a complaint.
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Effective Date
This Notice is effect as of April 14, 2003.
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