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, this Notice and make a revised Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you.

• Examples of How We May Use and Disclose PHI
• We are likely to use or disclose PHI for these purposes
• We are permitted to use or disclose PHI about you for these purposes
• Your Health Information Rights
• Other Uses and Disclosures of PHI
• For More Information or to Report a Problem

Effective Date

The following categories describe and provide examples of different ways that we use and disclose PHI:

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.

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.

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.

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.

We are permitted to use or disclose PHI about you for the following purposes:

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 Activities: 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.

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 1605 W. Fairbanks Avenue, Winter Park, Florida 32789.

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.

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 1605 W. Fairbanks Avenue, Winter Park, Florida 32789 (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.

This Notice is effective January 01, 2019