Orthopedic Associates of Southwest Florida, P.A.
13691 Metro Parkway, Ste 400
Fort Myers, FL 33912
239-768-2272
Fax: 239-768-5549
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.
Our practice is dedicated to protecting your medical information.
We are required by law to maintain the privacy of protected
health information and to provide you with this Notice of our
legal duties and privacy practices with respect to protected
health information. Our practice is required by law to abide
by the terms of this Notice.
This Notice of Privacy Practices 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 access and 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 or
condition and related health care services.
Our office is required to abide by the terms of this Notice
of Privacy Practices. We may change the terms of our notice,
at any time. The new notice will be effective for all protected
health information that we maintain at that time. Upon your
request, we will provide you with any revised Notice of Privacy
Practices. To request a revised notice you may call the office
and request that a revised copy be sent to you in the mail
or asking for one at the time of your next appointment.
HOW YOUR MEDICAL INFORMATION WILL BE USED AND DISCLOSED:
We will use your medical information as part of rendering
patient care. For example, your medical information may
be used by
the doctor or nurse treating you, by the business office
to process your payment for the services rendered and in
order
to support the business activities of the practice, including,
but not limited to, use by administrative personnel reviewing
the quality of the care you receive, employee review activities,
training of medical students, licensing, contacting or arranging
for other business activities..
We may also use and/or disclose your information in accordance
with federal and state laws for the following purposes:
Appointment Reminders.
We may contact you to provide appointment reminders.
Treatment Information.
We may contact you with information about treatment alternatives
or other health-related benefits and services that may be
of interest to you.
Disclosure to Department of Health and Human Services.
We may disclose medical information when required by the
United States Department of Health and Human Services as
part of an investigation or determination of our compliance
with relevant laws.
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.
Disaster Relief.
We may disclose your medical information to a public or private
entity, such as the American Red Cross, for the purpose of
coordinating with that entity to assist in disaster relief
efforts.
Health Oversight Activities.
We may use or disclose your medical information for public
health activities, including the reporting of disease, injury,
vital events and the conduct of public health surveillance,
investigation and/or intervention. We may disclose your medical
information to a health oversight agency for oversight activities
authorized by law, including audits, investigations, inspections,
licensure or disciplinary actions, administrative and/or
legal proceedings.
Abuse or Neglect.
We may disclose your medical information when it concerns
abuse, neglect or violence to you in accordance with federal
and state law.
Legal Proceedings.
We may disclose your medical information in the course of
certain judicial or administrative proceedings.
Law Enforcement.
We may disclose your medical information for law enforcement
purposes or other specialized governmental functions.
Coroners, Medical Examiners and Funeral Directors.
We may disclose your medical information to a coroner, medical
examiner or a funeral director.
Organ Donation.
If you are an organ donor, we may disclose your medical information
to an organ donation and procurement organization.
Research.
We may use or disclose your medical information for certain
research purposes if an Institutional Review Board or a privacy
board has altered or waived individual authorization, the review
is preparatory to research or the research is on only decedent’s
information.
Public Safety.
We may use or disclose your medical information to prevent
or lessen a serious threat to the health or safety of another
person or to the public.
Workers Compensation.
We may disclose your medical information as authorized by laws
relating to workers’ compensation or similar programs.
Business Associates.
We may disclose your health information to a business associate
with whom we contract to provide services on our behalf. To
protect your health information, we require our business associates
to appropriately safeguard the health information of our patients.
AUTHORIZATIONS:
We will not use or disclose your medical information for any
other purpose without your written authorization. Once given,
you may revoke your authorization in writing at any time. To
request a Revocation of Authorization form, you may contact:
Joan Gagliardi, R.H.I.T.
Orthopedic Associates of Southwest Florida, P.A.,
13691 Metro
Parkway, Ste 400, Fort Myers, FL 33912
Telephone: 239-768-2272 Fax: 239-768-5549
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:
You have the following rights with respect to your medical
information:
You may ask us to restrict certain uses and disclosures
of your medical information. We are not required to agree
to
your request, but if we do, we will honor it.
You have the right to receive communications from us in
a confidential manner.
Generally, you may inspect and copy your medical information.
This right is subject to certain specific exceptions, and
you may be charged a reasonable fee for any copies of your
records.
You may ask us to amend your medical information. We may
deny your request for certain specific reasons. If we deny
your request, we will provide you with a written explanation
for the denial and information regarding further rights
you may have at that point.
You have the right to receive an accounting of the disclosures
of your medical information made by our practice during
the last six years (or following April 14, 2003), except
for
disclosures for treatment, payment or healthcare operations,
disclosures which you authorized and certain other specific
disclosure types.
You may request a paper copy of this Notice of Privacy
Practices for Protected Health Information.
You have the right to complain to us and/or to the United
States Department of Health and Human Services if you believe
that we have violated your privacy rights. If you choose
to file a complaint, you will not be retaliated against
in any way. To complain to us, please contact:
Joan Gagliardi, R.H.I.T.
Orthopedic Associates of Southwest Florida, P.A.,
13691 Metro Parkway, Ste 400, Fort Myers, FL 33912
Telephone: 239-768-2272 Fax: 239-768-5549
If you would like further information regarding your rights
or regarding the uses and disclosures of your medical information,
you may contact:
Joan Gagliardi, R.H.I.T.
Orthopedic Associates of Southwest Florida, P.A.,
13691 Metro Parkway, Ste 400, Fort Myers, FL 33912
Telephone: 239-768-2272 Fax: 239-768-5549
THIS NOTICE IS
EFFECTIVE AS OF APRIL 14, 2003.
REVISION OF NOTICE OF PRIVACY PRACTICES
We reserve the right to change the terms of this Notice,
making any revision applicable to all the protected health
information we maintain. If we revise the terms of this
Notice, we will post a revised notice at our office and
will make
paper copies of the revised Notice of Privacy Practices
available upon request.
2002-11-10 P1010
|
