|
PRIVACY 200
WINTER PARK UROLOGY
ASSOCIATES, P.A.
UROLOGICAL AMBULATORY SURGERY
CENTER, INC.
NOTICE OF PRIVACY PRACTICES
HIPAA
Effective Date: 2/1/2003
THIS
NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
If you
have any questions about this Notice of Privacy Practices (“Notice”), please
contact:
NAME:
Administrator
PHONE
NUMBER: (407) 897-3499
Section A: Who Will Follow
This Notice?
This
Notice describes our practices and that of: Any health care professional in this
physician practice (“Practice”) authorized to enter information into your
medical record.
·
Any member of a
volunteer group we allow to help you while you are receiving care from this
Practice.
·
All our
employees, staff and other personnel.
Urological Ambulatory Surgery, Kidney Stone Center of Central Florida Center,
Inc. All these entities, sites and locations follow the terms of this Notice.
In addition, these entities, sites and locations may share medical information
with each other for treatment, payment or practice operations purposes described
in this Notice. This list may not reflect recent acquisitions or sales of
entities, sites, or location.
Section B: Our Pledge
Regarding Medical Information.
We
understand that medical information about you and your health is personal. We
are committed to protecting medical information about you. We create a record
of the care and services you receive at this Practice. We need this record to
provide you with quality care and to comply with certain legal requirements.
This Notice applies to all of the records of your care generated or maintained
by this Practice. Any medical institution such as a hospital or nursing home at
which we may treat you may have different policies or Notices regarding that
medical institution’s use and disclosure of your medical information created in
that medical institution.
This
Notice will tell you about the ways in which we may use and disclose medical
information about you. We also describe your rights and certain obligations we
have regarding the use and disclosure of medical information.
We are
required by law to:
·
Make sure that
medical information that identifies you is kept private.
·
Give you this
Notice of our legal duties and privacy practices with respect to medical
information about you; and
·
Follow the terms
of the Notice that is currently in effect.
Section C: How We May Use
and Disclose Medical Information About You?
The
following categories describe different ways that we may use and disclose
medical information. For each category of uses or disclosures we will explain
what we mean and try to give some examples. Not every use or disclosure in a
category will be listed. However, all of the ways we are permitted to use and
disclose information will fall within one of the categories.
·
Treatment.
We may use medical information about you to provide you with medical treatment
or services. We may disclose medical information about you to doctors, nurses,
technicians, medical students, or other Practice personnel or personnel in
medical institutions such as a hospital or nursing home in which you receive
care. For example, a doctor working for a hospital or for another physician
practice who is treating you for a broken leg may need to know if you have
diabetes because diabetes may slow the healing process. In addition, the doctor
may need to tell the dietitian if you have diabetes so that the hospital or
nursing home can arrange for appropriate meals. We may share your medical
information with different departments of a hospital or nursing home in order to
coordinate the different things you need, such as prescriptions, lab work and
x-rays. We also may disclose medical information about you to other people
outside this Practice who may be involved in your medical care such as family
members, clergy or others who provide services that are part of you care.
·
Payment.
We may use and disclose medical information about you so that the treatment and
services you receive from this Practice may be billed to and payment may be
collected from you, and insurance company or a third party. For example, we may
give your health plan information about a medical procedure such as surgery that
we performed for you so your health plan will pay us or reimburse you for the
surgery. 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.
·
Health Care Operations. We may use and disclose medical information about you in
order to operate this Practice. These uses and disclosures are necessary to run
this Practice and to 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. We may also
combine medical information about other patients to decide what additional
services that we can offer, what services are not needed, and whether certain
new treatments are effective. We may also disclose information to other
doctors, nurses, technicians, medical students, and even personnel from other
medical institutions such as a hospital or nursing home for review and learning
purposes. We may also combine the medical information we have with medical
information from other medical institutions such as hospitals, nursing homes, or
other physician practices to compare how we are doing and see where we can make
improvements in the care and services we offer. We may remove information that
identifies you from this set of medical information so others may use it to
study health care and health care delivery without learning who the specific
patients are.
·
Appointment Reminders. We may use and disclose medical information to contact
you as a reminder that you have an appointment for treatment or medical care at
this Practice.
·
Treatment Alternatives. We may use and disclose medical information to tell you
about or recommend possible treatment options or alternatives that may be of
interest to you.
·
Health-Related Benefits and Services. We may use and disclose medical information to
tell you about health-related benefits or services that may be of interest to
you.
·
Hospital Directory. We may disclose certain information about you to a medical
institution such as a hospital or nursing home in order for that medical
institution to list you in its directory while you are a patient at that medical
institution. This information may include your name, location in the medical
institution, your general condition (e.g., fair, stable, etc.) and your
religious affiliation. This is so your family, friends and clergy can visit you
in the medical institution and generally know how you are doing.
·
Individuals Involved in Your Care or Payment for Your Care.
We may release medical information about you to a friend or family member who is
involved in your medical care. We may also give information to someone who
helps pay for your care. We may also tell your family or friends your condition
and that you are in a medical institution such as a hospital or nursing home.
In addition, we may disclose medical information about you to an entity
assisting in a disaster relief effort so that your family can be notified about
your condition, status and location.
·
Research.
Under certain circumstances, we may use and disclose medical information about
you for research purposes. For example, a research project may involve
comparing the health and recovery of all patients who received one medication to
those who received another, for the same condition. All research project6s,
however, are subject to a special approval process. This process evaluates a
proposed research project and its use of medical information, trying to balance
the research needs with patients’ need for privacy of their medical
information. Before we use or disclose medical information for research, the
project will have been approved through this research approval process, but we
may, however, disclose medical information about you to people preparing to
conduct a research project, for example, to help them look for patients with
specific medical needs, so long as the medical information they review does not
leave the location in which it was generated or maintained. We will almost
always generally ask for your specific permission if the researcher will have
access to you name, address or other information that reveals who you are, or
will be involved in your care at our Practice location(s).
·
As Required By Law. We will disclose medical information about you when required to do
so by federal, state or local law.
·
To Avert a Serious Threat to Health or Safety.
We may use and disclose medical information 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. Any disclosure, however, would only be to someone
able to help prevent the threat.
Section D: Special
Situations
·
Organ and Tissue Donation. If you are an organ donor, we may release medical
information to organizations that handle organ procurement or organ, eye or
tissue transplantation or to an organ donation bank, as necessary to facilitate
organ or tissue donation and transplantation.
·
Military and Veterans. If you are a member of the armed forces, we may release
medical information about you as required by military command authorities. We
may also release medical information about foreign military personnel to the
appropriate foreign military authority.
·
Workers’ Compensation. We may release medical information about you for
workers’ compensation or similar programs. These programs provide benefits for
work-related injuries or illness.
·
Public Health Risks. We may disclose medical information about you for public health
activities. These activities generally include the following:
§
To prevent or
control disease, injury or disability;
§
To report births
and deaths;
§
To report child
abuse or neglect;
§
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 if you
agree or when required or authorized by law.
·
Health Oversight Activities. We may disclose medical information to a health
oversight agency for activities authorized by law. These oversight activities
include, for example, audits, investigations, inspections, and licensure. These
activities are necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
·
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may
disclose medical information abut you in response to a court or administrative
order. We may also disclose medical information about you in response to a
subpoena, discovery request, or other lawful process by someone else involved in
the dispute, but only if efforts have been made to tell you about the request or
to obtain an order protecting the information requested.
·
Law Enforcement. We may release medical information if asked to do so by a law
enforcement official:
§
In response to a
court order, 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 a medical institution such as a hospital or nursing home; 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.
·
Coroners, Medical Examiners and Funeral Directors.
We may release medical information to a coroner or medical examiner. This may
be necessary, for example, to identity a deceased person or determine the cause
of death. We may also release medical information about our patients to funeral
directors as necessary to carry out their duties.
·
National Security and Intelligence Activities.
We may release medical information about you to authorized federal officials for
intelligence, counterintelligence, and other national security activities
authorized by law.
·
Protective services for the President and Others.
We may disclose medical information about you to authorized federal officials so
they may provide protection to the President, other authorized persons or
foreign heads of state or conduct special investigations.
·
Inmates.
If you are an inmate of a correctional institution or under the custody of a law
enforcement official, we may release medical information about you to the
correctional institution or law enforcement official. This release would by
necessary for the institution to provide you with health care, to protect your
health and safety or the health and safety of others, or for the safety and
security of the correctional institution.
Section E: Your Rights
Regarding Medical Information About You
You have
the following rights regarding medical information we maintain about you:
·
Right to Inspect and Copy. You have the right to inspect and copy some of the
medical information that may be used to make decisions about your care.
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.
·
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 the
Practice. In addition, you must provide a reason that supports your request.
·
We may deny your
request for an amendment if it is not in writing or does not include a reason to
support the request. In addition, we may deny your request if you ask us to
amend information that:
§
Was not created
by us, unless the person or entity that created the information is no longer
available to make the amendment;
§
Is not part of
the medical information kept by or for the Practice;
§
Is not part of
the information which you would be permitted to inspect and copy; or
§
Is accurate and
complete.
·
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. Your request must
state a time period, which may not be longer than six years and may not include
dates before April 14, 2003. Your request should indicate in what form you want
the list (for example, on paper, electronically). 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. We will notify you of the cost involved
and you may choose to withdraw or modify your request at the time before any
costs are incurred.
·
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 request a limit on the medical information we disclose about you to someone
who is involved in your care or the payment for your care, like a family member
or friend. For example, you could ask that we not use or disclose information
about a surgery you had.
In your request, you must tell us what information you want
to limit our use, disclosure, or both, and to who you want the limits to apply
(for example, disclosures to your spouse).
We are not required to agree to your request.
If we do agree, we will comply with your request unless the information is
needed to provide you emergency treatment.
|
