NOTICE OF PRIVACY PRACTICES
The Clinic of Plant City believes that your health information is personal and we are committed to keeping your health information private. In addition, we are required by law keep certain health care information, known as Protected Health Information (“PHI”) confidential.
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.
USES AND DISCLOSURES OF PHI
We may use PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission. The following are examples of these uses:
- For treatment -We may use information about you to diagnose your medical condition and carry out your medical care. We may disclose this information to doctors, nurses, or other our staff who take care of you.
- For payment – We may use and share information about you so that services you received may be billed and payment collected from you, an insurance company, or another third party.
- For health care operations – We may use and share information about you in order to perform our administrative and operational functions. We may use your information to conduct business planning, design staff training programs, and obtain legal and financial services. We may share PHI with business associates who provide services to us. Business associates are legally bound to protect your information as we would.
- Your PHI may be disclosed to another health care provider, however the entity receiving the information must have a relationship with you and the PHI pertains to that relationship (i.e. your primary care physician).
- In order to provide the best care possible, we may use your PHI for quality improvement and assurance activities and processing grievances or complaints.
- Follow-up care and other services – We may contact you by mail, telephone, or email regarding follow-up care (if any). We may also contact you regarding other of our health-related products and services offerings.
USE AND DISCLOSURE OF PHI REQUIRING AN OPPORTUNITY TO AGREE OR OBJECT
Family Members, Friends – We may release your PHI to a family member, other relatives, or close personal friend or other individual involved in your care or payment of your care. Whenever possible, we will give you an opportunity to object to such a disclosure. In certain situations/emergencies, however, we may need to share information about you with other individuals or organizations to plan and implement your care.
USE AND DISCLOSURE OF PHI WITHOUT YOUR AUTHORIZATION
We are permitted to use PHI without your written authorization in the following situations:
- Fraud Prevention – We may use your information in order to detect health care fraud and abuse and maintain compliance with applicable law and regulations.
- Public Health Activities -We may disclose PHI as part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report adverse events such as product defects, or to notify a person about exposure to a possible communicable disease.
- Health Oversight -We may release PHI for health oversight activities including audits or investigations, surveys, disciplinary proceedings, and other actions authorized by state or federal government.
- Lawsuits and Disputes – We may disclose information for judicial and administrative proceedings as required by a court or administrative order, or in response to an valid and appropriate subpoena or other legal process.
- Law Enforcement – Disclosure may be necessary for law enforcement activities in limited situations (when there is a warrant for the information, or when the information is needed to locate a suspect or stop a crime).
- National Security – We may release information about you to authorized federal officials for national security activities and intelligence.
- Public Safety – We may use your information to avert a serious threat to the health and safety of a person or the public at large.
- Worker’s Compensation – We may release your information about you to workers’ compensation or similar programs that provide benefits for work-related injuries or illness.
- Research – In limited situations, we may use your information for research projects.
Any other use or disclosure of PHI, other than those listed above, will only be made with your written authorization. You may revoke your authorization at any time, in writing, except to the extent that we have already used or disclosed medical information in reliance on that authorization.
PATIENTS RIGHTS
As a patient, you have a number of rights with respect to the protection of your PHI, including:
- The right to access, copy or inspect your PHI – This means you may request a copy of the medical information about you that we maintain. We must receive the request in writing and normally provide access to this information within 30 days of request. We may also charge you a reasonable fee for any copies of your PHI. In limited circumstances, we may deny you access to your medical information, and you may appeal certain types of denials. If you wish to inspect and copy your medical information, you should contact the Privacy Officer listed below.
- The right to amend your PHI -You have the right to request an amendment to your PHI. If we agree, we will generally amend your information within 60 days of your request and will notify you of the amendment. We are permitted by law to deny your request in certain circumstances. Send request to the Privacy Officer listed below.
- The right to request an accounting of our use and disclosure of your PHI -You may request an accounting of certain disclosures of your PHI that we have made in the last six years prior to the date of your request. We are not required to give you an accounting of information we have used or disclosed for purposes of treatment, payment, or health care operations, or when we share your health information with our business associates. We are also not required to give you an accounting of our uses of PHI for which you have already given us written authorization.
- The right to request that we restrict the uses and disclosures of your PHI -You have the right to request that we restrict how we use and disclose your medical information that we have about you for treatment, payment or health care operations, or to restrict the information that is provided to family, friends and other individuals involved in your health care. We are not required to agree to any restrictions you request, but any restrictions we agree to are binding.
- Internet, Electronic Mail, and the Right to Obtain Copy of Paper Notice on Request – We will prominently post a copy of this Notice on our web site (put website here) and make the Notice available electronically through the web site. You may request a paper copy of this Notice.
REVISIONS TO THE NOTICE
We reserve the right to change the terms of this Notice at any time, and the changes will be effective immediately and will apply to all PHI that we maintain. A revised Notice will be promptly posted in our facilities and to our web site.
YOUR LEGAL RIGHTS AND COMPLAINTS
You also have the right to complain to us or to the Office of Civil Rights (http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html) if you believe your privacy rights have been violated. All complaints to us must be submitted in writing. You will not be retaliated against in any way for filing a complaint with us or to the government. Direct questions, comments, or complaints regarding this Notice to the Privacy Officer listed below.
The Clinic of Plant City Privacy Officer
802 W. Martin Luther King Jr. Blvd., Suite C
Plant City, FL 33563
Phone: (813)754-7999
Fax: (813)754-7111