Patient Copy
NOTICE OF HEALTH INFORMATION PRACTICES
(as required by Federal and Florida state laws)
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY AND SIGN THE ATTACHED AUTHORIZATION.
Introduction
At Bay Heart Group, we are committed to treating and
using protected health information about you responsibly. This Notice for
Health Information Practices describes the personal information we collect, and
how and when we use or disclose that information. It also describes your rights
as they relate to your protected health information (medical records). This
Notice is effective October 21, 2002, and applies to all protected health
information, as defined by federal regulations.
Each time you visit Bay Heart Group, a record of your
visit is made. Typically, this record contains your symptoms, examination and
test results, diagnoses, treatment, and a plan for future care or treatment.
This information, often referred to as your health or medical record, serves as
a:
·
Basis for
planning your care and treatment,
·
Means of
communication among the many health professionals who contribute to your care,
·
Legal
document describing the care you received,
·
Means by
which you or a third-party payer can verify that services billed were actually
provided,
·
A tool in
educating health professionals,
·
A source of
data for medical research,
·
A source of
information for public health officials charged with improving the health of
this state and the nation,
·
A source of
data for planning,
·
A tool with
which we can assess and continually work to improve the care we render and the
outcomes we achieve,
Understanding what is in your record and how your health
information is used helps you to: ensure its accuracy, better understand who,
what, when, where and why others may access your health information, and make
more informed decisions when authorizing disclosure to others.
Although
your health record is the physical property of Bay Heart Group, the information
belongs to you. You have the right to:
·
Obtain a
paper copy of this notice of information practices upon request,
·
Inspect and
copy your health record as provided for in 45 CFR 164.524,
·
Amend your
health record as provided in 45 CFR 164.528,
·
Obtain an
accounting of disclosures of your health information as provided in 45 CFR
164.528,
·
Request
communications of your health information by alternative means,
·
Request a
restriction on certain uses and disclosures of your information as provided by
45 CFR 164.522, and
·
Revoke your
authorization (in writing) to use or disclose health information except to the
extent that action has already been taken.
Bay
Heart Group, P.A. is required to:
· Maintain the privacy of your health information,
· Provide you with this notice as to our legal
duties and privacy practices with respect to information we collect and
maintain about you,
· Abide by the terms of this notice,
· Notify you if we are unable to agree to a
requested restriction, and
· Accommodate reasonable requests you may have to
communicate health information by alternative means.
We reserve the right
to change our practices and to make the new provisions effective for all
protected health information we maintain. Should our information practices
change, we will mail a revised notice to the address you’ve supplied us, or if
you agree, we will email the revised notice to you.
We
will not use or disclose your health information without your authorization,
except as described in this notice. We will also discontinue to use or disclose
your health information after we have received a written authorization
according to the procedures included in the authorization.
If you have questions and would like additional
information, you may contact the practice’s Privacy Officers, Terry Poole or
Hillary Galpin at (813) 875-9000.
If
you believe your privacy rights have been violated, you can file a complaint
with either the practice’s Privacy Officer or the Office for Civil Rights. The
address for the OCR is listed below.
U.S.
Department of Health and Human Services
200
Independence Ave., S.W.
Room
509F, HHH Building
Washington,
D.C. 20201
We will use your health information
for treatment and billing purposes.
For example: Information obtained by a nurse, physician, or
other member of your health care team will be recorded in your record and used
to determine the course of treatment that should work best for you. Your
physician will document in your record his or her plan of care. In that way,
the physician will know how you are responding to treatment.
We
will also provide your primary physician or a subsequent health care provider
with copies of various reports that should assist him or her in your treatment.
For example: A bill may be sent to you or a third-party
payer. The information on or accompanying the bill may include information that
identifies you, as well as your diagnosis, procedures, and supplies used.
For example: Bay Heart Group, staff and physicians may use
information in your health record to assess the care and outcomes in your case.
This information will then be used in an effort to continually improve the
quality and effectiveness of the healthcare and service we provide.
Business associates: There are some services provided in our
organization through contacts with business associates. Examples include
physician services in the emergency department, radiology, laboratory,
pacemaker and monitoring companies,
underwriting and general and liability insurance, home care agencies,
pharmacies. When these services are contracted, we may disclose your health
information to our business associate so that they can perform the job we’ve
requested and then bill you or your third-party payer for services rendered. To
protect your health information, however, we require the business associate to
appropriately safeguard your information.
Notification: We may use or disclose information to notify or
assist in notifying a family member, personal representative, or another person
responsible for your care, your location and your general condition.
Communication with family: Health professionals, using their best judgment,
may disclose to a family member, other relative, close personal friend or any
other person you identify, health information relevant to that person’s
involvement in your care or payment related to your care.
Research: We may disclose information to clinicians 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 health information.
Funeral directors: We may disclose health information to funeral
directors, coroner or medical examiner consistent with applicable law to carry
out their duties.
Organ procurement organizations: Consistent with applicable law, we may disclose
health information to organ procurement organizations or other entities engaged
in the procurement, banking, or transplantation of organs for the purpose of
tissue donation and transplant.
Marketing: We may contact you (and may leave you a voice
message) to provide appointment reminders or information about treatment or
other health-related benefits and services.
Food and Drug Administration (FDA): We may disclose to the FDA health information
relative to adverse events with respect to food, supplements, product and
product defects, or post marketing surveillance information to enable product
recalls, repairs or replacement.
Worker’s compensation: We may disclose health information to the extent
authorized by and to the extent necessary to comply with laws relating to
workers compensation or related to an auto accident or other similar programs
established by law.
Public health: As required by law, we may disclose your health
information to public health or legal authorities charged with preventing or
controlling disease, injury or disability.
Correctional institution: Should you be an inmate of a correctional
institution, we may disclose to the institution or agents thereof, health
information necessary for your health and the health and safety of other
individuals.
Law enforcement: We may disclose health information for law
enforcement purposes as required by law or in response to a valid subpoena.
Federal
law makes provision for your health information to be released to an appropriate
health oversight agency, public health authority or attorney, provided that a
work force member or business associate believes in good faith that we have
engaged in unlawful conduct or have otherwise violated professional or clinical
standards and are potentially endangering one or more patients, workers or the
public.
Government Agencies: We may disclose PHI to various government
agencies for military and veterans activities; national security and
intelligence activities; protective service for the President, medical
suitability determinations.