|
HIPAA
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.
For purposes of this Notice “us” “we” and
“our” refers to Drs. Zamikoff, Klement, & Jungman and
“you” or “your” refers to our patients (or their legal
representatives as determined by us in accordance with Florida
informed consent law). When you receive health-care services
from us, we will obtain access to your medical information
(e.g., your health history). We are committed to maintaining the
privacy of your health information and we have implemented
numerous procedures to ensure that we do so.
Florida law and the Health Insurance Portability
& Accountability Act of 1996 (HIPAA) require us to maintain
the confidentiality of all your health-care records and other
individually identifiable health information used by or
disclosed to us in any form, whether electronically, on paper,
or orally(“PHI” or Protected Health Information). HIPAA is a
federal law that gives you significant new rights to understand
and control how your health information is used. HIPAA and
Florida law provide penalties for covered entities and records
owners, respectively, that misuse or improperly disclose PHI.
Starting April 14, 2003, HIPAA requires us to provide
you with this Notice of our legal duties and the privacy
practices we are required to follow when you first come into our
office for health-care services. If you have any questions about
this Notice, please ask to speak to our privacy officer, Ginny
Carter at (941) 792-2766.
Our doctors, clinical staff, Business Associates
(outside contractors we hire), employees and other office
personnel follow the policies and procedures set forth in this
notice. If your regular doctor is unavailable to assist you
(e.g. illness, on-call coverage, vacation, etc.), we may provide
you with the name of another health-care provider outside our
practice for you to consult with by telephone. If we do so, that
provider will follow the policies and procedures set forth in
this notice or those established for his or her practice, so
long as they substantially conform to those for our practice.
OUR
RULES ON HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION
Under
the law, we must have your signature on a written, dated Consent
form and/ or an Authorization form (not an Acknowledgment form)
before we will use and disclose your PHI for certain purposes as
detailed in the rules below.
Documentation
You will be asked to sign a Consent form and/or an Authorization
form when you receive this Notice of Privacy Practices. If you
did not sign such a form or need a copy of the one you signed,
please contact our privacy officer. You may take back or revoke
your Consent or Authorization at any time (unless we already
have acted based on it) by submitting our Revocation form in
writing to us at our address listed above. Your revocation will
take effect when we actually receive it. We cannot give it
retroactive effect, so it will not affect any use or disclosure
that occurred in our reliance on your Consent or Authorization
prior to revocation (e.g., if after we provide services to you,
you revoke your Authorization or Consent in order to prevent us
billing or collecting for those services, your revocation will
have no effect because we relied on your Authorization or
Consent to provide services before you revoked it).
General
Rule
If you do not sign our Consent
form or if you revoke it, as a general rule (subject to
exceptions described below under “Healthcare Treatment,
Payment and Operations Rule” and “Special Rules”), we
cannot in any manner use or disclose to anyone (excluding you,
but including payers and Business Associates) your PHI or any
other information in your medical record. Under Florida law, we
are unable to submit claims to payers under assignment of
benefits without your signature on our Consent form. We will not
condition treatment on your signing an Authorization, but we may
be forced to decline you as a new patient or discontinue you as
an active patient if you choose not to sign the Consent or
revoke it.
Health-care Treatment, Payment and Operations Rule
With your signed Consent, we may use or disclose your PHI in
order:
·
To
provide you with or coordinate health-care treatment and
services. For example, we may review your health history form to
form a diagnosis and treatment plan, consult with other doctors
about your care, delegate tasks to ancillary staff, call in
prescriptions to your pharmacy, disclose needed information to
your family or others so they may assist you with home care,
arrange appointments with other health-care providers, schedule
lab work for you, etc.;
·
To
bill or collect payment from you, an insurance company, a
managed-care organization, a health benefits plan or another
third party. For example, we may need to verify your insurance
coverage, submit your PHI on claim forms in order to get
reimbursed for our services, obtain pre-treatment estimates or
prior authorizations form your health plan or provide your
X-rays because your health plan requires them for payment; or
·
To
run our office, assess the quality of care our patients receive
and provide you with customer service. For example, to improve efficiency and reduce costs associated with
missed appointments, we may contact you by telephone, mail or
otherwise remind you of scheduled appointments, we may leave
messages with whomever answers your telephone or e-mail to
contact us (but we will not give out detailed PHI), we may call
you by name from the waiting room, we may ask you to put your
name on a sign-in sheet, we may tell you about or recommend
health-related products and complementary or alternative
treatments that may interest you, we may review your PHI to
evaluate our staff’s performance, or our privacy officer may
review your records to assist you with complaints. If you prefer
that we not contact you with appointment reminders or
information about treatment alternatives or health-related
products and services, please notify us in writing at our
address listed above and we will not use or disclose your PHI
for these purposes.
Special Rules Notwithstanding anything else contained in this
Notice, only in accordance with applicable law, and under
strictly limited circumstances, we may use or disclose your PHI
without your permission, Consent or Authorization for the
following purposes:
·
When
required under federal, state or local law;
·
When
necessary in emergencies to prevent a serious threat to your
health and safety or the health and safety of other persons;
·
When
necessary for public health reasons (e.g., prevention or control
of disease, injury or disability; reporting information such as
adverse reactions to anesthesia; ineffective or dangerous
medications or products; suspected abuse, neglect or
exploitation of children, disabled adults or the elderly; or
domestic violence);
·
For
federal or state government health-care oversight activities
(e.g., civil rights laws, fraud and abuse investigations,
audits, investigations, inspections, licensure or permitting,
government programs, etc.);
·
For
judicial and administrative proceedings and law enforcement
purposes (e.g., in response to a warrant, subpoena or court
order; by providing PHI to coroners, medical examiners and
funeral directors to locate missing persons, identify deceased
persons or determine cause of death);
·
For
workers’ compensation purposes (e.g., we may disclose your PHI
if you have claimed health benefits for a work-related injury or
illness);
·
For
intelligence, counterintelligence or other national security
purposes (e.g., Veterans Affairs, U.S. military command, other
government authorities or foreign military authorities may
require us to release PHI about you);
·
For
organ and tissue donation (e.g., if you are an organ donor we
may release your PHI to organizations that handle organ, eye or
tissue procurement, donation and transplantation);
·
For
research projects approved by an Institutional Review Board or a
privacy board to ensure confidentiality (e.g., if the researcher
will have access to your PHI because involved in your clinical
care, we will ask you to sign an Authorization);
·
To
create a collection of information that is “de-identified”
(e.g., it does not personally identify you by name,
distinguishing marks or otherwise and no longer can be connected
to you);
·
To
family members, friends and others, but only if you verbally
give permission; we give you an opportunity to object and you do
not; we reasonably assume, based on our professional judgment
and the surrounding circumstances, that you do not object (e.g.,
you bring someone with you into the operatory or exam room
during treatment or into the conference area when we are
discussing your PHI); we reasonably infer that it is in your
best interest (e.g., to allow someone to pick up your records
because they knew you were our patient and you asked them in
writing with your signature to do so); or it is an emergency
situation involving you or another person (e.g., your minor
child or ward) and, respectively, you cannot consent to your
care because you are incapable of doing so or you cannot consent
to the other person’s care because, after a reasonable
attempt, we have been unable to locate you. In these emergency
situations we may, based on our professional judgment and the
surrounding circumstances, determine that disclosure is in the
best interests of you or the other person, in which case we will
disclose PHI, but only as it pertains to the care being provided
and we will notify you of the disclosure as soon as possible
after the care is completed.
Minimum
Necessary Rule
Our staff will not use or access your PHI unless it is necessary
to do their jobs (e.g., doctors uninvolved in your care will not
access your PHI; ancillary clinical staff caring for you will
not access your billing information; billing staff will not
access your PHI except as needed to complete the claim form for
the latest visit; janitorial staff will not access your PHI).
Also, we disclose to others outside our staff only as much of
your PHI as is necessary to accomplish the recipient’s lawful
purposes. For example, we may use and disclose the entire
contents of your medical record:
·
To
you (and your legal representatives as stated above) and any one
else you list on a Consent or Authorization to receive a copy of
your records;
·
To
health-care providers for treatment purposes (e.g. making
diagnosis and treatment decisions or agreeing with prior
recommendations in the medical record);
·
To
the U.S. Department of Health and Human Services (e.g., in
connection with a HIPAA complaint);
·
To
others as required under federal or Florida law;
·
To
our privacy officer and others as necessary to resolve your
complaint or accomplish your request under HIPAA (e.g., clerks
who copy records need access to your entire medical record).
In accordance with the law, we presume that requests
for disclosure of PHI from another Covered Entity (as defined in
HIPAA) are for the minimum necessary amount of PHI to accomplish
the requester’s purpose. Our privacy officer will individually
review unusual or non-recurring requests for PHI to determine
the minimum necessary amount of PHI and disclose only that.
For
non-routine requests or disclosures, the Plan’s Privacy
Officer will make a minimum necessary determination based on,
but not limited to, the following factors:
·
The
amount of information being disclosed;
·
The
number of individuals or entities to whom the information is
being disclosed;
·
The
importance of the use or disclosure;
·
The
likelihood of further disclosure;
·
Whether
the same result could be achieved with de-identified
information;
·
The
technology available to protect confidentiality of the
information; and
·
The
cost to implement administrative, technical and security
procedures to protect confidentiality.
If
we believe that a request from others for disclosure of your
entire medical record is unnecessary, we will ask the requester
to document why this is needed, retain that documentation and
make it available to you upon request.
Incidental
Disclosure Rule We will take reasonable administrative, technical and security
safeguards to ensure the privacy of your PHI when we use or
disclose it (e.g., we require employees to talk softly when
discussing PHI with you, we use computer passwords and change
them periodically [e.g., when an employee leaves us], we allow
access to areas where PHI is stored or filed only when we are
present to supervise and prevent unauthorized access).
Business
Associate Rule
Business Associates and other third parties (if any) that
receive your PHI from us will be prohibited from re-disclosing
it unless required to do so by law or you give prior express
written consent to the re-disclosure. Nothing in our Business
Associate agreement will allow our Business Associate to violate
this re-disclosure prohibition.
Super-confidential
Information Rule If we have PHI about you regarding HIV testing, alcohol or substance
abuse diagnosis and treatment, or psychotherapy and mental
health records (super-confidential information under the law),
we will not disclose it under the General or Health-care
Treatment, Payment and Operations Rules (see above) without you
first signing and properly completing our Consent form (i.e.,
you specifically must initial the type of super-confidential
information we are allowed to disclose). If you do not
specifically authorize disclosure by initialing the
super-confidential information, we will not disclose it unless
authorized under the Special Rules (see above) (e.g., we are
required by law to disclose it). If we disclose
super-confidential information (either because you have
initialed the Consent form or the Special Rules authorize us to
do so), we will comply with state and federal law that requires
us to warn the recipient in writing that re-disclosure is
prohibited.
Changes
to Privacy Policies Rule We reserve the right to change our privacy practices (by changing the
terms of this Notice) at any time as authorized by law. The
changes will be effective immediately upon us making them. They
will apply to all PHI we create or receive in the future, as
well as to all PHI created or received by us in the past (i.e.,
to PHI about you that we had before the changes took effect). If
we make changes, we will post the changed Notice, along with its
effective date, in our office. Also, upon request, you will be
given a copy of our current Notice.
Authorization
Rule
We will not use or disclose your PHI for any purpose or to any
person other than as stated in the rules above without your
signature on a specifically worded, written Authorization form
(not a Consent or an Acknowledgement). If we need your
Authorization, we must obtain it on our Authorization form,
which is separate from any Consent or Acknowledgment we may have
obtained from you. We will not condition treatment on whether
you sign the Authorization (or not).
YOUR
RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
If you got this Notice via e-mail or web-site, you
have the right to get, at any time, a paper copy by asking our
privacy officer. Also, you have the following additional rights
regarding PHI we maintain about you:
To Inspect and Copy
You have the right to see and get a copy of your PHI including,
but not limited to, medical and billing records by submitting a
written request to our privacy officer on our Request to
Inspect, Copy or Summarize form. Original records will not leave
the premises, will be available for inspection only during our
regular business hours, and only if our privacy officer is
present at all times. You may ask us to give you the copies in a
format other than photocopies (and we will do so unless we
determine that it is impracticable) or ask us to prepare a
summary in lieu of the copies. We may charge you a fee not to
exceed Florida law to recover our costs (including postage,
supplies and staff time as applicable, but excluding staff time
for search and retrieval) to duplicate or summarize your PHI. We
will not condition release of the copies or summary on payment
of your outstanding balance for professional services (if you
have one), but we may condition release of the copies or summary
on payment of the copying fees. We will respond to requests in a
timely manner, without delay for legal review, in less than
thirty days if submitted in writing on our form or otherwise,
and in ten business days or less if malpractice litigation or
pre-suit production is involved. We may deny your request in
certain limited circumstances (e.g., we do not have the PHI,
it came from a confidential source, etc). If we deny your
request, you may ask for a review of that decision. If required
by law, we will select a licensed health-care professional
(other than the person who denied your request initially) to
review the denial and we will follow his or her decision. If we
select a licensed health-care professional who is not affiliated
with us, we will ensure a Business Associate agreement is
executed that prevents re-disclosure of your PHI without your
consent by the outside professional.
To
Request Amendment / Correction If another doctor involved in your care tells us in
writing to change your PHI, we will do so as expeditiously as
possible upon receipt of the changes and will send you written
confirmation that we have made the changes. If you think PHI we
have about you is incorrect, or that something important is
missing from your records, you may ask us to amend or correct it
(so long as we have it) by submitting a Request for Amendment /
Correction form to our privacy officer. We normally will act on
your request within 60 days from receipt, but we may extend our
response time (within the 60-day period) no more than once and
by no more than 30 days, in which case we will notify you in
writing why and when we will be able to respond. If we grant
your request, we will let you know within five business days,
make the changes by noting (not deleting) what is incorrect or
incomplete and adding to it the changed language, and send the
changes within 5 business days to persons you ask us to and
persons we know may rely on incorrect or incomplete PHI to your
detriment (or already have). We may deny your request under
certain circumstances (e.g., it is not in writing, it does not
give a reason why you want the change, we did not create the PHI
you want changed (and the entity that did can be contacted), it
was compiled for use in litigation, or we determine it is
accurate and complete). If we deny your request, we will (in
writing within 5 business days) tell you: why and how to file a
complaint with us if you disagree, that you may submit a written
disagreement with our denial (and we may submit a written
rebuttal and give you a copy of it), that you may ask us to
disclose your initial request and our denial when we make future
disclosures of PHI pertaining to your request, and that you may
complain to us and the U.S. Department of Health and Human
Services.
To an Accounting of Disclosures
You may ask us for a list of those who got your PHI from us by
submitting a Request for Accounting of Disclosures form to us.
The list will not cover some disclosures (e.g. PHI given to you,
given to your legal representative, given to others for
treatment, payment or health-care-operations purposes). Your
request must state in what form you want the list (e.g., paper
or electronically) and the time period you want us to cover,
which may be up to but no more than the last six years
(excluding dates before April 14, 2003). If you ask us for this
list more than once in a 12-month period, we may charge you a
reasonable, cost-based fee to respond, in which case we will
tell you the cost before we incur it and let you choose if you
want to withdraw or modify your request to avoid the cost.
To Request Restrictions
You may ask us to limit how your PHI is used and disclosed (i.e.
in addition to our rules as set forth in this Notice) by
submitting a written Request for Restrictions on Use /
Disclosure form to us (e.g., you may not want us to disclose
your surgery to family members or friends involved in paying for
our services or providing your home care). If we agree to these
additional limitations, we will follow them except in an
emergency where we will not have time to check for limitations.
Also, in some circumstances we may be unable to grant your
request (e.g., we are required by law to use or disclose your
PHI in a manner that you want restricted; you signed an
Authorization form, which you may revoke, that allows us to use
or disclose your PHI in the manner you want restricted; in an
emergency).
To Request Alternative Communications
You may ask us to communicate with you in a different way or at
a different place by submitting a written Request for
Alternative Communication form to us. We will not ask you why
and we will accommodate all reasonable requests (including,
e.g., to send appointment reminders in closed envelopes rather
than by postcards, to send your PHI to a post office box instead
of your home address, to communicate with you at a telephone
number other than your home number). You must tell us the
alternative means or location you want us to use and explain to
our satisfaction how payments to us will be made if we
communicate with you as you request.
To
Complain or Get More Information We will follow our rules as set forth in this
Notice. If you want more information or if you believe your
privacy rights have been violated (e.g., you disagree with a
decision of ours about inspection / copying, amendment /
correction, accounting of disclosures, restrictions or
alternative communications), we want to make it right. We never
will penalize you for filing a complaint. To do so, please file
a formal, written complaint within 180 days with:
The
U.S. Department of Health & Human Services
Office
of Civil Rights
200 Independence Ave., S.W.
Washington, D.C. 20201
(877) 696-6775 (toll free)
Or,
submit a written Complaint form to us at the following address:
Drs. Zamikoff, Klement, & Jungman
2103 59th Street West
Bradenton, FL 34209
You
may get your complaint form by calling our privacy officer.
These
privacy practices will be effective April 14, 2003, and will
remain in effect until we replace them as specified above.
|
