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Privacy Policy

[Effective 4-14-2003]

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.

If you have any questions about this Notice, please contact the Privacy Officer by dialing 941-924-8700.

A 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.

We are required by law to maintain the privacy of protected health information, to provide you with a description of our privacy practices, and to abide by the terms of our Notice of Privacy Practices currently in effect.

We may change our Notice at any time. The new Notice will be effective for all protected health information that we maintain at that time and any future information. Upon your request, we will provide you with our revised Notice of Privacy Practices if you call the office and request that a revised copy be sent to you in the mail, or ask for one at the time of your next appointment.

1. Required Disclosures. We are required to disclose your protected health information to you, when requested, and to the Secretary of the Department of Health and Human Services to investigate or determine our compliance with federal regulations regarding privacy of protected health information. We do not need your permission, consent, or authorization prior to disclosing your protected health information for these purposes. Further, we are permitted to disclose your protected health information to you without permission, authorization or consent.

2. Uses and Disclosures of Protected Health Information for Treatment. We may use your protected health information for treatment purposes and may disclose your protected health information to any health care provider or practitioner involved with your care for treatment purposes, without your permission, consent or authorization.

The following are examples of the types of uses and disclosures of your protected health information that we may make for treatment:

To other physicians who may be treating you or to a physician to whom you have been referred, to ensure that the physician has the necessary information to diagnose your condition.

To determine whether a certain test or medication is indicated for your treatment.

You will be asked to sign a consent form to permit us to disclose your protected health information to other persons and/or entities for treatment purposes. If you refuse to sign the consent form or revoke it, we may decline you as a new patient or discontinue you as an active patient.

3. Use of Protected Health Information for Payment. We may use health information about you for purposes of obtaining payment from you, your insurance company or a third-party payer for treatment and services that you receive, without your permission, authorization or consent. For example, your diagnosis and treatment may be reviewed for medical necessity for purposes of obtaining payment on a claim submitted to a third party payor, such as an insurance company or health plan.

You will be asked to sign a consent form to permit us to disclose your protected health information to others, such as third party payers, to obtain payment for treatment and services that you receive from us, and for the payment activities of other health care providers, health plans and health care clearinghouses. If you refuse to sign the consent form, or revoke it, we may decline you as a new patient or discontinue you as an active patient.

4. Use of Protected Health Information for Health Care Operations. We may use health information about you for our operational purposes without your permission, authorization or consent. For example, we may use your information to evaluate the performance of our staff; assess quality of care and outcomes in your case and similar cases; or to learn how to improve our facilities or services.

You will be asked to sign a consent form to permit us to disclose your protected health information to others, such as our accountant, for our operational purposes, and to disclose your protected health information to health plans, health care clearinghouses and other health care providers, for their operations if they had a relationship with you, the information pertains to that relationship, and the disclosure is for quality assessment or quality improvement, to detect health care fraud and abuse, or to enforce compliance. If you refuse to sign this consent form, or revoke it, we may decline you as a new patient or discontinue you as an active patient.

5. To Family, Friends and Others Involved in Care. We may disclose your health information to a family member, friend or other person identified by you with your consent. In the event of your incapacity or emergency circumstances, we may disclose your information to family, friends or others involved in your care or payment, if we determine, in our professional judgment, that disclosure is in your best interest.

6. Other Permitted and Required Uses and Disclosures. We may also use or disclose protected health information without your permission, authorization or consent, in accordance with applicable law:

a. For public health activities, such as disclosure to a public health authority to prevent or control diseases;

b. To a health oversight agency for activities authorized by law, such as audits, investigations and inspections;

c. About victims of abuse, neglect or domestic violence;

d. In the course of judicial and administrative proceedings in response to an order of a court, and in certain conditions in response to a subpoena;

e. For law enforcement purposes;

f. To avert a serious threat to health or safety;

g. To a coroner, medical examiner or funeral director to perform duties authorized by law.

h. For cadaveric organ, eye or tissue donation purposes.

i. If the information protects your identity, for statistical or scientific research;

j. In a medical negligence or administrative proceeding, in which we expect to be or have been named as defendant;

k. To comply with workers= compensation laws;

l. Incident to any required or permitted use or disclosure. An incidental use or disclosure is one that occurs as a by-product. For instance, we may use sign-in sheets in our reception area;

m. To a business associate who provides services to us, if the business associate has agreed to appropriately safeguard your protected health information;

n. As required by law.

7. HIV, Substance Abuse and Mental Health. Florida law provides additional protection to health information regarding HIV testing or status, alcohol or substance abuse diagnosis and treatment, and psychotherapy and mental health diagnosis and treatment. This information will not be used or disclosed except in accordance with the law, or with your authorization or consent.

8. Appointments. We may contact you to provide appointment reminders.

9. Uses and Disclosures of Protected Health Information Based upon Your Written Authorization. Other uses and disclosures of your protected health information will be made only with your written authorization.

10. Your Rights. Although your health records are our physical property, you have certain rights. The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights:

· You have the right to access, inspect and copy (1) the medical records and billing records maintained by us or for us, about you; and (2) used by, or for us, to make decisions about you for as long as we maintain the protected health information. We may deny this right in limited circumstances, and the denial may be reviewable.

· You have the right to request restrictions on our uses and disclosures of your protected health information to carry out treatment, payment or health care operations, uses and disclosures to individuals involved in your care, and for disaster relief purposes. We are not required to agree to any requested restriction.

· You have the right to request to receive confidential communications from us by alternative means or at alternative locations.

· You have the right to request that we amend your protected health information, if you feel that the information is incorrect or incomplete. We may deny your request, and you will be notified of the reason for the denial. You may submit a statement of disagreement with the denial, and we may prepare a rebuttal, both of which will be appended to the health information at issue.

· You have the right to receive an accounting of certain disclosures of your protected health information.

· You have the right to obtain a paper copy of this Notice from us upon request, even if you have agreed to accept this Notice electronically.

· You have the right to revoke your authorization to use or disclose health information except to the extent that we have taken action in reliance on the authorization, or to the extent that the authorization was obtained as a condition of obtaining insurance coverage, other law provides the insurer with a right to contest a claim under the policy or the policy itself.

· You may exercise these rights by contacting our Front Office Personnel who will provide you with instructions and any necessary forms.

11. Complaints. You may complain to us or to the Secretary of The Department of Health and Human Services if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint. You may file a complaint with us by submitting a written complaint to our Privacy Officer.

You may file a formal, written complaint within one hundred eighty (180) days with: The Department of Health & Human Services, Office of Civil Rights, 200 Independence Avenue, Southwest, Washington, D.C. 20201, Telephone: 877-696-6775.

If you need any further information about matters covered by this Notice, you may contact our Privacy Officer at the address or telephone number listed below.

This Notice was published and becomes effective on April 14, 2003.

Contact Privacy Officer at:

3663 Bee Ridge Road
Sarasota, Florida 34233
Phone: 941-924-8700

Sarasota, Venice, Englewood  • 941-924-8700