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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.PLEASE READ IT CAREFULLY.
I. Our Duty to Safeguard Your Protected Information.
We understand that medical information about you is personal and confidential. Be assured that we are committed to protect that information. We are required by law to maintain the privacy of protected health information and to provide you with this notice of our legal duties and privacy practices with respect to protected health information. We are required by law to abide by the terms of this notice, and we reserve the right to change the terms of this notice, making any revision applicable to all the protected health information we maintain.
In general, when we release your personal information, we must release only the information needed to achieve the purpose of the use or disclosure. However, all of your personal health information that you designate will be available for release if you sign an authorization form, if you request the information yourself, to a provider regarding your treatment, or due to a legal requirement.
II. How We May Use and Disclose Your Protected Health Information.
For uses and disclosures relating to the treatment, payment, or health care operations, we do not need an authorization to use and disclose your medical information:
For Treatment: We may disclose your medical information to doctors, nurses and other health care personnel who are involved in providing your health care. We may use your medical information to provide you with medical treatment of services. Specialists might use your medical history to determine what method of treatment (such as a drug or surgery) is best for you. Your medical information might also be shared among members of your treatment team, or with your pharmacist(s).
To Obtain Payment: We may use and/or disclose your medical information to bill and collect payment for your health care services or to obtain permission for an anticipated plan of treatment. For example, for Medicaid or an insurance company to pay for your treatment, we must submit a bill that identifies you, your diagnosis, and the services provided to you. As a result, we will pass this type of health information on to an insurer to help receive payment for your medical bills. Please note our office, can use all contact information you give us to contact you as needed.
For Health Care Operations: We may use and/or disclose your medical information while operating our practice. For example, we may use your medical information in evaluating the quality of services provided, or disclose your medical information to our accountant or attorney for audit purposes.
In addition, we may use your health information to send you appointment reminders or information about treatment alternatives or other health-related benefits that may be of interest to you. For example, we may look at your medical record to determine the date and time of your next appointment with us, and then send you a reminder to help you remember the appointment. Or, we may look at your medical information and decide that another treatment or a new service we offer may interest you.
· We may also use and/or disclose your medical information in accordance with federal and state laws for the following purposes:
· We may disclose your medical information to law enforcement or other specialized government functions in response to a court order, subpoena, warrant, summons or similar process.
· We may disclose medical information when a law requires that we report information about suspected abuse, neglect, or domestic violence, or relating to suspected criminal activity, or in response to a court order. We must also disclose medical information to authorities who monitor compliance with these privacy requirements.
· We may disclose medical information when we are required to collect information about disease or injury, or to report vital statistics to the public health authority. We may also disclose medical information to the protection and advocacy agency, or another agency responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents.
· We may disclose medical information relating to an individual's death to coroners, medical examiners, or funeral directors, and to organ procurement organizations relating to organ, eye, or tissue donations or transplants.
· In certain circumstances, we may disclose medical information to assist medical/psychiatric research.
· In order to avoid a serious threat to health or safety, we may disclose medical information to law enforcement or other persons who can reasonably prevent or lessen the threat of harm, or to help with the coordination of disaster relief efforts.
· If people such as family members, relatives, or close personal friends are involved in your care or helping you pay your medical bills, we may release important health information about you to those people. We may also share medical information with these people to notify them about your location, general condition, or death.
· We may disclose your medical information as authorized by law relating to worker's compensation or similar programs.
· We may disclose your medical information in the course of certain judicial or administrative proceedings. Other uses and disclosures of your medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. You understand that we are unable to take back any disclosures we have already made with your permission, and we are required to retain our records of the care that we provided you.
III. Your Rights Regarding Your Medical Information.
You have several rights with to your health information.
· You have the right to ask that we limit how we use or disclose your medicinal information. You have the right to ask that we send you information at an alternative address or by an alternative means. We will consider your request, but are not legally bound to agree to the restriction. We will agree to your request as long as it is reasonably easy for us to do so.
· With a few exceptions (such as psychotherapy notes or information gathered for judicial proceedings), you have a right to inspect and copy your protected health information if you put your request in writing. If we deny your access, we will give you written reasons for the denial and explain any right to have the denial reviewed. We may charge you a reasonable fee if you want a copy of your health information. You have the right to choose what portions of your information you want copied and to have prior information on the cost of copying.
· If you believe that there is a mistake or missing information in our record of your medical information, you may request that we correct or add to the record. Your request must be in writing and give a reason as to why your health information should be changed. Any denial will state the reasons for denial and explain your rights to have the request and denial, along with any statement in response that you proved, appended to your medical information. If we approve the request for amendment, we will change the medical information and so inform you so.
· In some limited circumstances, you have the right to ask for a list of the disclosures of your health information we have made during the previous six years. The list will not include disclosures made to you; for purposes of treatment, payment, or health operations, for which you signed an authorization or for other reasons for which we are not required to keep a record of disclosures. There will be no charge for up to one list each year. There may be a charge for more frequent requests.
NORTH MIAMI PEDIATRICS16401 NW 2ND AVENUESUITE 202NORTH MIAMI BEACHFLORIDA, 33169PHONE: 305 947 4734
Please sign below that you have received and reviewed the Notice of Privacy Practices form.