Notice of Privacy Practices
- Effective April 14, 2003 -
Who Will Follow This Notice
This notice describes
our practice's privacy and that of any physician or health care
professional authorized to enter information into your medical
chart:
All areas of the
practice
All employees, staff
and other office personnel
All these individuals, sites and locations follow the terms of
this notice. In addition, these individuals, sites and locations
may share medical information with each other or with third
party medical specialists for treatment, payment, or office
operations purposes described in this notice.
Our Pledge regarding
Medical Information
We understand that
medical information about you and your health is personal. We
are committed to protecting medical information about you. We
create a record of the care and services you receive at our
medical office. We need this record to provide you with quality
care and to comply with certain legal requirements. This notice
applies to all of the records of your care generated by our
office.
This notice will tell you about the ways in which we may use and
release medical information about you. We also describe your
rights and certain obligations we have regarding the use and
release of medical information.
We are required by law to make sure that medical information
that identifies you is kept private and to give you this notice
of our legal duties and privacy practices with respect to
medical information about you; and follow the terms of this
notice that is currently in effect.
How We May Use and Release Medical Information About You
The following categories describe different ways that we use and
disclose medical information. Not every use or release category
will be listed. However, all of the ways we are permitted to use
and release information will fall within one of the categories.
For Treatment
We may use medical
information about you to provide you with medical treatment or
services. We may release medical information about you to the
practice's office personnel who are involved in taking care of
you at the office or elsewhere. We also may release medical
information about you to people outside our office who may be
involved in your care after you leave the office, such as family
members or others we use to provide services that are part of
your care provided you have consented to such release. These
entities include third party physicians, hospitals, nursing
homes, pharmacies or clinical labs with whom the office consults
or makes referrals.
For Payment
We may use and release
medical information about you so that the treatment and services
you recieve at the medical office may be billed to and payment
may be collected from you, an insurance company or a third
party. For example, we may need to give your health plan
information about medical procedures you received at the office
so your health plan about a treatment you are going to receive
to obtain prior approval or to determine wether your plan will
cover the treatment.
For Health Care
Operations
We may use and release
medical information about you for medical office operations.
These uses and releases are necessary to run the medical office
and make sure that all of our patients receive quality care. For
example, we may use medical information to review our treatment
and services and to evaluate the performance of our staff in
caring for you. We may also combine medical information about
many medical office patients to decide what additional services
the office should offer, what services are not needed, and
wether certain new treatments are effective. We may also release
information to physicians, nurses, and other office personnel
for review and learning purposes.
Appointment Reminders
We may use and release
medical information to contact you as a reminder that you have
an appointment for treatment or medical care at the office.
Treatment Alternatives
We may use and release
medical information to tell you about or recommend possible
treatment options or alternatives that may be of interest to
you.
Health-Related Benefits
and Services
We may use and release
medical information to tell you about health-related benefits or
services that may be of interest to you.
Individuals Involved In Your Care or Payment For Your Care
We may release medical information about you to a friend or
family member who is involved in your medical care provided you
have consented to such release. We may also give information to
someone who helps pay for your care. In addition, we may release
medical information about you to an entity assisting in a
disaster relief effort so that your family can be notified about
your condition, status and location.
As Required By Law
We will disclose
medical information about you when required to do so by federal,
state or local law.
To Avert a Serious
Threat to Health or Safety
We may use and release
medical information about you when necessary to prevent a
serious threat to your health and safety or the health and
safety of the public or another person. Any release, however,
would only be to someone able to prevent the threat.
Special Situations
Health Oversight
Activities
We may release medical
information to a health oversight agency for activities
authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure.
These activities are necessary for the government to monitor the
health care system, government programs and compliance with
civil rights laws.
Lawsuits and Disputes
If you are involved in
a lawsuit or a dispute, we may release medical information about
you in response to a court or administrative order. We may also
release medical information about you in response to a subpoena,
discovery request, or other lawful process by someone else
involved in the dispute, but only if efforts have been made to
tell you about the request or to obtain an order protecting the
information requested.
Coroners, Medical Examiners
and Funeral Directors
We may also release
medical information to a coroner or medical examiner. This may
be necessary, for example, to identify a deceased person or
determine the cause of death. We may also release medical
information about patients of the office to funeral directors as
necessary to carry out their duties.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we
maintain about you:
Right to Inspect and
Copy
You have the right to
inspect and copy medical information that may be used to make
decisions about your care. To inspect and copy medical
information that may be used to make decisions about you, you
must submit your request in writing to our medical records
clerk. If you request a copy of the information, there will be a
fee for the costs of copying, mailing, or other office supplies
associated with your request. We may deny your request to
inspect and copy in certain very limited circumstances.
Right to Amend
If you feel that
medical information we have about you is incorrect or
incomplete, you may ask us to amend the information. You have
the right to request an amendment for as long as the information
is kept by or for the medical office. To request an amendment,
your request nust be made in writing and submitted to the office
manager. In addition, you must provide a reason that supports
your request. We may deny your request for an amendment if it is
not in writing or does not include a reason to support the
request. In addition, we may deny your request if you ask us to
amend information that:
• Was not created by us, unless the person or entity that
created the information is no longer available to make the
amendment;
• Is not part of the medical information kept by or for the
medical office;
• Is not part of the information which you would be permitted to
inspect or copy; or
• Is accurate and complete.
Right to an Accounting
of Disclosures
you have the right to
request an "Accounting of Disclosures". This is a list of
releases we made of medical information about you.
To request this list of disclosures, you must submit your
request in writing to our medical records department. Your
request must state a time period which may not be longer than
six years and may not include dates before 4/13/03. Your request
should indicate in what form you want the list (for example, on
paper, electronically). The first list you request within a 12
month period will be free. For additional lists, we may charge
you the cost for providing the list. We will notify you of the
cost involved and you may choose to withdraw or modify your
request at that time before any costs are incurred.
Right to Request
Restrictions
You have the right to
request a restriction or limitation on the medical information
we use or release about you for treatment, payment or health
care operations. You also have the right to request a limit on
the medical information we release about you to someone who is
involved in your care or the payment for your care, like a
family member or friend. For example, you could ask that we not
use or release information about a surgery you had.
We are not required to agree to your request. If we
do agree, we will comply with your request unless the
information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing
to our office. In your request, you must tell us (1) what
information you want to limit; (2) wether you want to limit our
use, release or both; and (3) to whom you want the limits to
apply, for example, releases to your spouse.
Right to Request
Confidential Communications
You have the right to
request that we communicate with you about medical matters in a
certain way or at a certain location. For example, you can ask
that we only contact you at work or by mail. To request
confidential communications, you must make your request in
writing to the office manager. We will not ask you the reason
for your request. We will accommodate all reasonable requests.
Your request must specify how or where you wish to be contacted.
Right to a Paper Copy of
This Notice
you have the right to a
paper copy of this notice. You may ask us to give you a copy of
this notice at any time. Even if you have agreed to receive this
notice electronically, you are still entitled to a paper copy of
this notice. To obtain a paper copy of this notice from our
front office staff, just ask. You may obtain a copy of this
notice at our website,
www.FloridaObesitySurgical.com.
Changes to This Notice
We reserve the right to
change this notice. We reserve the right to make the revised or
changed notice effective for medical information we already have
about you as well as any information we receive in the future.
We will post a copy of the current notice in the office. The
notice will contain on the first page, in the top left hand
corner, the effective date. In addition, each time you register
we will offer you a copy of the current notice in effect.
Complaints
If you believe your
privacy rights have been violated, you may file a complaint with
the office or with the Secretary of the Department of Health and
Human Services. To file a complaint with our practice, contact
our practice manager. All complaints must be submitted in
writing.
You will not be penalized or retaliated against for filing a
complaint.
Other Uses Of Medical
Information
Other uses and releases
of medical information not covered by this notice or the laws
that apply to us will be made only with your written permission.
If you provide us with permission to use or release medical
information about you, you may revoke that permission, in
writing, at any time. If you revoke your permission, we will no
longer use or release medical information about you for the
reasons covered by your written authorization. You understand
that we are unable to take back any release we have already made
with your permission, and that we are required to retain our
records of the care that we provided to you.
Website
Privacy Policy:
At Florida Obesity Surgical Associates, we dedicate ourselves to providing secure, value-added
online services to our patients. In that
effort, we respect and protect the privacy of those who use our
services, both healthcare providers and patients. This document,
effective September 1, 2005, specifically describes how we
handle your personally identifiable information and applies to
all information that we collect and store in our databases.
If you are a patient visiting our web site we may collect the
following types of information about you: (through our services
such as RemidyMD)
General information - Information such as your name, address,
phone, and e-mail address to help your healthcare provider to
contact you and bill your insurance.
Information to verify your identity - Information such as your
username and password, in order to provide you with secure
access. We may also verify your identity, or your status as a
registered user, by means of cookies or sessions.
Surgical history information - Information about past surgeries,
if any. Your healthcare provider needs this background
information to safely and effectively diagnose and treat your
medical conditions.
Medical history and systems information - Information about
medical problems or conditions that you currently have or have
had in the past, if any. Your healthcare provider needs this
background information to safely and effectively diagnose and
treat your medical conditions.
Medication and medication allergy information - Information
about medications you are currently taking and medication
allergies, if any. Your healthcare provider needs this
background information to safely and effectively diagnose and
treat your medical conditions.
Social and family history information - Information about your
social and family history. Your healthcare provider need this
background information to safely and effectively diagnose and
treat your medical conditions.
Weight and comorbidity information - Information such as height,
weight, bmi, weightloss diets, comorbidities, etc.
Diet and activity information - Information
such as caloric intake, exercises, food consumption, etc.
If you are a medical professional visiting our web site we may
collect the following types of information about you:
General information - Information such as your name, address,
phone, and e-mail address to help us fulfill your requested
services and contact you.
Information to verify your identity - Information such as your
user name and password, in order to provide you with secure
access
We may also verify your identity, or your status as a registered
user, by means of cookies or sessions.
When it may be necessary to share the information patients
provide:
We do not share any of the personally identifiable protected
health information we collect with third parties unless it is
related to fulfilling the services you have asked us to perform,
or as is permitted by law. The information you provide us can
only be shared under limited circumstances. These include:
With your healthcare provider - As a patient, when you enter
information into this web site, your healthcare provider is able
to access your health information.
For legal reasons - In some cases we may be required to disclose
certain information to comply with the law, an investigation, or
a legal process, such as a court order or subpoena.
In case of a sale of business - Your information may be
transferred in connection with a sale, merger, transfer,
exchange, or other disposition (whether of assets, stock, or
otherwise) of all or a portion of a business of FOSA.
When it may be necessary to share the information healthcare
providers provide:
FOSA does not share any of the information we collect from
healthcare providers with third parties unless it is related to
fulfilling the services you have asked us to perform, or as is
permitted by law. The information you provide us can only be
shared under limited circumstances. These include:
For legal reasons - In some cases we may be required to disclose
certain information to comply with the law, an investigation, or
a legal process, such as a court order or subpoena.
In case of a sale of business - Your information may be
transferred in connection with a sale, merger, transfer,
exchange, or other disposition (whether of assets, stock, or
otherwise) of all or a portion of a business of FOSA.
Our Security Safeguards
We employ industry-standard, physical, electronic, and
procedural security safeguards to protect all of the information
that you have provided to us from loss, misuse, or unauthorized
alteration. Whenever we prompt you to transmit sensitive
information, such as personal medical information, to us through
our web site, we support strong encryption of your data as it is
transmitted.
Former Patients
We treat information concerning our former customers and
patients the same
way we treat information about our current patients.
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