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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 review it carefully. If you have any questions about
this Notice, please contact: our Privacy Contact who is
Charlene Proeger, 351-3640.
This Notice of
Privacy Practices describes how we may use and disclose your
protected health information to carry out treatment, payment
or health care operations and for other purposes that are
permitted or required by law. It also describes your rights to
access and control your protected health information.
"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 protect the privacy of your information,
provide this notice about our information practices, and abide
by the terms of this Notice of Privacy Practices. We may
change the terms of our notice at any time. The new notice
will be effective for all protected health information that we
maintain at that time. If this policy changes, you will be
notified in person or by mail. You can request a copy of our
notice at any time.
1. Uses and
Disclosures of Protected Health Information
We use
protected health information about you for planning and
coordinating services and receiving payment. Any other uses or
disclosures of your protected health information will be made
only with your written authorization. You may revoke this
authorization at any time, in writing, except to the extent
that we have taken an action in reliance on the use or
disclosure indicated in the authorization.
We may use or
disclose identifiable health information about you without
your authorization for other reasons. Subject to certain
requirements, we may disclose protected health information
without your consent or authorization for public health
purposes, for auditing purposes, for research studies, and for
emergencies. We also provide protected health information when
otherwise required by law, or for law enforcement purposes,
legal proceedings, military activity and national security,
coroner, funeral director or medical examiner, and when
required by the Secretary of the Department of Health and
Human Services. For example, Florida law requires that persons
at immanent risk of harming themselves are others be reported.
In addition, the abuse or neglect of elderly persons must be
reported.
2. Your
Rights. Although your health record is the physical property
of Proeger & Associates that compiled it, the information
belongs to you. You have the right to:
-
request a
restriction on certain uses and disclosures of your
information as provided by 45 CFR 164.522
-
obtain a
paper copy of the notice of privacy practices upon request -
inspect and obtain a copy of 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 or at alternative locations
-
revoke your
authorization to use or disclose protected health
information except to the extent that action has already
been taken
You have the
right to inspect and copy your protected health information
for as long as we maintain the protected health information.
Under federal law, however, you may not inspect or copy the
following records: psychotherapy notes; information compiled
in reasonable anticipation of, or use in, a civil, criminal,
or administrative action or proceeding; and protected health
information that is subject to law that prohibits access to
protected health information. Depending on the circumstances,
a decision to deny access may be reviewable. Please contact
our Privacy Contact if you have questions about access to your
records.
You have the
right to request a restriction of your protected health
information. This means you may ask us not to use or disclose
any part of your protected health information for the purposes
of treatment, payment or healthcare operations. We are not
required to agree to a restriction that you may request. If we
agree to the requested restriction, we may not use or disclose
your protected health information in violation of that
restriction. You may request a restriction by written request,
mailed to Proeger & Associates.
You have the
right to amend your protected health information. This means
you may request an amendment of protected health information
about you in a record for as long as we maintain this
information. In certain cases, we may deny your request for an
amendment. If we deny your request, you have the right to file
a statement of disagreement with us and we may prepare a
rebuttal to your statement and will provide you with a copy of
any such rebuttal. Please contact our Privacy Contact if you
have questions about amending your records.
You have the
right to receive an accounting of certain disclosures we have
made, if any, of your protected health information. This right
applies to disclosures for purposes other than treatment,
payment or healthcare operations as described in this Notice
of Privacy Practices. It excludes disclosures we may have made
to you, to family members or friends, or for notification
purposes. You have the right to receive specific information
regarding these disclosures that occurred after April 14,
2003. The right to receive this information is subject to
certain exceptions, restrictions and limitations.
You have a
right to request receipt of confidential communications by
alternative means or at alternative locations if you clearly
state that disclosure could endanger you. You have the right
to have this request reasonably accommodated.
You have the
right to obtain a paper copy of this notice from us.
You may
complain to us or to the Secretary of Health and Human
Services if you believe your privacy rights have been violated
by us. You may file a complaint with us by notifying our
privacy contact of your complaint. We will not retaliate
against you for filing a complaint. You may contact our
Privacy Contact, Charlene Proeger, at 351-3640 for further
information about the complaint process.
This notice
was published and becomes effective on April 14, 2003.
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