Effective Date: This policy is in effect as of April 14, 2003.
Expiration Date: This policy remains in effect until superseded or cancelled.
Analgesic Healthcare, Inc
7823 N Dale Mabry Hwy, Suite 202.
Tampa, FL 33614
Reviewed September 4, 2013
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.
We are required by law to give you this Notice. It explains how we may use and disclose your protected health information and how you can get access to that information. lt also describes certain rights you have regarding your protected health information, and tells you how to file a complaint, either with AHC or with the Secretary of Health and Human Services.
WAYS IN WHICH WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
ln the following section, we tell you about the different ways Analgesic Healthcare Inc, Inc (AHC) may use and disclose your protected health information. We provide examples, but they are not meant to be exhaustive.
Every use and disclosure will fall into one of the following categories. Except for the purposes described below, we will use and disclose Health information only with your written permission.
You may revoke such permission at any time by writing to our Privacy Officer.
We will use and disclose your protected health information to provide you with care and treatment.
For example, we may discuss your electrode placement with your doctor to help ensure you receive quality care, or to contact you for refill or prescription reminders.
We will use and disclose your protected health information to ensure that we are paid for the services and treatments we provide for you. For example, we may disclose information that identifies you to a third-party payor, such as an insurance company.
Health care operations:
We will use and disclose your protected health information to monitor and improve our ongoing operations. For example, we may share your information during surveys by our state licensing or accrediting body in order to review our quality of service.
As required by law:
We will use and disclose your protected health information when required by federal, state, or local law, statute, ordinance, or regulation.
Others involved in your health care:
We will disclose your protected health information to a family member, friend, relative or other person you identify who is involved with your health care or payment for health care services.
We will use and disclose your protected health information to tell you about alternative treatments or other products or services that you may be interested in.
We may disclose your protected health information to researchers, provided that the research program has been approved by an lndependent Review Board, and that satisfactory assurances have been made to protect the privacy of your protected health information.
To avert a serious threat to public health or safety:
We will disclose your protected health information to public health authorities that are allowed to collect and receive such information for the purpose of controlling disease. lf requested, we will also disclose your protected health information to a foreign government agency that is cooperating or collaborating with the public health authority.
Disclosures for workers’ compensation purposes are exempt from the HIPAA Privacy Rule. We may use and disclose your protected health information pursuant to workers’ compensation or similar programs that provide benefits to you if you are injured or ill on the job.
Military and veterans:
lf you are a member of the Armed Forces, we may disclose your protected health information as required by military command authorities. We may also release protected health information
about foreign military personnel to the appropriate foreign military authority.
Lawsuits and disputes:
lf you are involved in a lawsuit or dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process by someone else involved in the lawsuit or dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested information.
lf you are an inmate in a correctional facility or under custody of a law enforcement official, we will disclose your protected health information to the facility or law enforcement official if necessary for the facility to provide you with health care, protect the health and safety of you or others, or for the safety and security of the correctional facility.
National security activities:
We may disclose your protected health information to authorized federal officials for intelligence, counterintelligence, and other national security activities as authorized by law.
Health oversight activities:
We may disclose your protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system.
YOUR PRIVACY RIGHTS
The medical record that AHC maintains about you is the physical property of AHC. However, the information contained in that record belongs to you, and you have the right to:
A copy of this Notice:
You have the right to receive a paper copy of this Notice upon request. You also have the right to receive an electronic copy of this Notice upon request. Additionally, you may download and print a copy from our website, or request a printed copy via our website or by contacting our Privacy Officer.
An Electronic Copy of Electronic Medical Records;
lf your Protected Health lnformation is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your Protected Health Information in the form or format you request, if it is readily producible in such form or format. lf the Protected Health Information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
Request confidential communications:
You may ask that we communicate with you in a particular way. For example, you may want us to call you only at work. Your request must be submitted in writing to our Privacy Officer. We will make every effort to accommodate any reasonable request.
Inspect and/or copy:
You have the right to inspect and receive a copy of the health information we maintain about you in our designated record set. The designated record set includes billing and treatment records, as well as any other information we use to make decisions about you.
lf we have received any psychotherapy notes about you from other health care providers, they are, by law, not available for your inspection. We may charge a reasonable fee to cover the cost of copying, mailing, and other supplies necessary to fulfill your request. lf you wish to inspect or copy your medical information you must submit your request in writing to our Privacy Officer. We will respond to your request within 30 days.
Amend your health record:
You have the right to request that we amend your health record if you believe that it is incomplete or inaccurate. You must make this request in writing to our Privacy Officer, and you must tell us what information is in error and why you believe it is in error. We may deny your request if it is not a written request or if it does not include a reason for the amendment.
We may also deny your request if you ask us to amend information that.
– Was not created by AHC, unless the person or entity that created the information is no longer available to make the amendment, or;
– Is not part of the protected health information kept by or for AHC, or;
– Is not part of the information you would normally be permitted to inspect or copy, or; AHC believes is accurate and complete.
Restricted use and disclosure:
You may request restrictions on how we use or disclose your protected health information for treatment, payment, and ongoing operations. For example, you may ask that we not disclose medication information to a family member. Your request must be submitted in writing to our Privacy Officer. We are not required to agree to your request. lf we do agree, we will comply with your request except when emergency treatment is required.
Out-of-Pocket Paid in Full Payments (generally not applicable to workers’ compensation).
lf you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your Protected Health lnformation with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
The following uses and disclosures will be made only with your authorization: (i) most uses and disclosures of psychotherapy notes (if recorded by AHC); (ii) uses and disclosures of protected health information for marketing purposes, including subsidized treatment communications; (iii) disclosures that constitute a sale of protected health information; and (iv) other uses and disclosures not described herein.
Accounting of disclosures:
You may request a list of disclosures we’ve made for purposes other than treatment, payment, or operations. Your request must be in writing and must specify the time period for which you want the list. You may not request information for dates prior to November 1,2007, or for a
period of more than six years. Your first request in any 12-month period is free, but we may charge a reasonable fee for subsequent requests within the same 12-month period. We are required to notify you of any breach or unauthorized disclosure of your protected health
USES AND DISCLOSURES NOT COVERED
Uses and disclosures of your protected health information not covered by this Notice or the various laws that apply to us may only be made with your written authorization. You may revoke an authorization at any time and we will stop using and disclosing the information.
Any use or disclosure made prior to the revocation is not affected by the revocation. Your written authorization must tell us what information to release, to whom it should be released, and when the authorization should expire.
TO FILE A COMPLAINT
You have the right to complain to us or to the Secretary of Health and Human Services about the ways in which we have used or disclosed your protected health information. Complaints must be made in writing and signed by you or your authorized representative.
Complaints should be sent to our Privacy Officer at the address shown below. lf you wish to complain to the Secretary, send your written complaint to:
Office of Civil Rights
U.S. Department of Health & Human Services Atlanta Federal Center
61 Forsythe St. SW
Atlanta, GA 30303-8909
CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for any protected health information we already have about you, as well as any protected health information we may receive about you in the future. We will post a copy of the current Notice on our website. We are not required to automatically give a copy of the revised Notice if you have already received a copy of the previous Notice.
TO CONTACT US
Analgesic Healthcare, Inc.
Attn: Privacy Officer
7823 North Dale Mabry Hwy
Tampa, Florida 33614