Notice of Privacy Practices

Understanding Your Health Record

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your “health record” or “medical record,” serves as a:

• Basis for planning your care and treatment
• Means of communication among the many health professionals who contribute to your care
• Legal document describing the care you received
• Means by which you or a third-party payer can verify that services billed actually were provided
• Tool in educating health professionals
• Source of data for medical research
• Source of information for public health officials charged with improving the health of the nation
• Source of data for facility planning and marketing
• Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who may access your health information, and make more informed decisions when authorizing disclosure to others.

How We May Use and Disclose Your Health Information

Treatment. We use your health information to provide and coordinate your care, and we may share it with other providers involved in your treatment — for example, sending records to a specialist we refer you to, or to a laboratory or imaging center.

Payment. We may use and disclose your information to bill and obtain payment from you, your insurance company, or another third party — for example, sharing a diagnosis so a claim can be processed.

Health care operations. We may use your information to run the practice — quality review, training, care coordination, and administrative functions.

Uses and Disclosures That Require Your Written Authorization

Most uses and disclosures not described in this notice will be made only with your written authorization. This specifically includes most uses and disclosures of psychotherapy notes, any use or disclosure of your information for marketing purposes, and any sale of your health information.

You may revoke an authorization in writing at any time, except to the extent that we have already acted in reliance on it.

Your Health Information Rights

Although your health record is the physical property of the healthcare practitioner or facility 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
• Restrict disclosure to your health plan when you pay for a service in full, out of pocket — if you ask us not to share that information with your health plan, we must honor that request (45 CFR 164.522(a)(1)(vi))
• Obtain a paper copy of this notice of information practices upon request, even if you agreed to receive it electronically
• Inspect and copy your health record as provided for in 45 CFR 164.524
• Amend your health record as provided in 45 CFR 164.526
• 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 health information except to the extent that action has already been taken
• Be notified in the event of a breach of unsecured protected health information
• Choose someone to act for you — a person with legal authority to make health care decisions on your behalf may exercise these rights for you

Our Responsibilities

This notice describes the information privacy practices followed by all employees of Family Medical Doctors. We are required to:

• Maintain the privacy and security of your health information
• Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• Abide by the terms of this notice currently in effect
• Notify you if we are unable to agree to a requested restriction
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations
• Notify you following a breach of unsecured protected health information
• Train our personnel concerning privacy and confidentiality

We will not use or disclose your health information without your consent or authorization, except as described in this notice or otherwise required by law.

We reserve the right to change our practices and to make the new provisions effective for all individually identifiable health information that we maintain. If we change our information practices, we will post the revised notice in the office and on our website, and we will mail a revised notice to the address that you have given.

Other Uses or Disclosures

• We provide some services through contracts with business associates
• We may use or disclose information to notify or assist in notifying a family member, a personal representative, or another person responsible for your care, location, and general condition
• Unless you object, health professionals, using their best judgment, may disclose to a family member, other relative, a close personal friend, or any other person that you identify, health information relevant to that person’s involvement in your care or payment related to your care
• We may disclose health information to funeral directors consistent with applicable law to enable them to carry out their duties
• We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you
• We may disclose to the FDA health information relative to adverse effects/events with respect to food, drugs, supplements, product or product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement
• We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law
• As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability
• If you are an inmate of a correctional institution or in the custody of law enforcement, we may disclose health information necessary for your health and the health and safety of other individuals
• We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena
• If an employee of Family Medical Doctors, or a business associate, believes in good faith that we have engaged in unlawful conduct or otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public, they may disclose your health information to health oversight agencies and/or public health authorities, such as the department of health
• Under the privacy standards, we must disclose your health information to the U.S. Department of Health and Human Services as necessary to determine our compliance with those standards

Questions and Complaints

If you have questions about this notice, or if you believe your privacy rights have been violated, please contact our office. We would like the opportunity to address your concern directly.

Privacy Officer — Family Medical Doctors, LLC
5234 Little Road, New Port Richey, FL 34655
Telephone: (727) 807-6900  ·  Fax: (727) 807-6901
Email: [email protected]

You may also file a written complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-877-696-6775, or online at hhs.gov/ocr/privacy/hipaa/complaints.

You will not be penalized or retaliated against in any way for filing a complaint.