This notice describes how medical information about you may be used and disclosed and how you can get access to this information. If you have any questions about this Notice please contact our Office Manager at the office location or our Privacy Officer at: 1100 Clearwater-Largo Road, Largo, FL 33770.
1) Uses and Disclosures of Protected Health information based Upon Your Written Consent Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. Payment: Your PHI will be used, as needed, to obtain payment for your health care services. Office Support Activities: We may use or disclose, as-needed, your PHI in order to support the business activities of our practice.
2) Uses and Disclosures of Protected Health Information Based upon Your Written Authorization Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below.
3) Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person's involvement in your health care. In Emergencies we may use or disclose your PHI for emergency treatment. If a Communication Barrier exists if, using professional judgment, the provider determines your intent use or disclosure under the circumstances.
4) Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object As Required By Law. To a public health authority that is permitted by law to collect or receive the
information. If authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition. To a health oversight agency for activities authorized by law. To a public health authority that is authorized by law to receive reports of child abuse or neglect. To the Food and Drug Administration to report adverse events, product defects or problems. In Legal Proceedings in response to an order of a court. For law enforcement purposes as long applicable legal requirements are met. To Coroners, Funeral Directors, and Organ Donation Organizations. For Research when research has been approved by an institutional review board. In the case of Criminal Activity only when consistent with applicable federal and state laws. For Military Activity and National Security when the appropriate conditions apply. To comply with workers' compensation laws. If an inmate, to a correctional facility. When required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.
5. Your Rights
You have the right to inspect and copy your protected health information. Under federal law, however,
you may not inspect or copy the following records; psychotherapy notes.
You have the right to request a restriction of your protected health information.
You have the right to request to receive confidential communications from us by alternative means or at
an alternative location
You may have the right to have your physician amend your protected health information.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected
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 Officer of your
complaint. We will not retaliate against you for filing a complaint.
7. Effective Date: This notice was published and becomes
effective on April 14. 2003.