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.

OUR LEGAL DUTY

We are required by applicable federal and state law to maintain the privacy of your health information. We are also required to give you this Notice about our privacy practices, our legal duties, and your rights concerning your health information. We must follow the privacy practices that are described in this Notice while it is in effect. This Notice takes effect April 14, 2003, and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this notice at any time provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all the health information that we maintain, including health information we created or received before we made the changes. In the event we make a material change in our privacy practices we will change this Notice and provide it to you at your next visit or it can be viewed in the office. You may request a copy of your Notice at any time. For more information about our privacy practices or for additional copies of this Notice, please contact us using the information listed at the end of the Notice.

USES AND DISCLOSURES OF HEALTH INFORMATION

We use health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care and service that you receive. Your health information is contained in a medical record which is the physical property of Dr. Henry O'Neal.

HOW AND WHY WE MAY DISCLOSE YOUR HEALTH INFORMATION

For Treatment

We may share or disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital and medical personnel who are involved in your care, up to and including the provision, coordination, or management of health care and related services by healthcare providers; consultation between health care providers relating to a patient; and the referral of a patient for health care from one health care provider to another

For Payment

We may use and disclose your health information to others for the purpose of processing and receiving payment for treatment and services provided to you. This may include billing and collection activities and related data processing; actions by a health plan or insurer to determine or fulfill its responsibilities for coverage and provision of the benefits under its health plan or insurance agreement, determinations of eligibility or coverage, adjudication or subrogation of health benefit claims; medical necessity and appropriateness of care reviews, utilization review activities; and disclosure to consumer reporting agencies of information relating to collection of payments.

For Health Care Operation

We may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of staff to evaluate the performance of our associates; assess the quality of services, product and care in your case and similar cases; learn how to improve our facilities and services; conduct training programs or credentialing activities; and determine how to continually improve the quality and effectiveness of the product, service and care we provide.

Appointments, Treatment, and Quality Assurance

We may use your information to provide appointment reminders or recall notices (such as voicemail messages, postcards or letters) or information about treatment alternatives or other health-related benefits, products and services that may be of interest to you. We may also contact you to conduct our own survey about the quality of the products and services we provide.

To You, Your Family and Friends

We must disclose your health information to you, as described in the Your Health Information Rights section of this Notice. We may disclose your health information to a family member, friend, or other person to the extent necessary to help with your healthcare or with payment for your healthcare, but only if you agree that we may do so, or, even if you are not able to agree, if it is necessary in our professional judgment.

Person Involved In Care

We may use or disclose health information to notify or assist in the notification of (including identifying or locating) a family member, your personal representative or another person responsible for your care, of your location or your general condition. If you are present, then prior to use or disclosure of your health information we will provide you with an opportunity to object to such uses or disclosures. In the event of your incapacity, or in emergency circumstances, we will disclose health information based on a determination using our professional judgment disclosing only health information that is directly relevant to the person's involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies, photos, or other similar forma of health information.

Required By Law

We may use and disclose information about you as required by law. For example, we may disclose information for the following purposes: For judicial and administrative proceeding pursuant to legal authority; To report information related to victims of abuse, neglect, or domestic violence; To assist law enforcement officials in their law enforcement duties; or to assist public health officials avert a serious threat to the health or safety of you or any other person.

Decedents

Health information may be disclosed to funeral director or coroner to enable them to carry out their lawful duties.

 

 

 

Organ/Tissue Donations

Your health information may be used or disclosed for cadaver organ, eye, or tissue donation purposes.

Research

We may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.

Government Functions

Specialized government functions such as protection of public officials or reporting to various branches of the armed services that may require use or disclosure of your health information.

Workers' Compensation

Your health information may be used or disclosed in order to comply with laws and regulations related to Workers' Compensation.

Marketing Health Products or Services

From time to time we participate in product mailings with health care product manufacturers. The mailing list is composed with a HIPPA privacy compliant computer program. At no time will any health information about you be revealed to anyone.

Your Authorization

Inaddition to our use of your health information for treatment, payment, and/or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us any authorization you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization we cannot use or disclose your health information for any reason except those described in this notice.

YOUR HEALTH INFORMATION RIGHTS

Access

You have the right to review or get copies of your health information with limited exception. You may request that we provide copies in a format other than photocopies. We will use the format you request unless we cannot practicably do so. You may be asked to make a request in writing to obtain access to your health information. You may obtain a form to request access by using the contact information listed at the end of this Notice. We will charge you a reasonable cost-based fee for expenses such as those for copies and staff time. You may also request access by sending us a letter to the address at the end of this Notice setting forth the specific information to which you desire access. If you request an alternative format, provided that it is practicable for us to produce the information in such format, we will charge a cost-based fee for providing your health information if that format. If you prefer, we will prepare a summary or an explanation of your health information for a fee. Contact us using the information listed at the end of this Notice for a full explanation of our fee structure.

Disclosure Accounting

You have the right to receive a list of instances from the last six years in which we or our business associates disclosed your health information for purposes other than treatment, payment, healthcare operation, where you have provided an authorization and certain other activities, but not for disclosures made prior to April 14, 2003. If you request this accounting more than once in a 12-month period we may charge you a reasonable, cost-based fee for responding to these additional requests.

Restriction

You have the right to request that we place additional restrictions on our use or disclosure of your health information. We are not required to agree to these additional restrictions, but if we do, we will abide by our agreement (except, possibly, in an emergency)

Alternative Communication

You have the right to request in writing that we communicate with you about your health information by alternate means or to an alternate location. Your request must specify the alternate means and/or location, and provide a satisfactory explanation of how payments will be handled under the alternate means and/or location you request.

Amendment

You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under circumstances. You may obtain a form to request an amendment to your health information by using the contact information listed at the end of this Notice.

Electronic Notice

If you receive this Notice by electronic mail (e-mail), you are also entitled to receive it in written form.

QUESTIONS AND COMPLAINTS

If you want more information about our privacy practices, or have questions or concerns, please contact us. If you are concerned that we may have violated your privacy rights or you disagree with a decision we made about access to your health information or response to a request you made to amend or restrict the use or disclosure of your health information or to have us communicate with you by alternative means or at an alternative location, you may complain to us using the contact information listed at the end of this Notice. You may also submit a written complaint to the U.S. Department of Health and Human Services. Upon request, we will provide you with the address for the Department of Health and Human Services so that you can file your complaint. We support your right to the privacy of your health information. We will not retaliate in any way if you choose to file a complaint with us or the U.S. Department of Health and Human Services.

OUR CONTACT INFORMATION

If you have any questions or concerns please contact:

Dr. Henry J. O'Neal                                                                                                                            13701 Bruce B. Downs Blvd. Suite 113                                                                                           Tampa, FL 33613 Phone #: (813) 971-2351

 

 

DON'T LOSE YOUR RIGHT TO DECIDE!

You cannot remove all uncertainty about your future healthcare needs but by having an advance directive you can have the peace of mind that comes from making your wishes known in advance!

 

If you have any further questions, you can contact your family attorney, local hospital, or local medical association for additional information.

Omnibus Budget Reconciliation Act of 1990 (Patient Self-Determination Act) Chapter 765, Florida Statues