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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
carefully.
If you
have any questions about this Notice please
contact: our Compliance Officer/Privacy
Coordinator who is Candice Ruffing,
CPC,CENTC.
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 of future
physical or mental health or condition and
related health care services.
We are
required to 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. You can obtain any revised Notice of
Privacy Practices by accessing our website
at
www.otodocs.com,
or by calling the office and requesting that
a revised copy be sent to you in the mail or
asking for one at the time
of your next appointment.
1.
Uses and Disclosures of Protected Health
Information
Uses
and Disclosures of Protected Health
Information Based Upon Your Written Consent
Once you
have consented to use and disclosure of your
protected health information for treatment,
payment and
health care operations by signing the
consent form, your physician will use or
disclose your protected health
information as described in this section 1.
Your protected health information may be
used and disclosed by our
Practice representatives and others outside
of our office that are involved in your care
and treatment for the
purpose of providing health care services to
you. Your protected health information may
also be used and
disclosed to pay your health care
claims/bills and to support the operation of
our Practice.
Following
are examples of the types of uses and
disclosures of your protected health care
information that our
Practice is permitted to make once you have
signed our consent form. These examples are
not meant to be
exhaustive, but to describe the types of
uses and disclosures that may be made by our
office once you have
provided consent.
Treatment: We will use and disclose your
protected health information to provide,
coordinate, or manage your
health care and any related services. This
includes the coordination or management of
your health care with a
third party that has already obtained your
permission to have access to your protected
health information. For
example, we would disclose your protected
health information, as necessary, to a home
health agency that
provides care to you. We will also disclose
protected health information to other
physicians who may be
treating you when we have the necessary
permission from you to disclose your
protected health information.
For
example, your protected health information
may be provided to a physician to whom you
have been referred
to ensure that the physician has the
necessary information to diagnose or treat
you.
In
addition, we may disclose your protected
health information from time-to-time to
another physician or health
care provider (i.e., a specialist or
laboratory) who, at the request of your
Health Care Provider, becomes
involved in your care by providing
assistance with your health care diagnosis
or treatment to your Health Care
Provider.
Payment:
Your protected health information will be
used, as needed, to obtain payment for your
health care
services. This may include certain
activities that your health insurance plan
may undertake before it approves
or pays for the health care services we
recommend for you such as; making a
determination of eligibility or
coverage for insurance benefits, reviewing
services provided to you for medical
necessity, and undertaking
utilization review activities. For example,
obtaining approval for a hospital stay may
require that your relevant
protected health information be disclosed to
the health plan to obtain approval for the
hospital admission.
Healthcare Operation: We may use or
disclose, as-needed, your protected health
information in order to
support the business activities of our
Practice. These activities include, but are
not limited to, quality
assessment activities, employee review
activities, training of medical students,
licensing, direct marketing
activities, and conducting or arranging for
other business activities.
For example, we may disclose your protected
health information to medical school
students that see patients at
our office. In addition, we may use a
sign-in sheet at the registration desk where
you will be asked to sign your
name. We may also call you by name in the
waiting room when your Health Care
Professional is ready to see
you. We may use or disclose your protected
health information, as necessary, to contact
you to remind you of
your appointment.
We will share your protected health
information with third party “business
associates” that perform various
activities (i.e., billing, transcription
services) for the Practice. Whenever an
arrangement between our office and
a business associate involves the use or
disclosure of your protected health
information, we will have a written
agreement that contains terms that will
protect the privacy of your protected health
information.
We may use or disclose your protected health
information, as necessary, to provide you
with information about
treatment alternatives or other
health-related benefits and services that
may be of interest to you. We may also
use and disclose your protected health
information for other marketing services.
For example, your name and
address may be used to send you a newsletter
about our Practice and the services we
offer. We may also send
you information about products or services
that we believe may be beneficial to you.
You may contact our
Compliance Officer/Privacy Coordinator to
request that these materials not be sent to
you.
Uses and Disclosures of Protected Health
Information Based Upon Your Written
Authorization
Other uses and disclosures of your protected
health information will be made only with
your written
authorization, unless otherwise permitted or
required by law as described below. You may
revoke this
authorization, at any time, in writing,
except to the extent that our Practice has
taken an action in reliance on the
use or disclosure indicated in the
authorization.
Other Permitted and Required Uses and
Disclosures That May Be Made With Your
Consent,
Authorization or Opportunity to Object
We may use and disclose your protected
health information in the following
instances. You have the
opportunity to agree or object to the use or
disclosure of all or part of your protected
health information. If you
are not present or able to agree or object
to the use or disclosure of the protected
health information, then the
Practice may, using professional judgment,
determine whether the disclosure is in your
best interest. In this
case, only the protected health information
that is relevant to your health care will be
disclosed.
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 protected health
information that directly relates to
that person’s involvement in your health
care. If you are unable to agree or object
to such a disclosure, we may
disclose such information as necessary if we
determine that it is in your best interest
based on our professional
judgment. We may use or disclose protected
health information to notify or assist in
notifying a family
member, personal representative or any other
person that is responsible for your care,
your location, general
condition or death. Finally, we may use or
disclose your protected health information
to an authorized public or
private entity to assist in disaster relief
efforts and to coordinate uses and
disclosures to family or other
individuals involved in your health care.
Emergencies: We may use or disclose your
protected health information in an emergency
treatment situation.
If this happens, the Practice will try to
obtain your consent as soon as reasonably
practical after the delivery of
treatment. If the Practice is required by
law to treat you and the Health Care
Professional has attempted to
obtain your consent but is unable to do so,
he or she may still use or disclose your
protected health information
to treat you.
Communication Barriers: We may use and
disclose your protected health information
if the Practice attempts
to obtain consent from you but is unable to
do so due to substantial communication
barriers and the Health Care
Professional determines, using professional
judgment, that you intend to consent to use
or disclose under the
circumstances.
Other Permitted and Required Uses and
Disclosures That May Be Made Without Your
Consent,
Authorization or Opportunity to Object
We may use or disclose your protected health
information in the following situations
without your consent or
authorization. These situations include:
Required by Law: We may use or disclose your
protected health information to the extent
that the use or
disclosure is required by law. The use or
disclosure will be made in compliance with
the law and will be
limited to the relevant requirements of the
law. You will be notified, as required by
law, of any such uses or
disclosures.
Public Health: We may disclose your
protected health information for public
health activities and purposes to a
public health authority that is permitted by
law to collect or receive the information.
The disclosure will be
made for the purpose of controlling disease,
injury or disability. We may also disclose
your protected health
information, if directed by the public
health authority, to a foreign government
agency that is collaborating with
the public health authority.
Communicable Diseases: We may disclose your
protected health 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.
Health Oversight: We may disclose protected
health information to a health oversight
agency for activities
authorized by law, such as audits,
investigations, inspections and quality
assurance purposes. Oversight
agencies seeking this information include
government agencies that oversee the health
care system, government
benefit programs, other government
regulatory programs and civil right laws.
Abuse or Neglect: We may disclose your
protected health information to a public
health authority that is
authorized by law to receive reports of
child abuse or neglect. In addition, we may
disclose your protected
health information if we believe that you
have been a victim of abuse, neglect or
domestic violence to the
governmental entity or agency authorized to
receive such information. In this case, the
disclosure will be made
consistent with the requirements of
applicable federal and state laws.
Food and Drug Administration: We may
disclose your protected health information
to a person or company
required by the Food and Drug Administration
to report adverse events, product defects or
problems, biologic
product deviations, track products; to
enable product recalls; to make repairs or
replacements, or to conduct post
marketing surveillance, as required.
Legal Proceedings: We may disclose protected
health information in the course of any
judicial or
administrative proceeding, in response to an
order of a court or administrative tribunal
(to the extent such
disclosure is expressly authorized), in
certain conditions in response to a
subpoena, discovery request or other
lawful process.
Law Enforcement: We may also disclose
protected health information, so long as
applicable legal
requirements are met, for law enforcement
purposes. These law enforcement purposes
include (1) legal
processes and otherwise required by law, (2)
limited information requests for
identification and location
purposes, (3) pertaining to victims of a
crime, (4) suspicion that death has occurred
as a result of criminal
conduct, (5) in the event that a crime
occurs on the premises of the Practice, and
(6) medical emergency (not on
the Practice’s premises) and it is likely
that a crime has occurred.
Coroners, Funeral Director’s, and Organ
Donation: We may disclose protected health
information to a
coroner or medical examiner for
identification purposes, determining cause
of death or for the coroner or
medical examiner to perform other duties
authorized by law. We may also disclose
protected health
information to a funeral director, as
authorized by law, in order to permit the
funeral director to carry out their
duties. We may disclose such information in
reasonable anticipation of death. Protected
health information
may be used and disclosed for cadaveric
organ, eye or tissue donation purposes.
Research: We may disclose your protected
health information to researchers when their
research has been
approved by an institutional review board
that has reviewed the research proposal and
established protocols to
ensure the privacy of your protected health
information.
Criminal Activity: Consistent with
applicable federal and state laws, we may
disclose your protected health
information, if we believe that the use or
disclosure is necessary to prevent or lessen
a serious and imminent
threat to the health or safety of a person
or the public. We may also disclose
protected health information if it is
necessary for law enforcement authorities to
identify or apprehend an individual.
Military Activity and National Security:
When the appropriate conditions apply, we
may use or disclose
protected health information of individuals
who are Armed Forces personnel (1) for
activities deemed necessary
by appropriate military command authorities;
(2) for the purpose of a determination by
the Department of
Veterans Affairs of your eligibility for
benefits, or (3) to foreign military
authority if you are a member of that
foreign military services. We may also
disclose your protected health information
to authorized federal officials
for conducting national security and
intelligence activities, including for the
provision of protective services to
the President or others legally authorized.
Workers’ Compensation: Your protected health
information may be disclosed by us as
authorized to comply
with worker’s compensation laws and other
similar legally-established programs.
Inmates: We may use or disclose your
protected health information if you are an
inmate of a correctional
facility and the Practice created or
received your protected health information
in the course of providing care to
you.
Required Uses and Disclosures: Under the
law, we must make disclosures to you and
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.
2. Your Rights
Following is a statement of your rights with
respect to your protected health information
and a brief description
of how you may exercise these rights.
You have the right to inspect and copy your
protected health information. This means you
may inspect
and obtain a copy of protected health
information about you that is contained in a
designated record set for as
long as we maintain the protected health
information. A “designated record set”
contains medical and billing
records and any other records that our
Practice uses for making decisions about
you.
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.
In some
circumstances, you may have the right to
have this decision reviewed. Please contact
our Compliance
Office/Privacy Coordinator if you have
questions about access to your medical
record.
You have the right to request a restriction
of your protected health information. This
means you may ask
us not to use any part of your protected
health information for the purposes of
treatment, payment or healthcare
operations. You may also request that any
part of your protected health information
not be disclosed to family
members or friends who may be involved in
your care or for notification purposes as
described in this Notice of
Privacy Practices. Your request must state
the specific restriction requested and to
whom you want the
restriction to apply.
We are not required to agree to a
restriction that you may request. If we
determine it is in your best interest to
permit use and disclosure of your protected
health information, your protected health
information will not be
restricted. If the Practice agrees to the
requested restriction, we may not use or
disclose your protected health
information in violation of that restriction
unless it is needed to provide emergency
treatment. With this in
mind, please discuss any restriction you
wish to request with our Compliance
Officer/Privacy Coordinator. You
may request a restriction by sending us a
written request outlining the specific data
you wish to restrict and to
whom. Your correspondence should be sent to:
Candice Ruffing, CPC, CENTC
Compliance Officer/Privacy Coordinator
Drs. Berghash & Lanza, P.L., d/b/a
South Coast Ear, Nose & throat
1801 S.E. Hillmoor Drive
Suite B105
Port St. Lucie, Florida 34952
You have the right to request to receive
confidential communications from us by
alternative means or at
an alternative location. We will accommodate
reasonable requests. We may also condition
this
accommodation by asking you for information
as to how payment will be handled or
specification of an
alternative address or other method of
contact. We will not request an explanation
from you as to the basis for
the request. Please make this request in
writing to:
Candice Ruffing, CPC, CENTC
Compliance Officer/Privacy Coordinator
Drs. Berghash & Lanza, P.L., d/b/a
South Coast Ear, Nose & throat
1801 S.E. Hillmoor Drive
Suite B105
Port St. Lucie, Florida 34952
You may have the right to request that our
Practice amend your protected health
information. This
means you may request an amendment of
protected health information about you in a
designated record set for
as long as we maintain this information. In
certain cases, we may deny your request for
an amendment. If we
deny your request for amendment, 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
Compliance Officer/Privacy Coordinator if
you have questions about amending your
medical record.
You have the right to receive an accounting
of certain disclosures we have made, if any,
of your protectedhealth 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,
for a facility directory, to family members
or friends involved in your care, or for
notification purposes. You
have the right to receive specific
information regarding these disclosures that
occurred after April 14, 2003.
You may request a shorter timeframe. The
right to receive this information is subject
to certain exceptions,
restrictions and limitations.
You have the right to obtain a paper copy of
this notice from us, upon request, even if
you have agreed to
accept this notice electronically.
3. Complaints
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 Compliance
Officer/Privacy Coordinator, Candice Ruffing,
CPC, CENTC at 772-323-2174 or
cruffing@otodocs.com for further
information about the complaint process.
Our initial notice was published on April
14, 2003. The most current version was
posted on April 1, 2010. |
