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NOTICE OF PRIVACY PRACTICES THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND
HOW YOU MAY GET ACCESS TO THIS INFORMATION.
PLEASE READ IT CAREFULLY. OUR
OFFICE IS DEDICATED TO PROTECTING YOUR MEDICAL INFORMATION.
WE ARE REQUIRED BY LAW TO MAINTAIN THE PRIVACY OF PROTECTED HEALTH
INFORMATION AND TO PROVIDE YOU WITH THIS NOTICE OF OUR LEGAL DUTIES AND PRIVACY
PRACTICES WITH RESPECT TO PROTECTED HEALTH INFORMATION.
OUR OFFICE IS REQUIRED BY LAW TO ABIDE BY THE TERMS OF THIS NOTICE. HOW
YOUR MEDICAL INFORMATION WILL BE USED AND DISCLOSED: WE
WILL USE YOUR MEDICAL INFORMATION AS PART OF RENDERING PATIENT CARE.
FOR EXAMPLE, YOUR MEDICAL INFORMATION MAY BE USED BY THE DOCTOR OR NURSE
TREATING YOU, BY THE BUSINESS OFFICE TO PROCESS YOUR PAYMENT FOR THE SERVICES
RENDERED AND BY ADMINISTRATIVE PERSONNEL REVIEWING THE QUALITY OF THE CARE YOU
RECEIVE. WE
MAY ALSO USE AND/OR DISCLOSE YOUR INFORMATION IN ACCORDANCE WITH FEDERAL AND
STATE LAWS FOR THE FOLLOWING PURPOSES:
APPOINTMENT
REMINDERS WE MAY CONTACT YOU
TO PROVIDE APPOINTMENT REMINDERS. TREATMENT
INFORMATION WE
MAY CONTACT YOU WITH INFORMATION ABOUT TREATMENT ALTERNATIVES OR OTHER HEALTH-RELATED
BENEFITS AND SERVICES THAT MAY BE OF INTEREST TO YOU. DISCLOSURE
TO DEPARTMENT OF HEALTH AND HUMAN SERVICES. WE
MAY DISCLOSE MEDICAL INFORMATION WHEN REQUIRED BY THE UNITED STATES DEPARTMENT
OF HEALTH AND HUMAN SERVICES AS PART OF AN INVESTIGATION OR DETERMINATION OF OUR
COMPLIANCE WITH RELEVANT LAWS. FAMILY
AND FRIENDS UNLESS
YOU OBJECT IN WRITING, WE MAY DISCLOSE YOUR MEDICAL INFORMATION WITH FAMILY
MEMBERS, OTHER RELATIVES OR CLOSE PERSONAL FRIENDS WHEN THE MEDICAL INFORMATION
IS DIRECTLY RELEVANT TO THAT PERSON’S INVOLVEMENT WITH YOUR CARE. IF YOU DO
NOT WISH US TO DO THIS PLEASE SPECIFY IN WRITING WITH WHOM WE MAY DISCLOSE
INFORMATION. NOTIFICATION UNLESS
YOU OBJECT, WE MAY USE OR DISCLOSE YOUR MEDICAL INFORMATION TO NOTIFY A FAMILY
MEMBER, A PERSONAL REPRESENTATIVE OR ANOTHER PERSON RESPONSIBLE FOR YOUR CARE OF
YOUR LOCATION, GENERAL CONDITION OR DEATH. DISASTER
RELIEF WE
MAY DISCLOSE YOUR MEDICAL INFORMATION TO A PUBLIC OR PRIVATE ENTITY, SUCH AS THE
AMERICAN RED CROSS, FOR THE PURPOSE OF COORDINATING WITH THAT ENTITY TO ASSIST
IN DISASTER RELIEF EFFORTS. HEALTH
OVERSIGHT ACTIVITIES
WE MAY USE OR DISCLOSE YOUR MEDICAL INFORMATION FOR PUBLIC HEALTH
ACTIVITIES, INCLUDING THE REPORTING OF DISEASE, INJURY, VITAL EVENTS AND THE
CONDUCT OF PUBLIC HEALTH SURVEILLANCE, INVESTIGATION AND/OR INTERVENTION.
WE MAY DISCLOSE YOUR MEDICAL INFORMATION TO A HEALTH OVERSIGHT AGENCY FOR
OVERSIGHT ACTIVITIES AUTHORIZED BY LAW, INCLUDING AUDITS, INVESTIGATIONS,
INSPECTIONS, LICENSURE OR DISCIPLINARY ACTIONS, ADMINISTRATIVE AND/OR LEGAL
PROCEEDINGS. ABUSE
OR NEGLECT WE
MAY DISCLOSE YOUR MEDICAL INFORMATION WHEN IT CONCERNS ABUSE, NEGLECT OR
VIOLENCE TO YOU IN ACCORDANCE WITH FEDERAL AND STATE LAW. LEGAL
PROCEEDINGS WE
MAY DISCLOSE YOUR MEDICAL INFORMATION IN THE COURSE OF CERTAIN JUDICIAL OR
ADMINISTRATIVE PROCEEDINGS. LAW
ENFORCEMENT WE
MAY DISCLOSE YOUR MEDICAL INFORMATION FOR LAW ENFORCEMENT PURPOSES OR OTHER
SPECIALIZED GOVERNMENTAL FUNCTIONS. CORONERS,
MEDICAL EXAMINERS AND FUNERAL DIRECTORS WE
MAY DISCLOSE YOUR MEDICAL INFORMATION TO A CORONER, MEDICAL EXAMINER OR A
FUNERAL DIRECTOR. ORGAN
DONATION IF
YOU ARE AN ORGAN DONOR, WE MAY DISCLOSE YOUR MEDICAL INFORMATION TO AN ORGAN
DONATION AND PROCUREMENT ORGANIZATION. RESEARCH WE
MAY USE OR DISCLOSE YOUR MEDICAL INFORMATION FOR CERTAIN RESEARCH PURPOSES IF AN
INSTITUTIONAL REVIEW BOARD OR A PRIVACY BOARD HAS ALTERED OR WAIVED INDIVIDUAL AUTHORIZATION,
THE REVIEW IS PREPARATORY TO RESEARCH OR THE RESEARCH IS ON ONLY DECEDENT’S
INFORMATION. PUBLIC
SAFETY WE
MAY USE OR DISCLOSE YOUR MEDICAL INFORMATION TO PREVENT OR LESSEN A SERIOUS
THREAT TO THE HEALTH OR SAFETY OF ANOTHER PERSON OR TO THE PUBLIC. WORKERS’
COMPENSATION WE
MAY DISCLOSE YOUR MEDICAL INFORMATION AS AUTHORIZED BY LAWS RELATING TO
WORKERS’ COMPENSATION OR SIMILAR PROGRAMS. BUSINESS
ASSOCIATES WE
MAY DISCLOSE YOUR HEALTH INFORMATION TO A BUSINESS ASSOCIATE WITH WHOM WE
CONTRACT TO PROVIDE SERVICES ON OUR BEHALF.
TO PROTECT YOUR HEALTH INFORMATION, WE REQUIRE OUR BUSINESS ASSOCIATES TO
APPROPRIATELY SAFEGUARD THE HEALTH INFORMATION OF OUR PATIENTS. NOTE:
WE WILL NOT USE OR DISCLOSE YOUR MEDICAL INFORMATION FOR ANY OTHER PURPOSE
WITHOUT YOUR WRITTEN AUTHORIZATION. ONCE
GIVEN, YOU MAY REVOKE YOUR AUTHORIZATION IN WRITING AT ANY TIME.
YOU
HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR INFORMATION: ·
YOU MAY ASK US TO RESTRICT CERTAIN USES AND DISCLOSURES IN
WRITING, OF YOUR MEDICAL INFORMATION. WE
ARE NOT REQUIRED TO AGREE TO YOUR REQUEST, BUT IF WE DO, WE WILL HONOR IT. ·
YOU HAVE THE RIGHT TO RECEIVE COMMUNICATIONS FROM US IN A
CONFIDENTIAL MANNER. ·
GENERALLY, YOU MAY INSPECT AND COPY YOUR MEDICAL INFORMATION.
THIS RIGHT IS SUBJECT TO CERTAIN SPECIFIC EXCEPTIONS, AND YOU MAY BE
CHARGED A REASONABLE FEE FOR ANY COPIES OF YOUR RECORDS.
WE DO ASK FOR THESE REQUESTS IN WRITING AND ALLOW US 7-14 BUSINESS DAYS
TO COMPLY. ·
YOU MAY ASK US TO AMEND YOUR MEDICAL INFORMATION. WE MAY DENY YOUR
REQUEST FOR CERTAIN SPECIFIC REASONS. IF
WE DENY YOUR REQUEST, WE WILL PROVIDE YOU WITH A WRITTEN EXPLANATION FOR DENIAL
AND INFORMATION REGARDING FURTHER RIGHTS YOU MAY HAVE AT THAT POINT. REQUESTS WILL BE DECIDED BY THE DOCTOR OR OFFICE MANAGER AND
MIGHT REQUIRE AN APPOINTMENT. ·
YOU HAVE THE RIGHT TO RECEIVE AN ACCOUNTING OF THE DISCLOSURES OF
YOUR MEDICAL INFORMATION MADE BY OUR OFFICE DURING THE LAST SIX YEARS (OR
FOLLOWING APRIL 14,2003), EXCEPT FOR DISCLOSURES FOR TREATMENT, PAYMENT OR
HEALTHCARE OPERATIONS, DISCLOSURES WHICH YOU AUTHORIZED, AND CERTAIN OTHER
SPECIFIC DISCLOSURE TYPES. ·
YOU MAY REQUEST A PAPER COPY OF THIS NOTICE OF PRIVACY PRACTICES
FOR PROTECTED HEALTH INFORMATION. ·
YOU HAVE THE RIGHT TO COMPLAIN TO US AND/OR TO THE UNITED STATES
DEPARTMENT OF HEALTH AND HUMAN SERVICES IF YOU BELIEVE THAT WE HAVE VIOLATED
YOUR PRIVACY RIGHTS. IF YOU CHOOSE
TO FILE A COMPLAINT, YOU WILL NOT BE RETALIATED AGAINST IN ANY WAY.
TO COMPLAIN TO US, PLEASE CONTACT: o ORLANDO DIABETES AND ENDOCRINE SPECIALISTS’
OFFICE MANAGER 1603
S. HIAWASSEE RD SUITE
105 ORLANDO,
FL 32835 407-293-2150 THIS NOTICE IS EFFECTIVE AS OF APRIL 14, 2003 WE
RESERVE THE RIGHT TO CHANGE THE TERMS OF THIS NOTICE, MAKING ANY REVISION
APPLICABLE TO ALL THE PROTECTED HEALTH INFORMATION WE MAINTAIN.
IF WE REVISE THE TERMS OF THIS NOTICE, WE WILL POST A REVISED NOTICE AT
OUR OFFICE AND WILL MAKE PAPER COPIES OF THE REVISED NOTICE OF PRIVACY PRACTICES
AVAILABLE UPON REQUEST. |
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