NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
BLANE T. SHATKIN, M.D., P.A.
PLASTIC AND RECONSTRUCTIVE SURGERY
1604 TOWN CENTER BLVD., STE C
WESTON, FL 33326
TELEPHONE (954) 384-9997
WHO WILL FOLLOW THIS NOTICE
This notice describes the information privacy practices followed by our
employees, staff and other office personnel. The practices described in
this notice will also be followed by health care providers you consult
with by telephone (when your regular health care provider from our office
is not available) who provide “call coverage” for your health
care provider.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about your
health, health status, and the health care and services you receive at
this office. We are required by law to give you this notice. It will tell
you about the ways in which we may use and disclose health information
about you and describes your rights and our obligation regarding the use
and disclosure of that information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For treatment
We may use health information about you to provide you with medical treatment
or services. We may disclose health information about you to doctors,
nurses, technicians, office staff or other personnel who are involved
in taking care of you and your health.
For example, your doctor may be treating you for a heart condition and
may need to know if you have other health problems that could complicate
your treatment.
The doctor may use your medical history to decide what treatment is best
for you. The doctor may also tell another doctor about your condition
so that doctor can help determine the most appropriate care for you.
Different personnel in our office may share information about you and
disclose information to people who do not work in our office in order
to coordinate you care such as phoning in prescription to your pharmacy,
scheduling lab work and ordering x-rays. Family members and other health
care providers may be part of your medical care outside this office and
may require information about you and that we have.
For Payment
We may use and disclose health information about you so that the treatment
and services you receive at this office may be billed to and payment may
be collected from you, an insurance company or a third party. For example,
we may need to give your health plan information about a service you received
here so your health plan will pay us or reimburse you for the service.
We may also tell your health plan about a treatment you are going to receive
to obtain prior approval, or to determine whether your plan will cover
the treatment.
For Health Care Operations
We may use and disclose health information about you in order to run the
office and make sure that you and our other patients receive quality care,
for example, we may use your health information to evaluate the performance
of our staff in caring for you. We may also use health information about
all or many of our patients to help use decide what additional services
we should offer, how we can become more efficient, or whether certain
new treatments are effective.
Appointment Reminders
We may contact you as a reminder that you have an appointment for treatment
or medical care at the office.
Treatment Alternatives
We may contact you about or recommend possible treatment options or alternatives
that may be of interest to you.
Health Related Products and Services
We may tell you about health related products or services that may of
interest to you.
Please notify us if you do not wish to be contacted for appointment reminders,
or if you do not wish to receive communications about treatment alternatives
or health related products and services. If you advise us in writing (at
the address listed at the top of this Notice) that you do not wish to
receive such communications, we will not use or disclose your information
for these purposes.
You may revoke your Consent at any time by giving us written notice. Your
revocation will be effective when we receive it, but it will not apply
to any uses and disclosures, which occurred before at all time.
If you do revoke your Consent, we will not be permitted to use or disclose
information for purposes of treatment, payment or health care operations,
and we may therefore choose to discontinue providing you with health care
treatment and services.
SPECIAL SITUATIONS
We may use or disclose health information about you without your permission
for the following purposes, subject to all applicable legal requirements
and limitations:
To Avert a Serious Threat to Health or Safety
We may use and disclose health information about you when necessary to
prevent a serous threat to your health and safety or the health and safety
of the public or another person.
Required by Law
We will disclose health information about you when required to do so by
federal, state or local law.
Research
We may use and disclose health information about you for research projects
that are subject to a special approval process. We sill ask you for your
permission if the researcher will have access to your name, address or
other information that reveals who you are, or will be involved in you
care at the office.
Organ and Tissue Donation
If you are an organ donor, we may release health information to organizations
that handle organ procurement or organ, eye or tissue transplantations
or to an organ donation bank, as necessary to facilitate such donation
and transplantation.
Military, Veterans, National Security and Intelligence
If you are or were a member of the armed forces, or part of the national
security or intelligence communities, we may be required by military command
or other government authorities to release health information about you.
We may also release information about foreign military personnel to the
appropriate foreign military authority.
Worker’s Compensation
We may release health information about you for workers’ compensation
or similar programs. These programs provide benefits for work related
injuries or illness.
Public Health Risks
We may disclose health information about you for public health reasons
in order to prevent or control disease, injury or disability; or report
births, deaths, suspected abuse or neglect, non-accidental physical injuries,
reactions to medications or problems with products.
Health Oversight Activities
We may disclose health information to a health oversight agency for audits,
investigations, inspections, or licensing purposes. These disclosures
may be necessary for certain state and federal agencies to monitor the
health care system, government programs, and compliance with civil rights
laws.
Lawsuits and disputes
If you are involved in a lawsuit or a dispute, we may disclose health
information about you in response to a court or administrative order.
Subject to all applicable legal requirements, we may also disclose health
information about you in response to a subpoena.
Law Enforcement
We may release health information if asked to do so by a law enforcement
official in response to a court order, subpoena, warrant, summons or similar
process, subject to all applicable legal requirements.
Coroners, Medical Examiners and Funeral Directors
We may release health information about you in a way that does not personally
identify you or reveal who you are.
Family and Friends
We may disclose health information about you to your family members or
friends if we obtain your verbal agreement to do so or if we give you
an opportunity to object to such a disclosure and you do not raise an
objection. We may also disclose health information to your family or friends
if we can infer from the circumstances, based on our professional judgment
that you would not object. For example, we may assume you agree to your
disclosure of your personal health information to your spouse when you
bring your spouse with you into the exam room during treatment or while
treatment is discussed.
In situations where you are not capable of giving consent (because you
are not present or due to your incapacity or medical emergency), we may,
using our professional judgment, determine that a disclosure to your family
member or friend is in your best interest. In that situation, we will
disclose only health information relevant to the person’s involvement
in your care. For example, we may inform the person who accompanied you
to the emergency room that you suffered inferences that it is in your
best interest to allow another person to act on your behalf to pick up,
for example, filled prescriptions, medical supplies, or X-rays.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
We will not use or disclose your health information for any purpose other
than those identified in the previous sections without your specific,
written Authorization. We must obtain your Authorization, separate from
any Consent we may have obtained from you. If you give us Authorization
to use or disclose health information about you, you may revoke that Authorization,
in writing, at any time. If you revoke your Authorization, we will no
longer use or disclose information about you for the reasons covered by
your written Authorization, but we cannot take back any uses or disclosures
already made with your permission.
If you have HIV or substance abuse information about you, we cannot release
that information without a special signed, written authorization (different
than the Authorization and Consent mentioned above) from you. In order
to disclose these types of records for purposes of treatment, payment
or health care operations, we will have to have both your signed Consent
and a special written Authorization that complies with the law governing
HIV or substance abuse records.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we maintain
about you:
Right to Inspect and Copy
You have the right to inspect and copy your health information, such as
medical and billing records, that we use to make decisions about your
care. You must submit a written request to our privacy official in order
to inspect and/or copy your health information. If you request a copy
of the information, we may change a fee for the costs of copying, mailing
or other associated supplies. We may deny your request to inspect and/or
copy in certain limited circumstances. If you are denied access to your
health information, you may ask that the denial be reviewed. If such a
review is required by law, we will select a licensed health care professional
to review your request and our denial. The person conducting the review
will not be the person who denied your request, and we will comply with
the outcome of the review.
Right to Amend
If you believe health information we have about you is incorrect or incomplete,
you may ask us to amend the information. You have the right to request
an amendment as long as the information is kept by this office.
To request an amendment, complete and submit a Medical Record Amendment/Correction
Form to our privacy official. We may deny your request for an amendment
if it is not in writing or does not include a reason to support the request.
In addition, we may deny your request if you ask us to amend information
that:
a) We did not create, unless the person or entity that created the information
is no longer available to make amendment.
b) Is not part of the health information that we keep.
c) You would not be permitted to inspect and copy.
d) Is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures.”
This is a list of the disclosures we made of medical information about
you for purposes other than treatment, payment and health care operations.
To obtain this list, you must submit your request in writing to our privacy
official. It must state a time period, which may not be longer than six
years and may not include dates before April 14, 2003. Your request should
indicate in what form you want the list (for example, on paper, electronically).
We may charge you for the costs of providing the list. We will notify
you of the cost involved and you may choose to withdraw or modify your
request at that time before any costs are incurred.
Right to Request Restrictions
You have the right to request a restriction or limitation on the health
information we use or disclose about you for treatment, payment or health
care operations. You also have the right to request a limit on the health
information we disclose about you to someone who is involved in your care
of the payment for it, like a family member or friend. For example, you
could ask that we not use or disclose information about a surgery you
had.
We are Not Required to Agree to Your Request
If we do agree, we will comply with your request unless the information
is needed to provide you emergency treatment. To request restrictions,
you may complete and submit a Request For Restricting Uses and Disclosures
and Confidential Communications Form Information to our privacy official.
Right to Request Confidential Communications
You have the right to request that we communicate with you about medical
matters in a certain way or at a certain location. For example, you can
ask that we only contact you at work or by mail. To request confidential
communications, you may complete and submit the Request For Restricting
Uses and Disclosures and Confidential Communications to our privacy official.
We will not ask you the reason for your request. We will accommodate all
reasonable requests. Your request must specify how or where you wish to
be contacted.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this notice. You may ask us to give
you a copy of this notice at any time. Even if you have agreed to receive
it electronically, you are still entitled to a paper copy. To obtain such
a copy, contact our privacy official.
CHANGES TO THIS NOTICE
We reserve the right to change this notice, and to make the revised or
changed notice effective for medical information we already have about
you as well as any information we receive in the future. We will post
a summary of the current notice with its effective date in the top right
hand corner. You are entitled to a copy of the notice currently in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a
complaint with our office or with the Secretary of the Department of Health
and Human Services. To file a complaint with our office, contact our privacy
official. You will not be penalized for filing a complaint.
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