The Health Insurance Portability Act of 1996 (HIPPA) protects the confidentiality of medical records
and other personal health information. The rule limits the use and release of individually identifiable
health information; gives patients the right to access their medical records; restricts most disclosure
of health information to the minimum needed for the intended purpose; and establishes safeguards and
restrictions regarding disclosure of records for certain public responsibilities, such as public health,
research and law enforcement. Improper uses or disclosures under the rule are subject to criminal
and civil sanctions prescribed in HIPAA.
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.
I. Our Privacy Obligations
We are legally required to protect the privacy of your health information, which is called “protected
health information” or “PHI” and it includes information that we have created or received about your
past, present, or future health or condition, the provision of health care to you or the payment of
this health care. We must provide you with this notice about our privacy practices that explains how,
when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more
of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally
required to follow the privacy practices that are described in this notice.
However, we reserve the right to change the terms of this notice and our privacy policies at any time.
Any changes will apply to the PHI we already have. Before we make a significant change to our policies,
we will promptly change this notice and post a new notice in our main reception areas. You may also
request a copy of this notice from the contact person listed in Section IV below at any time, and you
can also print this notice.
II. Uses and Disclosures of PHI
We may use or disclose your PHI without your authorization for the following reasons:
A. Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations.
For treatment. We may disclose your PHI to physicians and other health care personnel who provide you
with health care services or are involved in your care. We may contact you to provide appointment
reminders or information about treatment alternatives or other health-related benefits and services
that may be of interest to you.
To obtain payment for treatment. We may use or disclose your PHI in order to bill and collect payment
for the treatment and services provided to you. For example, disclosures to obtain payment from your
health insurer, HMO, or other company that arranges or pays the cost of some or all of your health
care to verify that said payer will pay for the treatment. You should be aware that if you are not
the insurance policy holder, certain information may be disclosed to the policyholder by the insurance
carrier. We may also provide your PHI to our business associates such as billing companies, claims
processing companies, and others that process our health care claims.
For health care operations. We may disclose your PHI for health care operations, which include
internal administration and activities that improve the quality and cost effectiveness of care that we
deliver to you. We may disclose PHI to our administrative staff in order to resolve any complaints
you may have and ensure that you have a comfortable visit with us.
B. To Personal Representatives. We may disclose PHI to your personal representative who is a
legal guardian, a court-appointed individual, or a person designated by you (via a health care power
of attorney) to act on your behalf in making decisions related to your health care. We will obtain
written documentation of the person’s qualification to act as your personal representative prior to
allowing them to make health care decisions on your behalf.
C. Disclosure to Relatives and Close Friends. We may use or disclose PHI to a family member,
other relative, a close personal friend or any other person identified by you when you are present for,
or otherwise available prior to, the disclosure, if we (1) obtain your agreement; (2) provide you with
the opportunity to object to the disclosure and you do not object; or (3) reasonably infer that you do
not object to the disclosure.
If you are not present, or the opportunity to agree or object to a use or disclosure cannot practicably
be provided because of your incapacity or an emergency circumstance, we may exercise our professional
judgment to determine whether a disclosure is in your best interests. If we disclose information to a
family member, other relative or a close personal friend, we would disclose only information that is
directly relevant to the person’s involvement with your health care or payment related to your health
care. We may also disclose your PHI in order to notify (or assist in notifying) such persons of your
location, general condition or death.
D. For Public Health Activities. We may disclose PHI for public health activities and purposes,
as an example to report health information to authorities for the purpose of preventing or controlling
disease, injury or disability or to alert a person who may have been exposed to a communicable disease
or may otherwise be at risk of contracting or spreading a disease or condition.
E. Decedents. We may disclose PHI to coroners, medical examiners, and funeral directors necessary
information relating to an individual’s death.
F. When required by federal, state or local law, judicial or administrative proceedings, or law
enforcement. We may disclose PHI as required or permitted by a law that requires we report information
to government agencies and law enforcement personnel in circumstances included but not limited to abuse,
neglect or domestic violence; when dealing with gunshot or other wounds; or when ordered by a judicial
or administrative proceeding.
G. For Health Oversight Activities. We may disclose PHI to assist the government when it conducts
an investigation or inspection of a health care provider or organization.
H. For Purposes of Organ Donation. We may disclose PHI to organizations that facilitate organ,
eye or tissue procurement, banking or transplantation.
I. For Research Purposes. We may use or disclose PHI in certain circumstances in order to
conduct medical research.
J. To Avoid Harm. We may use or disclose PHI to prevent or lessen a threat of imminent, serious
physical violence against you or another readily identifiable individual.
K. For Worker’s Compensation purposes. We may disclose PHI as authorized by and to the extent
necessary to comply with laws relating to workers’ compensation or other similar programs.
L. As required by Law. We may use and disclose PHI when required to do so by any other law not
already referred to in this notice.
M. All other Uses and Disclosures Require your Prior Written Authorization. In any other situation
not described in Section I A – L above, we will ask for your written authorization before using or
disclosing any of your PHI. This form is available on our website at: www.vieradiagnostic.com or at
our center. If you choose to sign an authorization to disclose your PHI, you can
later revoke that authorization in writing to stop any future use and disclosures.
III. Your Individual Rights regarding Your PHI
You have the following rights with respect to your PHI:
A. The Right to Request Limits on Uses and Disclosure of Your PHI. You have the right to ask that
we limit how we use and disclose your PHI. While we will consider all requests for restrictions
carefully, we are not required to agree to a requested restriction. If we accept your request, we
will put any limits in writing and abide by them except in emergency situations. You may not limit
the use or disclosure that we are legally required or allowed to make. If you wish to request limits
on uses and disclosure of your PHI, you must do so in writing, and direct your request to the
Administrator/Privacy Officer of Viera Diagnostic Center. We will send you a written response.
B. The Right to Choose How we Send PHI to You. You have the right to ask that we send information
to you at an alternative address or by an alternate means. We must agree to your request so long as
we can easily provide it in the format you requested.
C. The Right to Inspect and Copy your Health Information. You may request access to your medical
records and billing records in order to inspect and obtain copies of the records. Under limited
circumstances, we may deny you access to a portion of your records. If you desire access to your
records, please obtain a records request form at your physician’s office and submit the completed
form by mail or in person to the address designated on the form. If you request copies, we will
charge you $1.00 for each page up to 25 pages, then .25 cents per page thereafter. We will respond
within 30 days of receiving your request.
(Please note that if you are a parent or legal guardian of a minor, certain portions of the minor’s
medical record will not be accessible to you including records relating to pregnancy, abortion,
sexually transmitted disease, substance use and abuse, and contraception and/or family planning
services).
D. The Right to Amend or Update your PHI. If you believe that there is a mistake in your PHI or
that a piece of important information is missing, you have the right to request that we correct the
existing information or add the missing information. Please obtain an amendment request form from
your physician’s office and submit as indicated on the form. We will respond to you within 60 days
of receiving the request. We will comply with your request unless we believe that the information
that would be amended is correct and complete or other special circumstances apply. If your request
is denied, you will receive a written notification which will state the reason(s) for the denial and
explain your right to file a written statement of disagreement with the denial. If you do not file
one, you have the right to ask that your request and our denial be attached to all future disclosures
of your PHI.
E. The Right to Receive an Accounting of Disclosures. You have the right to request a list of
those instances where we have disclosed your PHI other than for treatment, payment, health care
operations or where you specifically authorized a disclosure. The request must state the time
period desired for the accounting, which must not exceed six years and does not apply to disclosures
made prior to April 14, 2003. Please obtain a disclosure request form from your physician’s office
and submit as indicated on the form.
We will respond within 60 days of receiving your request for an accounting of disclosures.
The list will include the date of the disclosure, the name and address to whom PHI was disclosed,
a description of the information disclosed, and the reason for the disclosure. We will provide the
list to you at no charge, but if you make more than one request within a twelve (12) month period,
we will charge a $50 service charge for each additional request.
F. The Right to Revoke An Authorization. You may revoke an authorization by delivering a written
revocation statement to our Administrator/Privacy Officer. Please note that the revocation will
not be applicable to any action taken prior to the receipt of this statement.
IV. Person to Contact for Information about our Privacy Practices or to File a Complaint
If you desire further information about your privacy rights, are concerned that we have violated your
privacy rights or disagree with a decision that we made about access to PHI, you may contact our
Administrator/Privacy Officer,
c/o Viera Diagnostic Center, 7000 Spyglass Ct. Suite 206 Viera, Fl. 32940 Phone: (321) 254-7880.
You may also send a written complaint to the Department of Health and Human
Services, Office of Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201.
V. Effective Date of This Notice
This notice is effective on April 14, 2003.
Complaints
If you are concerned that we have violated your privacy rights, and or would like to express a
concern regarding our privacy practices, you may report your incident in writing. Please ask for the
person listed below for assistance in filing a complaint. You may also send a written complaint to the
U.S. Department of Health and Human Services.
The U.S. Department of Health and Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
Toll Free 1-877-696-6775
Our Legal Duty
We are required by law to protect the privacy of your information, provide this notice about our
practices, and to follow the guidelines described in this notice.
