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.
