NOTICE OF PRIVACY PRACTICES

Individual Rights

You have the following rights regarding your health information. Please contact the person listed below to obtain the appropriate form for exercising these rights. Request Restrictions:
You may request restrictions on certain uses and disclosures of your health information. We are not required to agree to such a restriction. But if we do, we must abide by those restrictions.

Confidential Communications:

You may ask us to communicate with you confidentially by sending notices to special addresses or using specific phone numbers.
Inspect and Obtain Copies:
In most cases, you have the right to look at and get a copy of your health information.
Amended Information:
If you believe that information in your record is incorrect, if important information is missing, you have the right to request that we make a correction to the existing information or add the missing information.
Accounting Disclosure:
You may request a list of instances where we have disclosed your health information for reasons other than treatment, payment, or health care operations.
If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about your health information, you may contact the person listed below.

PRACTICE POLICIES

Authorization to Release or Use Information for Treatment, Payment, and Health Care Operations
I authorize the release of my individually identifiable information and medical record information by Primary Care of Central Florida, Inc., in order to facilitate treatment, payment or health care operations.
You have the right to request that we restrict how protected health information about you is used or disclosed for treatment, payment, and/ or healthcare operations. We are not required to agree to this restriction, but if we do, we are bound by our agreement.
You have the right to review the Notice of Privacy Practices for a more complete description of the potential release and use of such information. You have the right to review such notice prior to signing this consent form.
We reserve the right to change the terms of the Notice of privacy practice at any time. If we do make changes to the terms, you may obtain a copy of the revised notice.
You retain the right to request that we further restrict how your PHI is released and/or used to carry out treatment, payment, and health care operations.
At all times, I have the right to revoke this consent. Such revocation must be submitted in writing. The revocation shall be effective except to the extent that the practice has already taken action on the prior consent. The practice may refuse the treat you if you (or an authorized representative) do not sign this consent form. If you (or an authorized representative) sign the consent and then revoke it, the practice has the right to refuse to provide further treatment to you as of the time of the revocation (except to the extent that he practices is required by law to treat individuals).

Release of Healthcare Information

Use of Patient Health Information or “PHI”
Under federal law, your patient’s health information is protected and confidential. PHI includes information about your conditions, illness, symptoms, diagnosis, results, treatment and all related medical information. Your health information may also include billing, insurance and payment information.
We may use your information for treatment and care, to obtain records or payment. On occasion we can use it for routine heath care operations, including administrative purposes and treatment evaluation. Under some circumstances, we may be asked to disclose the information without your permission.
We may use and disclose PHI to provide you with medical treatment or services. Providers, administrators, and staff will record information in your chart and use it to determine the most appropriate course of care. We may also disclose your information to other health care providers participating in your treatment.
We will use your PHI for payment purposes. We will need to obtain authorization from insurance companies. We will submit bills and need to maintain the record of payments.
We will use and disclose your information to conduct routine internal operations, including record maintenance, evaluation of quality treatment, and follow up care.
We may also use your information to contact you for appointments and reminders. We may also use your PHII to provide information about treatment and other health-related benefits to you.

Other Uses

We may be required by law to report suspected abuse or neglect, or similar injuries and events.
We may use your PHI for approved medical research.
As required by law, we may disclose vital statistics, diseases, diagnoses, information related to recalls, and similar information, to public health care agencies.
We may be required to disclose your PHI to aid in investigations, audits, eligibility for government programs, or similar activities. We may be asked to provide information through subpoena or court order.
We will be asked to report information regarding deaths to coroners, medical examiners, funeral directors, and organ donation services.
We may use and disclose your PHI when necessary to prevent a serious health threat to your health and safety concern to you or to the health, safety, or general well fare to the public or another person.
We may release information about you to worker compensation or similar programs providing benefits for work-related injuries or illness.
In any other situation, we will ask for your written consent before using or disclosing any identifiable health information.