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.
This joint notice applies to the staff, volunteers, business associates, and physicians who provide services on behalf of any Advanced Urology Institute office location, outpatient diagnostic or treatment center, laboratory, or affiliated ambulatory surgery center. Advanced Urology Institute locations and providers are located throughout Florida. This notice describes how we will use and share your information, how we are required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to your protected health information (PHI). PHI is information about you, including demographic information, that may identify you and that relates to your health or condition and related health care services. We will tell you if your PHI has been breached. We are required to abide by the terms of the notice currently in effect. If you have questions about any part of this notice or if you want more information about our privacy practices, contact our Privacy Officer at the [email protected].
We are required by law to:
- Maintain the privacy of your medical information to the extent required by state and federal law.
- Give you this Notice explaining our legal duties and privacy practices with respect to medical information about you.
- Notify affected individuals following a breach of unsecured medical information under federal law.
- Notice that is currently in effect.
HOW WE (Including Our Affiliated Entities and Other Physicians Who Are Treating You) MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
We are committed to protecting the privacy of your health information. The law permits us to use or share your health information for the following purposes:
- Treatment: We may use and disclose medical information about you to provide you with health care treatment and related services, including coordinating and managing your health care. We may disclose medical information about you to physicians, nurses, other health care providers and personnel who are providing or involved in providing health care to you (both within and outside of the Practice).
- Payment: We may use and disclose medical information about you so that we or may bill and collect from you, an insurance company, or a third party for the health care services we provide. For example, obtaining approval for payment of services from your health plan may require that your PHI be shared with your health plan. We may also provide your PHI to our business associates or other providers’ business associates, such as billing companies, transcriptionists, collection agencies, and vendors who mail billing statements. If, however, you pay for an item or service in full, out of pocket and request that we not disclose to your health plan the medical information solely relating to that item or service, as described more fully in Your Rights Regarding Medical Information About You, we will follow that restriction on disclosure unless otherwise required by law.
- Health Care Operations: We may use and disclose medical information about you for our health care operations. These uses and disclosures are necessary to operate and manage our practice and to promote quality care. For example, we may need to use or disclose your medical information in order to assess the quality of care you receive or to conduct certain cost management, business management, administrative, or quality improvement activities or to provide information to our insurance carriers. In addition, we may also provide your PHI to accountants, attorneys, consultants, accrediting agencies, outside funding sources and others to make sure we’re complying with the laws that affect us.
- Notification and Communication with Family: Unless you object, we may release to a relative, close friend or any other person you identify, information that directly relates to that person’s involvement in your health care or who helps pay for your care. We may also use or release PHI to notify or assist in notifying a family member, personal representative or any other person responsible for your care to tell them your location or general condition. If you are unable to provide written authorization, agree or object to the release, we may release information as necessary if we determine that it is in your best interest based on our professional judgment, such as emergency situations. Finally, we may use or share your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and releases to family or other individuals involved in your health care.
- Required by Law, Court or Law Enforcement: We may release PHI when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect or domestic violence, when dealing with crime or when ordered by a court.
- Quality Assurance: We may need to use or disclose your medical information for our internal processes to assess and facilitate the provision of quality care to our patients.
- Utilization Review: We may need to use or disclose your medical information to perform a review of the services we provide in order to evaluate whether that the appropriate level of services is received, depending on condition and diagnosis.
- Credentialing and Peer Review: We may need to use or disclose your medical information for us to review the credentials, qualifications and actions of our health care providers.
- Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that we believe may be of interest to you.
- Public Health: As required or permitted by law, we may release PHI or a limited data set to public health authorities for purposes related to preventing or controlling disease, injury or disability, reporting to the Food and Drug Administration problems with products and reactions to medications and reporting disease or infection exposure.
- Health Oversite Activities: We may release PHI to health agencies for activities authorized by law. These oversight activities include audits, investigations and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs and compliance with civil rights laws. For example, we may release PHI to the Secretary of the Department of Health & Human Services so they can determine or compliance and privacy.
- Deceased Person Information: We may release your health information to coroners, medical examiners and funeral directors. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about our patients to funeral home directors as necessary to carry out their duties.
- Organ and Tissue Donation: If you are an organ donor, we may use and disclose medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.
- Research: We may, in certain situations, release your health information or limited data set to researchers conducting research. Additionally, we may use or disclose your medical information for research purposes if your authorization has been obtained when required by law, or if the information we provide to researchers is “de-identified.”
- Specific Government Functions: We may share your health information for military or national security purposes or in certain cases if you are in law enforcement custody.
- Law Enforcement, National Security and Intelligence Activities: In certain circumstances, we may disclose your medical information if we are asked to do so by law enforcement officials, or if we are required by law to do so. We may disclose your medical information to law enforcement personnel, if necessary, to prevent or decrease a serious and imminent threat of injury to your physical, mental or emotional health or safety or the physical safety of another person. We may disclose medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- Inmates: If you are an inmate of a correctional institution or under custody of a law enforcement official, we may disclose medical information about you to the health care personnel of a correctional institution as necessary for the institution to provide you with health care treatment.
- Workers’ Compensation: We may share your health information as necessary to comply with workers’ compensation laws. We report any injuries referred to us from an employer to the Department of Workers’ Compensation and any work-related deaths to OSHA. All employers are given health information regarding work-related injuries they have referred to us.
- Appointment Reminders and Health Related Benefits and Services: We may use and disclose medical information, in order to contact you (including, for example, contacting you by phone; leaving a message on an answering machine; sending a text or email message) to provide appointment reminders and other information. We may use and disclose medical information to tell you about health-related benefits or services that we believe may be of interest to you.
- Fundraising, Marketing and the Sale of PHI: We may contact you to participate in fundraising activities. You have a right to opt out of receiving such fundraising communications. We will not sell your PHI or use or disclose it for marketing purposes without your specific permission.
- Florida State-Specific Requirements: When Florida’s laws are stricter than federal privacy laws, we are required to follow the state law.
- Affiliated Covered Entity: PHI will be made available to staff at local affiliated entities as necessary to carry out treatment, payment and health care operations. Caregivers at other facilities may have access to PHI at their locations to assist in reviewing past treatment information as it may affect treatment at this time. You may contact the Privacy Department for more information on specific sites included in this affiliated covered entity.
- Treatment of Sensitive Information: Psychotherapy notes and diagnostic and therapeutic information regarding mental health, drug/alcohol abuse or sexually transmitted diseases (including HIV status) will not be disclosed without your specific permission, unless required or permitted by law.
- Military and Veterans: If you are a member of the armed forces, we may use and disclose medical information about you as required by the appropriate military authorities.
- Fundraising: We may use or disclose certain limited amounts of your medical information to send you fundraising materials. You have a right to opt out of receiving such fundraising communications. Any such fundraising materials sent to you will have clear and conspicuous instructions on how you may opt out of receiving such communications in the future.
OTHER USES OF MEDICAL INFORMATION
- Authorizations: There are times we may need or want to use or disclose your medical information for reasons other than those listed above, but to do so we will need your prior authorization. Other than expressly provided herein, any other uses or disclosures of your medical information will require your specific written authorization. Psychotherapy Notes, Marketing and Sale of Medical Information. Most uses and disclosures of “psychotherapy notes,” uses and disclosures of medical information for marketing purposes, and disclosures that constitute a “sale of medical information” under HIPAA require your authorization.
- Right to Revoke Authorization: If you provide us with written authorization to use or disclose your medical information for such other purposes, you may revoke that authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your medical information for the reasons covered by your written authorization. You understand that we are unable to take back any uses or disclosures we have already made in reliance upon your authorization, and that we are required to retain our records of the care that we provided to you.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
Federal and state laws provide you with certain rights regarding the medical information we have about you. The following is a summary of those rights:
- Right to Inspect and Copy. Under most circumstances, you have the right to inspect and/or copy your medical information that we have in our possession, which generally includes your medical and billing records. To inspect or copy your medical information, you must submit your request to do so in writing to the Practice’s Privacy Officer at the address listed in below. If you request a copy of your information, we may charge a fee for the costs of copying, mailing, or certain supplies associated with your request. The fee we may charge will be the amount allowed by state law. If your requested medical information is maintained in an electronic format (e.g., as part of an electronic medical record, electronic billing record, or other group of records maintained by the Practice that is used to make decisions about you) and you request an electronic copy of this information, then we will provide you with the requested medical information in the electronic form and format requested, if it is readily producible in that form and format. If it is not readily producible in the requested electronic form and format, we will provide access in a readable electronic form and format as agreed to by the Practice and you. In certain very limited circumstances allowed by law, we may deny your request to review or copy your medical information. We will give you any such denial in writing. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the Practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will abide by the outcome of the review.
- Right to Amend. If you feel the medical 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 for as long as the information is kept by the Practice. To request an amendment, your request must be in writing and submitted to the Privacy Officer at the address listed in Section VI below. In your request, you must provide a reason as to why you want this amendment. If we accept your request, we will notify you of that in writing. 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 was not created by us (unless you provide a reasonable basis for asserting that the person or organization that created the information is no longer available to act on the requested amendment), is not part of the information kept by the Practice, is not part of the information which you would be permitted to inspect and copy, or is accurate and complete. If we deny your request, we will notify you of that denial in writing.
Your Health Information Rights
- Right of an Accounting of Disclosure. You have the right to request an “accounting of disclosures” of your medical information. This is a list of the disclosures we have made for up to six years prior to the date of your request of your medical information, but does not include disclosures for Treatment, Payment, or Health Care Operations or disclosures made pursuant to your specific authorization, or certain other disclosures. If we make disclosures through an electronic health records (EHR) system, you may have an additional right to an accounting of disclosures for Treatment, Payment, and Health Care Operations. Please contact the Practice’s Privacy Officer at [email protected] for more information regarding whether we have implemented an EHR and the effective date, if any, of any additional right to an accounting of disclosures made through an EHR for the purposes of Treatment, Payment, or Health Care Operations. To request a list of accounting, you must submit your request in writing to the Practice’s Privacy Officer at the address at the bottom of this Notice. Your request must state a time period, which may not be longer than six years (or longer than three years for Treatment, Payment, and Health Care Operations disclosures made through an EHR, if applicable) and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a twelve-month period will be free. For additional lists, we may charge you a reasonable fee 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 medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a restriction or limitation on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.
Except as specifically described below in this Notice, we are not required to agree to your request for a restriction or limitation. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment. In addition, there are certain situations where we won’t be able to agree to your request, such as when we are required by law to use or disclose your medical information. To request restrictions, you must make your request in writing to the Practice’s Privacy Officer at the address listed below. In your request, you must specifically tell us what information you want to limit, whether you want us to limit our use, disclosure, or both, and to whom you want the limits to apply. As stated above, in most instances we do not have to agree to your request for restrictions on disclosures that are otherwise allowed. However, if you pay or another person (other than a health plan) pays on your behalf for an item or service in full, out of pocket, and you request that we not disclose the medical information relating solely to that item or service to a health plan for the purposes of payment or health care operations, then we will be obligated to abide by that request for restriction unless the disclosure is otherwise required by law. You should be aware that such restrictions may have unintended consequences, particularly if other providers need to know that information (such as a pharmacy filling a prescription). It will be your obligation to notify any such other providers of this restriction. Additionally, such a restriction may impact your health plan’s decision to pay for related care that you may not want to pay for out of pocket (and which would not be subject to the restriction).
- 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 home, not at work or, conversely, only at work and not at home. To request such confidential communications, you must make your request in writing to the Practice’s Privacy Officer at the address listed below. We will not ask the reason for your request, and we will use our best efforts to accommodate all reasonable requests, but there are some requests with which we will not be able comply. Your request must specify how and 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. To obtain a copy of this Notice, you must make your request in writing to the Practice’s Privacy Officer at the address below.
- Right to Breach Notification. In certain instances, we may be obligated to notify you (and potentially other parties) if we become aware that your medical information has been improperly disclosed or otherwise subject to a “breach” as defined in and/or required by HIPAA and applicable state law.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice at any time, along with our privacy policies and practices. We reserve the right 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 copy of the current notice, along with an announcement that changes have been made, as applicable, in our office. When changes have been made to the Notice, you may obtain a revised copy by sending a letter to the Practice’s Privacy Officer at the address listed below or by asking the office receptionist for a current copy of the Notice.
If you believe that your privacy rights as described in this Notice have been violated, to file a complaint to the Privacy Officer, send a written letter to the address or email address below:
Advanced Urology Institute
Attn: Privacy Officer
26750 US Highway 19 North
Clearwater, FL 33761
The Practice will not retaliate against any individual who files a complaint. You may also file a complaint with the Secretary of the Department of Health and Human Services.
In addition, if you have any questions about this Notice, please contact the Practice’s Privacy Officer at the address email address above.