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Privacy Policy for South
Florida Foot and Ankle Center
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. THE PRIVACY
OF YOUR MEDICAL INFORMATION IS IMPORTANT
TO US.
Our Legal Duty
We are required by applicable federal
and state laws to maintain the privacy
of your protected health information. We
are also required to give you this
notice about our privacy practices, our
legal duties, and your rights concerning
your protected health information. We
must follow the privacy practices that
are described in this notice while it is
in effect. This notice takes effect
2011, and will remain in effect until we
replace it.
We reserve the right to change our
privacy practices and the terms of this
notice at any time, provided that such
changes are permitted by applicable law.
We reserve the right to make the changes
in our privacy practices and the new
terms of our notice effective for all
protected health in formation that we
maintain, including medical information
we created or received before we made
the changes.
You may request a copy of our notice (or
any subsequent revised notice) at any
time. For more information about our
privacy practices, or for additional
copies of this notice, please contact us
using the information listed at the end
of this notice.
Uses and Disclosures of Protected
Health Information
We will use and disclose your protected
health information about you for
treatment, payment, and health care
operations. Following are examples of
the types of uses and disclosures of
your protected health care information
that may occur. These examples are not
meant to be exhaustive, but to describe
the types of uses and disclosures that
maybe made by our office.
Treatment: We will use and
disclose your protected health
information to provide, coordinate or
manage your healthcare and any related
services. This includes the coordination
or management of your health care with a
third party. For example, we would
disclose your protected health
information, as necessary, to a home
health agency that provides care to you.
We will also disclose protected health
information to other physicians who may
be treating you. For example, your
protected health information may be
provided to a physician to whom you have
been referred to ensure that the
physician has the necessary information
to diagnose or treat you.
In addition, we may disclose your
protected health information from time
to time to another physician or health
care provider (e.g., a specialist or
laboratory) who, at the request of your
physician, becomes involved in your care
by providing assistance with your health
care diagnosis or treatment to your
physician.
Payment: Your protected health
information will be used, as needed, to
obtain payment for your health care
services. This may include certain
activities that your health insurance
plan may undertake before it approves or
pays for the health care services we
recommend for you, such as: making a
determination of eligibility or coverage
for insurance benefits, reviewing
services provided to you for protected
health necessity, and undertaking
utilization review activities. For
example, obtaining approval for a
hospital stay may require that your
relevant protected health information be
disclosed to the health plan to obtain
approval for the hospital admission.
Health Care Operations: We may
use or disclose, as needed, your
protected health information in order to
conduct certain business and operational
activities. These activities include,
but are not limited to, quality
assessment activities, employee review
activities, training of students,
licensing, and conducting or arranging
for other business activities.
For example, we may use a sign-in sheet
at the registration desk where you will
be asked to sign your name. We may also
call you by name in the waiting room
when your doctor is ready to see you. We
may use or disclose your protected
health information, as necessary, to
contact you by telephone or mail to
remind you of your appointment.
We will share your protected health
information with third party "business
associates" that perform various
activities (e.g., billing, transcription
services) for the practice. Whenever an
arrangement between our office and a
business associate involves the use or
disclosure of your protected health
information, we will have a written
contract that contains terms that will
protect the privacy of your protected
health information.
We may use or disclose your protected
health information, as necessary, to
provide you with information about
treatment alternatives or other
health-related benefits and services
that may be of interest to you. We may
also use and disclose your protected
health information for other marketing
activities. For example, your name and
address may be used to send you a
newsletter about our practice and the
services we offer. We may also send you
information about products or services
that we believe may be beneficial to
you. You may contact us to request that
these materials not be sent to you.
Uses and Disclosures Based On Your
Written Authorization: Other uses
and disclosures of your protected health
information will be made only with your
authorization, unless otherwise
permitted or required by law as
described below.
You may give us written authorization to
use your protected health information or
to disclose it to anyone for any
purpose. If you give us an
authorization, you may revoke it in
writing at any time. Your revocation
will not affect any use or disclosures
permitted by your authorization while it
was in effect. Without your written
authorization, we will not disclose your
health care information except as
described in this notice.
Others Involved in Your Health Care:
Unless you object, we may disclose to a
member of your family, a relative, a
close friend or any other person you
identify, your protected health
information that directly relates to
that person's involvement in your health
care. If you are unable to agree or
object to such a disclosure, we may
disclose such information as necessary
if we determine that it is in your best
interest based on our professional
judgment. We may use or disclose
protected health information to notify
or assist in notifying a family member,
personal representative or any other
person that is responsible for your care
of your location, general condition or
death.
Marketing: We may use your
protected health information to contact
you with information about treatment
alternatives that may be of interest to
you. We may disclose your protected
health information to a business
associate to assist us in these
activities. Unless the information is
provided to you by a general newsletter
or in person or is for products or
services of nominal value, you may opt
out of receiving further such
information by telling us using the
contact information listed at the end of
this notice.
Research; Death; Organ Donation:
We may use or disclose your protected
health information for research purposes
in limited circumstances. We may
disclose the protected health
information of a deceased person to a
coroner, protected health examiner,
funeral director or organ procurement
organization for certain purposes.
Public Health and Safety: We may
disclose your protected health
information to the extent necessary to
avert a serious and imminent threat to
your health or safety, or the health or
safety of others. We may disclose your
protected health information to a
government agency authorized to oversee
the health care system or government
programs or its contractors, and to
public health authorities for public
health purposes.
Health Oversight: We may disclose
protected health information to a health
oversight agency for activities
authorized by law, such as audits,
investigations and inspections.
Oversight agencies seeking this
information include government agencies
that oversee the health care system,
government benefit programs, other
government regulatory programs and civil
rights laws.
Abuse or Neglect: We may disclose
your protected health information to a
public health authority that is
authorized by law to receive reports of
child abuse or neglect. In addition, we
may disclose your protected health
information if we believe that you have
been a victim of abuse, neglect or
domestic violence to the governmental
entity or agency authorized to receive
such information. In this case, the
disclosure will be made consistent with
the requirements of applicable federal
and state laws.
Food and Drug Administration: We
may disclose your protected health
information to a person or company
required by the Food and Drug
Administration to report adverse events,
product defects or problems, biologic
product deviations; to track products;
to enable product recalls; to make
repairs or replacements; or to conduct
post marketing surveillance, as
required.
Criminal Activity: Consistent
with applicable federal and state laws,
we may disclose your protected health
information, if we believe that the use
or disclosure is necessary to prevent or
lessen a serious and imminent threat to
the health or safety of a person or the
public. We may also disclose protected
health information if it is necessary
for law enforcement authorities to
identify or apprehend an individual.
Required by Law: We may use or
disclose your protected health
information when we are required to do
so by law. For example, we must disclose
your protected health information to the
U.S. Department of Health and Human
Services upon request for purposes of
determining whether we are in compliance
with federal privacy laws. We may
disclose your protected health
information when authorized by workers'
compensation or similar laws.
Process and Proceedings: We may
disclose your protected health
information in response to a court or
administrative order, subpoena,
discovery request or other lawful
process, under certain circumstances.
Under limited circumstances, such as a
court order, warrant or grand jury
subpoena, we may disclose your protected
health information to law enforcement
officials.
Law Enforcement: We may disclose
limited information to a law enforcement
official concerning the protected health
information of a suspect, fugitive,
material witness, crime victim or
missing person. We may disclose the
protected health information of an
inmate or other person in lawful custody
to a law enforcement official or
correctional institution under certain
circumstances. We may disclose protected
health information where necessary to
assist law enforcement officials to
capture an individual who has admitted
to participation in a crime or has
escaped from lawful custody.
Patient Rights
Access: You have the right to
look at or get copies of your protected
health information, with limited
exceptions. You must make a request in
writing to the contact person listed
herein to obtain access to your
protected health information. You may
also request access by sending us a
letter to the address at the end of this
notice. If you request copies, we will
charge you $25.00 for each page or$10.00
per hour to locate and copy your
protected health information, and
postage if you want the copies mailed to
you. If you prefer, we will prepare a
summary or an explanation of your
protected health information for a fee.
Contact us using the information listed
at the end of this notice for a full
explanation of our fee structure.
Accounting of Disclosures: You
have the right to receive a list of
instances in which we or our business
associates disclosed your protected
health information for purposes other
than treatment, payment, health care
operations and certain other activities
after April 14, 2003. After April 14,
2009, the accounting will be provided
for the past six (6) years. We will
provide you with the date on which we
made the disclosure, the name of the
person or entity to whom we disclosed
your protected health information, a
description of the protected health
information we disclosed, the reason for
the disclosure, and certain other
information. If you request this list
more than once in a12-month period, we
may charge you a reasonable, cost-based
fee for responding to these additional
requests. Contact us using the
information listed at the end of this
notice for a full explanation of our fee
structure.
Restriction Requests: You have
the right to request that we place
additional restrictions on our use or
disclosure of your protected health
information. We are not required to
agree to these additional restrictions,
but if we do, we will abide by our
agreement (except in an emergency). Any
agreement we may make to a request for
additional restrictions must be in
writing signed by a person authorized to
make such an agreement on our behalf. We
will not be bound unless our agreement
is so memorialized in writing.
Confidential Communication: You
have the right to request that we
communicate with you in confidence about
your protected health information by
alternative means or to an alternative
location. You must make your request in
writing. We must accommodate your
request if it is reasonable, specifies
the alternative means or location, and
continues to permit us to bill and
collect payment from you.
Amendment: You have the right to
request that we amend your protected
health information. Your request must be
in writing, and it must explain why the
information should be amended. We may
deny your request if we did not create
the information you want amended or for
certain other reasons. If we deny your
request, we will provide you a written
explanation. You may respond with a
statement of disagreement to be appended
to the information you wanted amended.
If we accept your request to amend the
information, we will make reasonable
efforts to inform others, including
people or entities you name, of the
amendment and to include the changes in
any future disclosures of that
information.
Electronic Notice: If you receive
this notice on our website or by
electronic mail (e-mail), you are
entitled to receive this notice in
written form. Please contact us using
the information listed at the end of
this notice to obtain this notice in
written form.
Questions and Complaints
If you want more information about our
privacy practices or have questions or
concerns, please contact us using the
information below. If you believe that
we may have violated your privacy
rights, or you disagree with a decision
we made about access to your protected
health information or in response to a
request you made, you may complain to us
using the contact information below. You
also may submit a written complaint to
the U.S. Department of Health and Human
Services. We will provide you with the
address to file your complaint with the
U.S. Department of Health and Human
Services upon request.
We support your right to protect the
privacy of your protected health
information. We will not retaliate in
anyway if you choose to file a complaint
with us or with the U.S. Department of
Health and Human Services.
Name of Contact Person:
Amber Galletta
11412 Okeechobee Blvd.
Royal Palm Beach, FL 33411
Phone: (561) 793-6170
Fax: (561) 795-3683
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