HIPAA Disclosure

updated 9/1/2016

We are required by federal law to give you a Notice of Privacy Practices (HIPPA Disclosure) that explains how medical information that we maintain about you may be utilized or disclosed. The Notice communicates how, when, and why we may use and disclose medical information about you. The Notice also provides an explanation of your rights and our obligations under federal and state privacy laws.

Your Rights
Although the records that we maintain about you belong to First Coast Heart & Vascular Center under the federal privacy law you have a range of rights with regards to the information maintained in those records. You have the right to:

• Obtain an electronic or paper copy of your medical record.
• You may ask to see or obtain an electronic or paper copy of your medical record.
• We will provide a copy or a summary of your health information, within 30 days of the date of your request. The State of Florida allows us to charge a reasonable fee.

You may request that we make corrections to your medical record.

• You can request to correct health information that you feel is incomplete or incorrect.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

• You may ask us to contact you in a particular way (for instance, office or home phone) or to send mail to another address.
• We will say “yes” to all reasonable requests.

Request us to restrict what we use or share

• You may ask us not to share or use specific health information for treatment, payment, or our business operations. We are not required to consent to your request, and we may say “no” if it would affect your care.
• If you pay out-of-pocket in full for a medical service or health care, you may ask us not to communicate that information for the purpose of payment with your health insurer. We will say “yes” except if a law requires that we share that information with your health insurance provider.

Obtain a list of entities that we have shared information

• You may ask for a list of entities that we have shared your health information with, and why.
• We will include all the disclosures excluding those not required by law.

Obtain a copy of this privacy notice

• You may request a paper copy of this notice at any time.

Select someone else to act for you

• If you have granted someone else medical power of attorney or if someone else is your legal guardian, that person may employ your rights and make decisions about your health information. We will ensure that this person has the proper authority and can act on your behalf before we take any action.

File a complaint if you feel your rights have been violated
You can file a complaint with the FCHVC Privacy Officer if you feel we have violated your rights.

First Coast Heart & Vascular Center
3901 University Blvd. S,
Suite 227
Jacksonville, FL 32216
Telephone (904) 423-0010
Attention: FCHVC Privacy Officer
U.S. Department of Health
Please contact FCHVC for the address and phone
We will not retaliate against you for filing a complaint.

Your Choices
For specific health information, you may notify us about your preferences about what we share. If you are not able to express your preference to us, for instance, if you are in a coma, we may share your information if we consider it is in your best interest or to reduce a dangerous and impending risk to health or safety.

In the following cases we never share your information without your written permission:

• Marketing purposes
• Sale of your information

Our Uses and Disclosures: How do we normally use or disclose your information?

• We normally use or share your information in the following ways:

We treat you

• We may use your information and share it with other professionals who are treating you.
• For electronic health information networks to enable the delivery of care.
• For instance: A doctor treating you for an injury questions another doctor about your general health.

Run our Practice

• We may use and disclose your health information to run our practice, improve your care, and contact you when necessary.
• For example: We may utilize your health information about you to manage your treatment and services.

Bill for your Services

• We may use and share your health information to charge and collect payment from health plans or other entities.
• For example: We share information about you to your health insurance plan so it will pay for services provided to you.

Other purposes we may share your health information
We are permitted or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We are required to satisfy many conditions in the law before we are able to disclose your information for these purposes.

Assist with public health and safety issues

• We can disclose health information about you for specific situations such as:
  Reporting adverse reactions to medications to the FDA.
  Preventing the spread of disease.
  Helping with product recalls.
  Reporting suspected abuse, domestic violence or neglect.
  Preventing or lessening a serious threat to someone’s health or safety.

Perform research

• We may use or disclose your information for health research.

Comply with the law

• We can share health information about you if a state or federal law requires us to do so. This includes the Department of Health and Human Services if they wish to verify that we are complying with federal privacy laws.

Respond to organ and tissue donation requests

• We can share health information about you with organ procurement organizations.

Work with medical examiner, coroner, or funeral director

• We can share health information with a coroner, medical examiner, or funeral director when a patient dies.

We can use or share health information about you concerning:

• Workers’ compensation claims.
• Law enforcement officials for law enforcement purposes.
• Health oversight agencies for activities authorized by law.
• Special government functions such as military, national security, or presidential protective services.

Reply to lawsuits and legal actions

• We can share health information about you in response to a subpoena or court or administrative order.

Third Party Business Associates

• We may share health information with third parties who provide services on our behalf so that they can perform the work we have requested them to do. The law requires that the business associate properly safeguard your information.

Open Treatment Areas

• Even though special care is employed to maintain patient privacy, others in the vicinity may overhear some patient information while receiving treatment.

Communication with Family and/or Friends

• When a family member(s) or a friend(s) come with you into an exam room, it is regarded as implied consent that a disclosure of your PHI is acceptable. We can, using our best judgment, disclose to a family member, close personal friend or any other person, health information relevant to that person’s involvement in your care or payment.

Communication

• We may communicate with you, using any provided number or information, to speak in person, leave a message on voice mail, by encrypted e-mail, or text appointment reminders, insurance items, care correspondence, patient satisfaction surveys and patient statements about your health care.
• We may record your phone calls so that we may monitor the quality of the service we provide you over the phone.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information
• Provide you with notice of our legal duties and privacy practices with respect to your protected health information.
• We will notify you know promptly if a breach arises that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of the notice.

Changes to the Terms of this Notice

• We may alter the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.