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.
Federal law requires that you be informed how all the information obtained from you, medical or demographic (referred to as “patient information”) , may used and disclosed to carry out treatment, payment or health care operations and for other purposes permitted or required by law. It also describes your rights to access and control to this information.
1. Uses and Disclosures of Your Protected Health Information (Patient Information)
We will use and/or disclose your patient information for the following reasons:
• to provide treatment as needed; such as a calling a pharmacy, a laboratory or a physician involved in your care,
• to obtain benefits, authorizations, and/or payment for services from your insurance and/or to give this information to other doctors involved in your care for medical or payment issues,
• for quality assessment and improvement activities, employee review activities, training programs, accreditation, certification, licensing, credentialing, review and auditing, including compliance reviews, medical reviews, legal services, and maintaining compliance programs, and business management and general administrative activities, and/or
• to inform you of your surgery date, of potential treatment alternatives or options, of health-related benefits or services that may be of interest to you, or to contact you to raise funds for the facility or an institutional foundation related to the facility.
• Beyond that we will require that you give us a written authorization.
Uses and Disclosures Permitted Without Your Authorization or Your Opportunity to Object
We will use and disclose your information as required by any federal, state, local or applicable law
You have the following rights regarding your health information
• You may inspect and obtain a copy of the patient information contained in your medical record, including medical and billing records and any other records that your surgeon and/or the facility uses to make decisions about your care, for as long as we maintain that information. To inspect and receive a copy your medical information, you must submit a written request to the Privacy Officer whose contact information is listed below. If you request a copy of your information, we will charge a fee of $1.00 per copy, for the cost of mailing and for other costs incurred in complying with your request, such as $10.00 per medical photography and diagnostic imaging reproductions.
• You may request an amendment to your patient information in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Requests for amendment must be in writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendments.
• You have the right to request an accounting of certain specific disclosures of your patient information made by us. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Privacy Notice. We are also not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures for a facility directory, to friends or family members involved in your care, or certain other disclosures we are permitted to make without your authorization. The request for an accounting must be made in writing to our Privacy Officer. The request should specify the time period sought for the accounting. We are not required to provide an accounting for disclosures that take place prior to April 14, 2003. Accounting requests may not be made for periods of time in excess of six years. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
• The right to obtain a paper copy of this notice. Upon request, we will provide a separate paper copy of this notice even if you have already received a copy of the notice or have agreed to accept this notice electronically.
The Institute Policy
The following are Institute policy. If for any reason you disagree with these policies you cannot continue being our patient and must seek medical care elsewhere.
• We maintain sign-in sheets in the different treatment areas by categories. Each patient must write their first and last name when arriving. The sheets are in public areas accessible to any staff, patient or other person in the office.
• We call patients in the waiting areas by their first and last name, where others present will hear your identity.
• We will not honor any requests for restrictions on the use and disclosure of the patient information.
• We will not honor any requests to receive confidential communications from us by alternative means or at an alternative location.
• We may disclose your patient information to your family members or a close personal friend if it is directly relevant to the person’s involvement in your care or payment. We can also disclose your information in connection with trying to locate or notify family members or others involved in your care concerning your location, condition or death.
The facility is required by law to maintain the privacy of your health information and to provide you with this Privacy Notice of our duties and privacy practices. We are required to abide by terms of this Notice as may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all future protected health information that we maintain. If the facility changes its Notice, we will provide a copy of the revised Notice by sending a copy of the revised Notice via regular mail or through in-person contact.
You have the right to express complaints to the facility and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. You may complain to the facility by contacting the facility’s Privacy Officer verbally or in writing, using the contact information below. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
The facility’s contact person for all issues regarding patient privacy and your rights under the federal privacy standards is the Privacy Officer. Information regarding matters covered by this Notice can be requested by contacting the Privacy Officer. If you feel that your privacy rights have been violated by this facility you may submit a complaint to our Privacy Officer by sending it to:
ATTN: Privacy Officer
Beraja Medical Institute
2550 Douglas Road
Coral Gables, FL 33134
The Privacy Officer can be contacted by telephone at (305) 443-7070
This Notice is effective April 14, 2003