NOTICE OF HEALTH

 

THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. 

 

Introduction

 

We at Southeastern Neuroscience Institute (SNI) are committed to treating and protecting health information about you responsibly.  This Notice of Health Information Practices describes the personal information we collect and how and when we use or disclose that information.  It also describes your rights as they relate to your personal health information. This notice is effective April 14, 2003 and applies to all protected health information as defined by applicable regulations.  Please note there may conflicts in applicable regulations and laws which may supersede, limit or prohibit these uses and disclosures.   SNI does not use or disclose protected health information in ways that would violate the Privacy Rule or state law.  In using or disclosing protected health information, we meet the Privacy Rule “minimum necessary requirement” as appropriate. 

 

Understanding Your Health Record/Information

 

Each time you visit Southeastern Neuroscience Institute, a record of your visit is made.  Typically, this record contains your history, symptoms, needs, complaints, medications, physical and/or mental status examination and test results, diagnosis, treatment and progress towards goals, legal matters, a plan for future treatment, billing and insurance data and other information.  SNI records also usually include information which has been obtained from referring sources and other past/current treatment professionals.  This information, often refer to as a health, psychological or medical record, serves as a:

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where and why others may access your health information, and make more informed decisions when authorizing disclosure to others. 

 

Privacy and the Laws

 

We also are required to tell you about privacy because of the privacy regulations of a Federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA).  This law requires us to keep your Personal Health Information (PHI) private and to give you this notice of our legal duties and our privacy practices which is called the Notice of Privacy Practices (or NPP).  We will obey the rules of this notice as long as it is in effect, but if we change it, the rule of the new NPP will apply to all PHI we keep.  If we change the NPP, we will post the new Notice in our office where it can be seen by everyone.  You or anyone else also can get a copy from our dedicated Privacy Officer at any time. 

 

Information used in this office to make decisions about your care is called “use”.  This includes sharing, employing, applying, examining and analyzing information that identifies you.  Information  shared with or sent to others outside this office is referred to as “disclosure”. This includes releasing, transferring or providing access to information about you to other parties. Except in special circumstances or as noted below, we use and disclose only the minimum necessary PHI needed for others to do their jobs.  The law gives you rights to know more about your PHI, how it is used and to have a say in how it is disclosed. 

 

We use and disclose PHI for several reasons.  After you read this Notice, you will be asked to sign a separate Consent form to allow us to use and share your PHI.  In most cases, this information will be used here or shared with other people  or organizations to provide treatment to you, arrange for payment or some other business functions called health care operations.  Together, these routine purposes are referred to as “TPO”and the Consent form allows us to use and disclose your PHI for TPO.  Next we will tell you more about TPO. 

 

Use and Disclose Information with your Consent

 

We will use your information for evaluation and treatment.  For example, information obtained by a nurse, physician, physician assistant, chiropractor, psychologist or other member of your health care team will be recorded in your record and used to make diagnostic and treatment decisions about you.  We may also provide a subsequent health care provider with copies of various reports or records that would assist that individual in treating you. 

 

We will use your health information for payment.  For example, bills may be sent to you or a third party payer such as your health insurance carrier.  The information on or accompanying the bill may include information that identifies you, your diagnosis, procedures, results of evaluation and treatment, progress to date, changes we may expect in your condition, and the like.  We may contact your insurance or other third party payer to check on exactly what your insurance covers, and to secure any certifications, authorizations or necessary referrals. 

 

We will use your health information for regular health operations.  For example, we may use your information to see where we can make quality improvement or may be required to supply some information to some government health agencies so they can study disorders and treatments and plan for needed services.  

 

Other Uses and Disclosure with your Consent

 

Appointment Reminders

 

We may use and disclose information to schedule, reschedule or remind you of appointment for diagnostic testing, treatment or other care.  If you want us to call or write you only at your work or only at your home or prefer some other way to reach you, we usually can arrange that.  Please let us know. 

 

Treatment Alternatives

 

We may use and disclose your PHI to tell you about or recommend possible treatments or alternatives that may be of help to you.

 

Other Benefits and Services

 

We may use and disclose your PHI to tell you about health related benefits or services that may be of interests to you. 

 

Research

 

We may use or share your information to do research to improve treatments and/or the education of health care personnel.  In all cases, name, address and other personal information will be removed.  If there is a need to identify you by name, a special Authorization would need to be signed by you before any information is shared. 

 

Business Associates

 

There are some services provided in our organization through contacts with business associates. Examples may include physician services in Hospitals and/or Emergency Departments, certain laboratory tests, answering services, billing agencies, transcription services, collection agencies, and the like.  When these services are contracted, we may disclose your health information to these associates so they can perform the jobs we have asked them to do.  To protect your health information, however, we require the associates to appropriately safeguard your information. 

 

Funeral Directors

 

We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

 

Organ Procurement Organizations

 

Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation or organs for the purpose of tissue donation and transplant. 

Food and Drug Administration (FDA)

 

We may disclose to the FDA health information relative to adverse events with respect to food, supplements, products and product defects, or post marketing surveillance information to enable recalls, repair or replacement. 

 

Uses and Disclosures which require neither Consent nor Authorization

 

To Avert a Serious Threat of Harm. 

 

Protected information will be used to alert those able to lessen or prevent the threat of a serious threat to the health or safety of a patient, another person or the public.  Circumstances include child/elder neglect, abandonment, or abuse, domestic violence or other imminent threats to self or other directed harm. 

 

Public Health

 

As required by law, we may disclose your health information to public health or proper legal authorities charged with preventing or controlling disease, injury or disability.  Florida law requires the reporting of suspected cases, carriers or death of specific diseases pf public health significance, immunizations, moderate to severe brain injuries or spinal cord injury, certain health information related to diagnosis and incidence of cancer, known cases of tuberculosis and sexually transmitted diseases. 

 

Workers Compensation

 

We will disclose health information to the extent authorized by and to the extent necessary to comply with all state and federal laws relating to workers compensation or similar programs established by law.  If you are seen for a worker’s compensation claim, federal law provides for the release of information relating to your claim.  Florida law provides that health care providers may be required to disclose protected information to the Division of Workers’ Compensation, or to an employer, carrier or authorized rehabilitation provider, when appropriate. 

 

Law Enforcement

 

We may disclose health information for law enforcement purposes and special governmental functions only as required by Federal, State or Local law.  

 

Government

 

Federal law makes provision for your health care information to be released to an appropriate health oversight agency, public health authority or attorney to verify that we are following applicable rules, including HIPAA or for a specialized government function such as national security.   We also may disclose your PHI information of military personnel and veterans to government benefit programs relating to eligibility and enrollment.  Protected information may also be disclosed in a medical negligence or administrative proceeding where a health care provider is the defendant. 

 

Uses and Disclosures Requiring Additional Consent  

 

If we want to use your information for any other purpose besides the TPO or those we described above, we must get your authorization on a separate form.  If you do authorize us to use or disclose your information, you can revoke that permission, in writing, at any time, following which we will not use or distribute your information for the purpose we agreed to.  Of course, we cannot take back any information we already disclosed with your permission or that we had used in our office.    

 

Family or Close Others

 

We can share some information with your family or close others.  We will only share information with those involved with your care and anyone else you choose such as close    friends. We will ask you about who you wish us to tell what information about your condition or treatment.  We will try to honor your wishes as long as they are legal and consistent with our best professional judgment. 

 

Emergencies

 

If it is an emergency-so we cannot ask if you disagree- we can share information if we believe it is what you would have wanted and we believe it will help you if we do share it.  If we do share information in an emergency, we will tell you as soon as possible.  If you don’t approve, we will stop as long as it is not against the law or best professional judgment. 

 

Judicial and Administrative

 

If you are involved in a court proceeding and is request for information about you is received (duly authorized subpoenas for records), you will be notified.  We will not release medical information without written authorization from you or your Attorney.  

 

PSYCHOLOGICAL Records

 

Use and Disclosure with Consent 

 

A Psychologist may use PHI for TPO with your consent.  This is an important statement.  Please make sure you understand it.  The terms “PHI”, “Use” and “disclosure” are as defined above.  To review, Treatment is when a psychologist provides, coordinates or manages health care and other services related to your visit.  Examples would include or consultation with another provider such as your family physician or another psychologist. 

 

Payment is when the psychologist obtains reimbursement for services provided.  Examples of payment are when the psychologist discloses PHI to your health insurance carrier to obtain reimbursement or to determine eligibility or coverage. 

Health Care Operations are activities that relate to the performance and operation of psychological practice.  Examples include quality assessment and improvement actions, business related matter such as audits and administrative services, case management or case coordination services. 

 

PHI also may be used, as defined, limited or restricted above, for Appointment Reminders, to discuss Treatment Alternatives, to do Research and in completing services through our Business Associates such as answering and transcription services or collection agencies.

 

Use and Disclosure of PSYCHOLOGICAL Records with Neither Consent nor Authorization

 

Your information may be used or disclosed without your consent or authorization in the following circumstances. 

 

Child abuse

 

If the psychologist knows or has reasonable cause to suspect that a child under the age of 18 is abused, abandoned, or neglected by a parent, legal custodian, care giver or other person responsible for the child’s welfare, the law requires a psychologist to file a report with the Department of Children and Family Services.  

 

Adult and Domestic Abuse

 

If the psychologist knows or has reasonable cause to suspect that a vulnerable adult has been or is being abused, neglected or exploited, the psychologist is required to immediately file a report of such knowledge or suspicion to the Central Abuse Hotline.

 

Serious Threat to Health and Safety

 

 When you present a clear and immediate probability of physical harm to yourself, to other individuals or to society, the psychologist may disclose relevant information concerning this to the potential victim, appropriate family member, or the law enforcement or other appropriate authorities. 

 

Health Oversight

 

If a complaint is filed with the Florida Department of Health on behalf of the Board of Psychology, the Department has the authority to subpoena confidential information from the psychologist relevant to that complaint.

 

Worker’s Compensation

 

If you file a worker’s compensation claim, the psychologist must, upon the request of your employer, the insurance carrier, an authorized qualified rehabilitation provider or the attorney for the employer or insurance carrier, furnish your relevant records to those persons.

 

Judicial or Administrative Proceedings

 

If you are involved in a court proceeding and a request is made for information about your diagnosis or treatment or records thereof, such information is privileged under State law.  The psychologist will not release information without the written authorization of you or your representative, or a subpoena of which you have been properly notified and have failed to inform the psychologist that you are opposing the subpoena or Court Order.  The privilege does not apply when you are being evaluated for a third party such as an “Independent Psychological or Neuropsychological Evaluations” or where the evaluation is Court Ordered.  You will be notified in advance if these apply. 

 

Law Enforcement

 

We may disclose health information for law enforcement purposes and special government functions as required by Federal, State or Local law. 

 

Communication with Family

 

If a family member or close friend calls for scheduling, payment or changing appointments and in our best judgment we do not believe you would object, we may communicate minimal information to facilitate scheduling, payments or appointments. With your signed consent, family members, other relatives, close personal friends or some other person you identify as participating in your care, can be given minimal necessary health information relevant to that person’s involvement in your care or payment for such care or in an emergency. 

 

Correctional Institution

 

If you are an inmate of a correctional institution, we may disclose to the institution or agents there your PHI necessary for your health and safety of other individuals. 

Use and Disclosure of PSYCHOLOGICAL Records requiring Additional Consent or Authorization.

 

We may use or disclose your PHI for purposes outside of TPO and the Above when your authorization is obtained.  An “authorization” is written permission above and beyond the general consent that permits only specific disclosures.  In those situations, you will be asked to sign an Authorization form before that information is disclosed. 

 

We would also need to obtain an authorization before releasing your “psychotherapy notes”.  “Psychotherapy notes” have a very limited definition under HIPAA, and would be notes made about analyses of conversations during a private, group, joint or family counseling session, which would be kept separate from the rest of your psychological record.  It is this office’s policy to not keep “psychotherapy notes” under the HIPAA definition.  Your diagnosis and relevant treatment information, symptoms/complaints and information about progress are maintained in “Progress Notes” which document your care. 

 

ALL PERSONS SEEN AT SOUTHEASTERN NEUROSCIENCE INSTITUTE HAVE HEALTH INFORMATION RIGHTS

 

Your Health Information Rights 

 

Although your actual health record is the physical property of SNI, the information contained therein belongs to you. 

 

You have the right to:

 

• Obtain a copy of this notice of information practices, upon request.

• Inspect and copy your health record, upon written request.  We will charge and collect a fee for the cost of copying, mailing, and associated costs.  In certain cases, we may deny requests.  We will provide you with our reasoning and inform you of additional rights.

• Amend your health record, upon written request and only if we created and maintained the information.  In certain cases, we may deny requests.  We will provide you with our reasoning  and inform you of additional rights. 

• Obtain an accounting of disclosures of your health information upon written request.  The request must state time period, which cannot be before April 14, 2003 and cannot be more than six years prior to the date of request.  We will charge and collect a fee for providing the list.  The accounting will exclude disclosures permitted under the Privacy Rule including those made for treatment, payment and care operations; made to you and authorized by you. 

• Request communication of your health care information by alternative means or at an alternative location, in writing.  We will honor reasonable requests.  No explanation is  necessary. 

• Request a restriction on certain uses and disclosures of your information, in writing.  We are not required to agree to your request.  If we agree, we do not need to honor the restriction in an emergency treatment situations, or in situations described in this notice as uses and disclosures not requiring authorization.  We may terminate the restriction without your approval.  If the restrictions are terminated without your approval, you will be notified and the restriction will be respected for the information gathered while the restriction was effective. 

• Revoke your authorization to use or disclose health information except to the extent action already has been taken.

You have specific rights under the Privacy Rule.  SNI will not retaliate against you for exercising your right to file a complaint. 

 

Our Responsibilities

 

• Maintain the privacy of your health care information.

• Provide you with this notice as to our legal duties and privacy practices with respect to the information we collect and maintain about you. 

• Follow internal policies designed to carry out the terms of this notice. 

We reserve the right to change our practices and make the new provisions effective for all protected health care information we maintain.  Should our information practices change, we will post a revised notice in our office, making the notice available upon request. 

 

For More Information or to Report a Problem:

 

If you have questions and would like additional information, you may contact the practice Privacy Officer, Ms. Bethany Martinez at 904-346-0707 ext 127.  

 

If you believe your privacy rights have been violated, you can file a complaint with the practices Privacy Officer, or with the Office of Civil Rights (OCR), U.S. Department of Health and Human Services. 

 

There will be no retaliation for filing a complaint with either the Privacy Officer or the Office of Civil Rights (OCR). 

 

The address for the OCR is listed below: