Privacy Practices Agreement
NOTICE OF PRIVACY PRACTICES* Fit MD, LLC
|This notice describes how medical information about you may be used and disclosed and how you can get access to this information.|
Fit MD, LLC is required by law to maintain the privacy of certain confidential health care information, known as Protected Health Information (PHI), and to provide you with a notice of our legal duties and privacy practices with respect to patients’ PHI. This Notice describes legal rights, advises of our privacy practices and outlines how Fit MD, LLC is permitted to use and disclose PHI about our patients.Fit MD, LLC is also required to abide by the terms of the version of this Notice currently in effect. In most situations we may use this information as described in this Notice without your authorization or opportunity to object, but there are some situations where we may use it only after we obtain our patients written authorization, if we are required by law to do so.
We realize that these laws are complicated, but we must provide you with the following important information:
The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times and on our website, and you may request a copy of our most current Notice at any time by contacting the Privacy Officer identified below.
B. WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) IN THE FOLLOWING WAYS
The following categories describe the different ways in which Fit MD, LLC may use and disclose your PHI.
1. Treatment. Our practice may use your PHI to treat you. This includes the provision, coordination, or management of health care and related services by one or more health care providers, including the coordination or management of health care by a health care provider with a third party; consultation between health care providers relating to a patient; or the referral of a patient for health care from one health care provider to another. For example, we may ask you to have laboratory tests (such as blood tests), and we may use the results to help us reach a diagnosis. Any of the people who work for our practice – including, but not limited to, our doctors, mid--level clinicians nurses, medical assistants and trainers, or indirectly with any provider to whom we refer you – may use or disclose your PHI in order to treat you, or to assist others in your treatment. Additionally, we may need to disclose your PHI to others who may assist in your care, such as your spouse, children, or parents.
2. PaymentOur practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment and health status to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members or insurance companies. Also, we may use your PHI to bill you directly for services and items. Fit MD will not use or disclose more information for payment purposes than is necessary. This is known as using the minimum necessary amount to accomplish the purpose of use or disclosure. We are accountable to the Secretary of Health and Human Services to safeguard and protect our patients’ information.
3. Health Care Operations. Our practice may use and disclose your PHI to operate our business. As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you receive from us, or to conduct cost--management and business planning activities for our practice.
4. Appointment Reminders. We may use and disclose medical information to contact and remind you about your appointments. If you are not home, we may leave this information on your answering machine or in a message with the person answering the phone (or to send you a text)
As required by the Privacy Regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
5. Sign In Sheet. We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.
|6. Treatment Options. Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
7. Health--Related Benefits and Services, and Marketing Communications. Our practice may use and disclose your PHI to contact you about health--related benefits or services that may be of interest to you.
8. Release of Information to Family/Friends. Our practice may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you.
9. Disclosures Required by Law. Our practice will use and disclose your PHI when we are required to do so by federal, state, or local law.
C. NOTIFICATION IN THE CASE OF A BREACH
Fit MD, LLC is required by law to notify our patients in case of a breach of their unsecured protected health information when it has been or is reasonably believed to have been accessed, acquired, used, or disclosed in violation of privacy regulations.
D. USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES
Fit MD, LLC is permitted to use PHI without written authorization, or opportunity to object in certain situations, including:
2. To another health care provider or entity for the payment activities of the provider or entity that receives the information (such as your hospital or insurance company).
3. To another health care provider for the health care operations activities of the entity that receives the information as long as the entity receiving the information has or has had a relationship with our patients and the PHI pertains to that relationship.
4. For health care fraud and abuse detection or for activities related to compliance with the law.
5. To a family member, other relative or close personal friend or other individual involved in our patients care if we obtain verbal agreement to do so or if we give our patients an opportunity to object to such a disclosure and you do not raise an objection.
6. To a public health authority in certain situations (such a reporting a birth, death, or disease as required by law, as part of a public health investigation, to report child or adult abuse or neglect or domestic violence, to report adverse events such as product defects or to notify a person about exposure to a possible communicable disease) as required by law.
7. For health oversight activities including audits or government investigations, inspections, disciplinary proceedings and other administrative or judicial actions undertaken by the government (or their contractors) by law to oversee the health care system.
9. For law enforcement activities in limited situations, such as when there is a warrant for the request or when the information is needed to locate a suspect or stop a crime.
10. For military, national defense and security and other special government functions.
11. To avert a serious threat to the health and safety of a person or the public at large.
12. For workers’ compensation purposes and in compliance with workers’ compensation laws.
13.To coroners, medical examiners and funeral directors for identifying a deceased person, determining cause of death, or carrying on their duties as authorized by law.
14. If our patient is an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ donation and transplantation.
|Any other use or disclosure of PHI, other than those listed above, will only be made with written authorization (the authorization must specifically identify the information we seek to use or disclose, as well as when and how we seek to use or disclose it). Authorization may be revoked at any time, in writing, except to the extent that we have already used or disclosed medical information in reliance on that authorization.
E. OUR PATIENTS HAVE A NUMBER OF RIGHTS WITH RESPECT TO PROTECTION OF THEIR PHI.
Fit MD, LLC will permit individuals to exercise patient rights.
If you have questions or if you wish to file a complaint or exercise any rights listed in this notice, please contact our Privacy Officer, Dr. Joseph Ramos at:
Fit MD, LLC