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.

Original Effective Date: April 14, 2003
Revised 05-08-03

The following categories describe the different ways we may use and disclose PHI for treatment, payment or health care operations without your consent or authorization. The examples included in each category do not list every type of use or disclosure that may fall within that category.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and related services. We may consult with other health care providers regarding your treatment to coordinate and manage your health care with others. For example, we may use and disclose PHI when you need a prescription, lab work, an X-ray or other health care services. In emergencies, we may use and disclose PHI to provide the treatment you need. We may also disclose PHI about you for the treatment activities of another health care provider. For example, we may send a report about you to a physician that we refer you to so that the other physician may treat you.

Payment: We may use and disclose PHI so that we can bill and collect payment for the treatment and services provided to you. Before providing treatment or services, we may share details with your health plan concerning the services you are scheduled to receive. We may use and disclose PHI to find out if your health plan will cover the cost of care and services we provide. We may use and disclose PHI to confirm you are receiving the appropriate amount of care to obtain payment for services. We may use and disclose PHI for billing, claims management, and collection activities. We may disclose PHI to insurance companies providing you with additional coverage. We may disclose limited PHI to consumer reporting agencies relating to collection of payments owed to us.

Health Care Operations: We may use and disclose PHI to support the business activities of our practice. For example – we may use medical information about you to review and evaluate our treatment and services or to evaluate our staff’s performance while caring for you. In addition, we may disclose your health information to a third party business associate who perform billing, consulting, or transcription services for our practice.

Research: This office and its practitioners are involved as a study site and serve as researchers in connection with certain clinical trials. Our participation in the advancement of science and medicine may be of benefit to you as our clinicians often are aware of certain on experimental treatments that may be available here and other select institutions, but which are not widely available elsewhere. However, in order to provide you with useful information concerning the availability to you of these treatments, we may review your medical record from time to time to determine whether you may be eligible to participate in certain studies in which you would then have access to certain experimental treatments. In certain instances, we believe it is consistent with our treatment of you to consider these kinds of options in connection with your care. Only our clinicians, employees or other members of our workforce with review your medical record during these reviews and none of your protected health information will be disclosed to third parties without your specific authorization. If it is preliminarily determined that you may be eligible for such treatment and that such treatment may be beneficial to you, your doctor or a member of our staff will contact you with further information.

Appointment Reminders: We will use and disclose your protected health information to contact you as a reminder about scheduled appointments or treatment.

Treatment Alternatives: We will use and disclose your protected health information to tell you about or to recommend possible alternative treatments or options that may be of interest to you.

Others Involved in Your Care: We will use and disclose your protected health information to a family member, a relative, a close friend, or any other person you identify that is involved in your medical care or payment for care.

As Required By Law: We may use and disclose PHI as required by federal, state or local law to the extent that the use or disclosure complies with the law and is limited to the requirements of the law.

Abuse, neglect, or Domestic Violence: We may disclose PHI in certain cases to proper government authorities if we reasonably believe that a patient has been a victim of domestic violence, abuse or neglect.

Lawsuits and Other Legal Proceedings: We may use or disclose PHI when required by a court or administrative tribunal order. We may also disclose PHI in response to subpoenas, discovery requests or other required legal process when efforts have been made to advise you of the request or to obtain an order protecting the information requested.

Coroner, Medical Examiners, Funeral Directors: We may disclose PHI to a coroner or medical examiner to identify a diseased person and determine the cause of death. In addition, we may disclose PHI to funeral directors, as authorized by law, so that they may carry out their jobs.

To Avert a Serious Threat to Health or Safety: We will use and disclose your PHI to a public health authority that is permitted to collect or receive the information for the purpose of controlling disease, injury or disability.

Disclosures Required by HIPPAA Privacy Rule: We are required to disclose PHI to the Secretary of the United States Department of Health and Human Services when requested by the Secretary to review our compliance with the HIPPAA Privacy Rule.

Although your health record is the physical property of the health care practitioner or facility that compiled it, the information belongs to you. You have the right to:

Request Restrictions: You have the right to request restriction or limitation of how we use or disclose your medical information for treatment, payment or health care operations. For example, you could request that we not disclose information about a prior treatment to a family member or a friend who may be involved in your care or payment for care. Your request must be made in writing to our privacy officer. We are not required to agree to your request. If we do agree to your request, we are required to comply with our agreement except in certain cases, including where the information is needed to treat you in the case of an emergency.

Request Confidential Communications: You have the right to request that you receive communications regarding PHI in a certain manner or at a certain location. For example, you may request that we contact you at home, rather than at work. You must make your request in writing. You must specify how you would like to be contacted (for example, by regular mail to your post office box and not your home.) We are required to accommodate only reasonable requests.

Rights to Inspect and Copy: You have the right to request the opportunity to inspect and receive a copy of PHI about you in certain records that we maintain. This includes your medical and billing records but does not include psychotherapy notes or information gathered or prepared for a civil, criminal or administrative proceeding. We may deny your request to inspect and copy PHI only in limited circumstances. To inspect and copy PHI, please contact our Privacy Officer. The time available to inspect a copy will be on Friday’s between noon and 1:00PM. You must make arrangements ahead of time. If you request a copy of PHI about you, we may charge you a reasonable fee for the copying, postage, labor and supplies used in meeting your request.

Right to Amend: You have the right to request that we amend PHI about you as long as such information is kept by or for our office. To make this type of request, you must submit your request in writing to our Privacy Officer. You must also give us a reason for your request. We may deny your request in certain cases, including if it is not in writing or if you do not give us a reason for the request.

Right to Receive and Accounting of Disclosures: You have the right to request a list of the disclosures of your health information we have made outside of our practice that were not for treatment, payment or healthcare operations. Your request must be made in writing and must state the time period for the requested information. You may not request information for any dates prior to April 14, 2003 (the compliance date for the federal regulation) nor for a period of time greater than six years (our legal obligation to retain information).

Right to a Paper Copy of this Notice: You have a right to receive a paper copy of this Notice at any time.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our privacy officer or directly to the Secretary of the United States Department of Health and Human Services. To file a complaint with our office; please submit in writing within 180 days of the suspected violation at the address listed below. We will not retaliate or take action against you for filing a complaint.

PRIVACY OFFICIAL CONTACT INFORMATION

You may contact our Privacy Official at the following address and phone number:

Privacy Official: Mary Ann Rahe
Address: 4520 Donald Ross Rd., Suite 200 Palm Beach Gardens, FL 33418
Telephone: 561-694-1010 x103

For more information about HIPAA or to file a complaint:
The U.S. Department of Health & Human Services, Office of Civil Rights
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202)619-0257 -or- Toll Free: 1-877-696-6775