Notice of Privacy Practices
Carlos J. Rodríguez-Feo,
PLEASE REVIEW IT CAREFULLY.
OUR OBLIGATIONS:
We have a commitment to protecting the
privacy rights of our patients. In keeping with this
commitment, and as required by law, we will:
·
Obtain your consent to use and disclose records about your
health and healthcare
·
Maintain the privacy of protected health information (PHI);
·
Give you this notice of our legal duties and privacy practices
regarding health information about you; and
·
Follow the terms of our notice of privacy practices that is
currently in effect.
When you receive services at Carlos J.
Rodriguez-Feo,
The following categories describe ways t
hat we may use and disclose health information that identifies you (“Health Information”). Some of the categories include examples, but not every type of use or disclosure of Health Information in a category is listed. Except for the purposes described below, we will use and disclose Health Information only with additional written permission from you. If you give us permission to use or disclose Health Information for a purpose not discussed in this notice, you may revoke that permission at any time by sending a written request to our Privacy Officer at the address listed at the end of this notice. a)
For Treatment. We may
use Health Information to treat you or provide you with health
care services. We may disclose Health Information to
doctors, nurses, technicians, or other personnel, including
people outside our office who may be involved in your medical
care. For example, we may tell your primary physician
about the care we provided you or give Health Information to a
specialist to provide you with additional services.
b)
For Payment. We may use and disclose
Health Information so that we or others may bill or receive
payment from you, an insurance company or a third party for the
treatment and services you receive. For example, we may
give your health plan information about your treatment so that
they will pay for such treatment. We also may tell your
health plan about a treatment you are going to receive to obtain
prior approval or to determine whether your plan will cover the
treatment.
c)
For Health Care Operations.
We may use and disclose Health Information for health care
operations and administrative purposes. These uses and
disclosures are necessary to make sure that all of our patients
receive quality care and for our operation and management
purposes. For example, we may use and disclose Health
Information to review the treatment and services we provide to
ensure that the care you receive is of the highest quality, for
evaluating the way we communicate with our patients, or we may
post thank-you notes or pictures that you send us. We may
also share Health Information with other entities that have a
relationship with you (for example, your health plan) for their
health care operation activities.
d)
Appointment Reminders, Treatment Alternatives,
and Health-Related Benefits and Services. We may use and
disclose Health Information to contact you as a reminder that
you have an appointment with us. We also may use and
disclose Health Information to tell you about treatment options
or alternatives or health-related benefits and services that may
be of interest to you.
e)
Individuals Involved in Your Care or
Payment for Your Care. We may disclose Health
Information to a person, such as a family member or friend, who
is involved in your medical care or payment for your care.
We also may notify your family about your location or general
condition or disclose such information to an entity assisting in
a disaster relief effort.
f) Research. Under certain circumstances, we may use and disclose Health Information for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication or treatment to those who received another, for the same condition. Before we use or disclose Health Information for research, though, the project will go through a special approval process. Even without special approval, we may permit researchers to look at records to help them identify patients who may be included in their research project or for other similar purposes, so long as they do not remove or take a copy of any Health Information.
g)
As Required by Law. We will disclose Health Information when required to do so by international, federal, state or local law.h) To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when necessary to prevent or lessen a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, will be to someone who may be able to help prevent the threat.
i) Business Associates. We may disclose Health Information to our business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
j) Organ and Tissue Donation. If you are 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 or tissue donation and transplantation.
k) HIV Test Results. If you received an HIV test and did not give us permission to use and disclose the results with your medical record, we will use and disclose the results of HIV tests that identify you only: (1) to provide you with health care services, for example, we may tell a specialist about your HIV status so the specialist can treat you; (2) when compiling or reviewing your records as part of routine billing; (3) if necessary to enable us to protect the quality of our services; (4) to child-placing or child-caring agencies, family foster homes, residential facilities or community-based care programs that are directly involved in placement, care, control or custody and who have a need to know such information; (5) to a sex or needle sharing partner in accordance with the law; (6) in accordance with a court order that specifically requires us to release HIV test results; and (7) in connection with organ donation.
l) Military and Veterans. If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.
m) Workers’ Compensation. We may disclose Health Information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
n) Public Health Risks. We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; track certain products and monitor their use and effectiveness; notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and conduct medical surveillance of our office in certain limited circumstances concerning workplace illness or injury. We also may release Health Information to an appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence; however, we will only release this information if you agree or when we are required or authorized by law.
o) Health Oversight Activities. We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
p) Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
q) Law Enforcement. We may release Health Information if asked by a law enforcement official for the following reasons: (1) in response to a court order, subpoena, warrant, summons or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime.
r) Medical Examiners and Funeral Directors. We may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties.
s) National Security and Intelligence Activities. We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
t) Protective Services for the President and Others. We may disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
u) Inmates or Individuals in Custody. In the case of inmates of a correctional institution or that are under the custody of a law enforcement official, we may release Health Information to the appropriate correctional institution or law enforcement official. This release would be made only if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution
You have the following rights regarding Health Information we maintain about you:o:p
a)
Right to Inspect and Copy. You have the right to inspect
and copy Health Information that may be used to make decisions
about your care or payment for your care by submitting a written
request form.
b)
Right to Amend. If you feel that Health Information we
have is incorrect or incomplete, you may ask us to amend the
information by submitting a written request form. You have
the right to request an amendment for as long as the information
is kept by or for our office. You must tell us the reason
for your request.
c)
Right to an Accounting of Non-routine Disclosures. You have the
right to request an accounting of certain disclosures of Health
Information we made by submitting a written request form.
d)
Right to Request Restrictions. You have the right to
request a restriction or limitation on the Health Information we
use or disclose for treatment, payment, or health care
operations by submitting a written request form. Please
note that we will not grant requests for restrictions that
pertain to your treatment. In addition, you have the right
to request a limit on the Health Information we disclose about
you to someone who is involved in your care or the payment for
your care, like a family member or friend. For example,
you could ask that we not share information about your surgery
with your spouse. We are not required to agree to your
request. If we agree, we will comply with your request
unless we need to use the information in certain emergency
treatment situations.
e)
Right to Request Alternate Communications. You have the
right to request that we communicate with you about medical
matters in a certain way or at a certain location by submitting
a written request form. For example, you can ask that we
contact you only by mail or at work. Your request must
specify how or where you wish to be contacted. We will
accommodate reasonable requests.
f)
Right to a Paper Copy of This Notice. You have the right
to a paper copy of this notice. You may ask us to give you
a copy of this notice during our office hours. Even if you
have agreed to receive this notice electronically, you are still
entitled to a paper copy of this notice. You may also
obtain a copy of this notice at our website,
www.JawSurgery.org.
To exercise your rights described in this
notice (other than to obtain a copy of this notice), you must
send a request, in writing, to our Privacy Officer at the
following address:
Privacy Officer, Carlos J. Rodríguez-Feo,
DDS, PA, 6601 Southwest 80th Street, Suite 125, Miami, Florida
33143
If you believe your privacy rights have
been violated, you may file a complaint with us or the Secretary
of the U.S. Department of Health and Human Services. To
file a complaint with our office, contact our Privacy Officer at
the address listed above. All complaints must be made in
writing. You will not be penalized for filing a complaint.
If you have any questions about
this notice, please contact our Privacy Officer at (305)
665-3721