Your Information. Your Rights. Our Responsibilities.
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information. We may charge a reasonable, cost-based fee.
ASK US TO CORRECT YOUR MEDICAL RECORD
- You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
- We may say “no” to your request, but we’ll tell you why in writing within 60 days
REQUEST CONFIDENTIAL COMMUNICATIONS
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
ASK US TO LIMIT WHAT WE USE OR SHARE
- You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you pay for a service or health care item out-of- pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
GET A LIST OF THOSE WITH WHOM WE'VE SHARED
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a easonable, cost-based fee if you ask for another one within 12 months.
GET A COPY OF THIS PRIVACY NOTICE
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
CHOOSE SOMEONE TO ACT FOR YOU
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
FILE A COMPLAINT IF YOU FEEL YOUR RIGHTS ARE VIOLATED
- You can complain if you feel we have violated your rights by contacting us at 561-627-9000.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, $.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.qov/ocr/privacy/hipaa/complaints
- We will not retaliate against you for filing a complaint.
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situation
- Include your information in a hospital directory
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
HOW DO WE TYPICALLY USE OR SHARE YOUR HEALTH INFORMATION?
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
RUN OUR ORGANIZATION
Example: We use health information about you to manage your treatment and services.
BILL FOR YOUR SERVICES
HOW ELSE CAN WE USE OR SHARE YOUR HEALTH INFORMATION?
HELP WITH PUBLIC HEALTH AND SAFETY ISSUES
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
COMPLY WITH THE LAW
RESPOND TO ORGAN AND TISSUE DONATION REQUESTS
WORK WITH A MEDICAL EXAMINER OR FUNERAL DIRECTOR
ADDRESS WORKERS’ COMPENSATION, LAW ENFORCEMENT, AND OTHER GOVERNMENT REQUESTS
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
RESPOND TO LAWSUITS AND LEGAL ACTIONS
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.