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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.
Your privacy and trust is of the utmost importance to Allergy and Immunology Care Center of South Florida. The providers of Allergy and Immunology Care Center of South Florida make every reasonable effort to ensure that any information you provide and that is maintained by us is private, confidential, and secure. Allergy and Immunology Care Center of South Florida clearly and fully discloses our security and privacy practices.
This is to notify you of all uses and disclosures that Allergy and Immunology Care Center of South Florida may make of your/your dependent’s protected health information (PHI). Please review it carefully. If you have any questions or concerns about this notice, please call our HIPAA Privacy Officer, Dr. Vivian Hernandez-Trujillo, at (786) 646-9280.
OUR RESPONSIBILITIES TO OUR PATIENTS
We are required by law to:
1. Maintain the privacy of our patient’s health information and to provide a Privacy Notice to our patients.
2. Comply with the terms of the current Privacy Notice. We reserve the right to change or add to our privacy practices at any time. Should any changes occur, the revisions will apply to all patient information we maintain, regardless of when the information was created or received. We will make the revised Privacy Notice available to you by posting it in our waiting room and on our website.
YOUR RIGHTS REGARDING YOUR/YOUR DEPENDENT’S HEALTH INFORMATION
1. You have a right to access your/your dependent’s medical record. You may inspect and, upon written request obtain a copy of the medical record, with limited exceptions. Request for Release of Medical Records Forms are available at the front desk. In certain circumstances, guardianship papers may need to be submitted with your written request. Payment is due in full before medical records will be released. We will charge $25 for each page and $10.00 per hour to locate and copy your protected health information, along with postage if you want the copies mailed to you. If you prefer, we will prepare a summary or an explanation of your protected health information for a fee. Contact us using the information listed at the end of this notice for a full explanation of our fee structure. The physicians of Allergy and Immunology Care Center of South Florida will continue to provide medical records to your treating physician(s) at no charge.
2. You have a right to alternative communication. You have the right to request that we communicate with you concerning the patient’s health matters in a confidential manner or in a private location. For example, you may request to be moved into a closed room to discuss your PHI. Our staff will accommodate any reasonable request.
3. You have a right to amend your/your dependent’s medical record. Any amendment you request must be made in writing and must state the reason you are requesting it. We may deny your request if the information: [a] was not created by you, unless you provide reasonable information that the person who created the information is no longer available to respond to your request; [b] is information to which you do not have a right of access; or [c] is already accurate and complete, as determined by us. If Allergy and Immunology Care Center of South Florida denies your requested amendment, we will notify you in writing, including the reason for our denial. You have a right to send a letter disagreeing with the denial. If you choose to send one, it will be attached to the medical record.
4. You have a right to request restrictions on uses and disclosures of your/your dependent’s PHI. You may request that we restrict the way we use or disclose the health information for treatment, payment, or healthcare operations. Allergy and Immunology Care Center of South Florida is not required to agree to the restriction, if provider feels it is in the best interest of the patient to permit use and disclosure of PHI. If we do agree to a restriction, we will honor that restriction, except in the event of an emergency. In an emergency, we will only disclose the minimum necessary for treatment.
5. You have a right to an accounting of disclosure. This is a listing of disclosures made by Allergy and Immunology Care Center of South Florida, but does not include disclosures for treatment, payment, and healthcare operations. You must submit your request in writing specifying the time period you are requesting, up to six years. The listing will include: [a] the disclosure date; [b] the name of the recipient, including the address, if known; [c] a brief description of the information sent; and [d] a brief statement of the purpose of the disclosure. You may be charged for the costs for completing the accounting, and a fee structure is available upon request.
6. You have a right to complain. Should you feel that your/your dependent’s privacy rights have been violated, or have any complaint regarding our Privacy Practices, please file a written complaint to Allergy and Immunology Care Center of South Florida HIPAA Privacy Officer, Dr. Vivian Hernandez-Trujillo at (786) 646-9280. Allergy and Immunology Care Center of South Florida will not retaliate against you in any way for filing a complaint. If you are not satisfied with the way we handle the complaint, you may contact the Secretary of US Department of Health and Human Services at 877-696-6775 or www.hhs.gov/ocr
7. You have a right to a paper copy of this notice. You may request a copy at any time. It is also available at our website, www.sflallergy.com. Allergy and Immunology Care Center of South Florida
HOW WE USE AND DISCLOSE YOUR/YOUR DEPENDENT’S HEALTH INFORMATION
The following categories describe some of the different ways we may use and disclose your/your dependent’s health information.
1. For treatment. We may use and disclose health information to provide you with treatment and services and to coordinate your continuing care. The information may be used by doctors, fellows, residents, students, nurses, medical assistants, labs, specialists, or other personnel involved in your care. For example, we may ask you to have laboratory tests and we may use the results to help us reach a diagnosis. A pharmacist will need certain information to fill a prescription ordered by your doctor. We may also disclose your health information to persons or facilities that will be involved in your care after you leave our office.
2. For payment. We may use and disclose health information so that we can bill and receive payment for the treatment and services you receive. For example, we may contact you health insurer to certify your eligibility for benefits or to request prior authorization for a proposed treatment or service. We may provide your insurer with details regarding your treatment to determine if your insurer will cover your treatment.
3. For health care operations. We may use and disclose health information as necessary for our internal operations, such as for general administration activities and to monitor the quality of care you receive with us. For example, we may use information to evaluate and improve the quality of care you received, for education and training purposes (including student, resident and fellow education), or to conduct cost-management and business planning activities for our practice. We may also call your name to enter the exam room, or contact you by telephone or mail. We may disclose health information to Business Associates who assist in administrative and other functions of the business, for example billing. These Business Associates also have responsibilities to protect your health information.
4. Appointment reminders. We may use health information to contact you and remind you of an appointment.
5. To avert a serious threat to health or safety. We may use and disclose health information when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another individual. Information will only be disclosed to someone able to lessen or prevent the threatened harm.
6. National security. We may use and disclose health information as needed to provide protection to the President of the United States, certain other persons or foreign heads of states, or to conduct certain special investigations as authorized by law.
7. Workers’ compensation. We may use and disclose health information to comply with laws relating to workers’ compensation or similar programs.
8. Reporting victims of abuse, neglect, or domestic violence. If we believe that a patient has been a victim of abuse, neglect, or domestic violence, we may use and disclose health information to notify a government authority. We are required to report suspected child or vulnerable adult abuse to the Florida Department of Child and Family Central Abuse Hotline.
9. Health oversight activities. We may disclose health information to a health oversight agency, a state or federal agency that oversees the healthcare system, for activities authorized by law. Some of the activities may include audits, investigations, and inspections.
10. Treatment options. We may use and disclose health information to inform you about treatment alternatives and health-related benefits and services that may be of interest to you.
11.. Research We may use and disclose your medical information for statistical or research purposes, including research planning and creation of research protocols. In limited situations, we may share your information with researchers if an IRB (Institutional Review Board) issues a waiver after having ensured that your medical information is safeguarded and in place to protect your privacy.
12. Process and Judicial and Administrative Proceedings: We may disclose your protected health information in response to a court or administrative order, subpoena, discovery request or other lawful process,under certain circumstances.
13. Law Enforcement: We may disclose limited information to a law enforcement official concerning the protected health information of a suspect, fugitive, material witness, crime victim or missing person. We may disclose the protected health information of an inmate or other person in lawful custody to a law enforcement official or correctional institution under certain circumstances. We may disclose protected health information where necessary to assist law enforcement officials to capture an individual who has admitted to participation in a crime or has ecaped from lawful custody. Under limited circumstances, such as a court order, warrant or grand jury subpoena, we may disclose your protected health information to law enforcement officials.
14. As required by law. We may use and disclose health information when required by law to do so. For example, we must disclose your protected health information to the U.S. Department of Health and Human Services upon request for purposes of determining whether we are in compliance with federal privacy laws. We may disclose your protected health information when authorized by workers' compensation or similar laws.
15. Minors For divorced or separated parents: Each parent has equal access to health information about their unemancipated child(ren), unless there is a court order to the contrary that is known to us or unless it is a type of treatment or service where parental rights are restricted.
16. Others Involved in your Health Care: We can release your medical information to a friend or family member that is involved in your medical care. For example, a babysitter or relative who is asked by a parent or guardian to take their child to the pediatrician’s office may have access to this child’s medical information. We prefer to have written authorization from the parent or guardian for someone else to accompany the child, and may make reasonable attempts to obtain this authorization.
Breach notification: In the case of a breach of protected health information, we will notify you, as required by law.
Allergy and Immunology Care Center of South Florida and its other members for the purpose of engaging in certain medical management, utilization review, quality assessment and improvement, and data aggregation activities. We may use and disclose your PHI without your consent in connection with the operations of Allergy and Immunology Care Center of South Florida. No member of the Allergy and Immunology Care Center of South Florida shall be liable or otherwise responsible in any manner for the acts or omissions of any other member of the Allergy and Immunology Care Center of South Florida by reason of its participation in such arrangement.
Your written authorization is required for other uses or disclosures of your/your dependent’s health information. Allergy and Immunology Care Center of South Florida will obtain your written authorization prior to making any disclosures. The authorization will expire after six years. You may revoke your written authorization, in writing, and we will no longer disclose the health information except where we have already taken actions in reliance on your authorization. Psychiatric, HIV/Aids-related information, and substance abuse treatment information requires a specific written authorization. A general authorization for release of medical information will not be sufficient for purposes relating to this information.
Name of Contact Person: Dr. Vivian Hernandez-Trujillo Telephone: (786) 646-9280 Address: 16371 NW 67th Avenue. Miami Lakes, FL 33014