NOTICE OF PRIVACY PRACTICES

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.

Uses and Disclosures

Treatment: Your health information may be used by staff members or dis­closed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For exam­ple, results of laboratory tests and procedures will be available in your medi­cal record to all health professionals who may provide treatment or who may be consulted by staff members. We may also use your health information to dispense prescribed medicines and/or medical supplies to you at our on-site Pharmacy, and this prescription information will also be available in your medical record.

 

Payment: Your health information may be used to seek payment from your
health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For exam­ple, your health plan may request and receive information on dates of ser­vice, the services provided, and the medical condition being treated.

Health care operations: Your health information may be used as necessary to support the day-to-day activities and management of Central Florida Family Health Center, Inc. For example, information on the services you received may be used to sup­port budgeting and financial reporting, and activities to evaluate and pro­mote quality.

Law enforcement: Your health information may be disclosed to law enforce­ment agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting.

Public health reporting: Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state's public health department.

Other uses and disclosures require your authorization: Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a writ­ten revocation of the authorization.


However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.

Additional Uses of Information


Your health information may be used by our staff to send you appointment reminders.

Individual Rights
You have certain rights under the federal privacy standards. These include:
- the right to request restrictions on the use and disclosure of your protected health information
- the right to receive confidential communications concerning your medical condition and treatment
- the right to inspect and copy your protected health information
- the right to amend or submit corrections to your protected health information
- the right to receive an accounting of how and to whom your protected health information has been disclosed
- the right to receive a printed copy of this notice

Central Florida Family Health Center, Inc. Duties

We are required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in this notice.

Right to Revise Privacy Practices
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. Upon request, we will provide you with the most recently revised notice on any office visit. The revised policies and practices will be applied to all pro­tected health information we maintain.

Requests to Inspect Protected Health Information
You may generally inspect or copy the protected health information that we maintain. As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Receptionist. Your request will be reviewed and will generally be approved unless there are legal or medical reasons to deny the request.

Complaints
If you would like to submit a comment or complaint about our privacy prac­tices, you can do so by sending a letter outlining your concerns to:

Chris Bowen
HIPAA Privacy Officer
Central Florida Family Health Center
2400 SR 415
Sanford, FL 32771
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

If you believe that your privacy rights have been violated, you should call the matter to our attention by sending a letter describing the cause of your con­cern to the same address.

You will not be penalized or otherwise retaliated against for filing a com­plaint.

Contact Person
The name and address of the person you can contact for further information concerning our privacy practices is:

Chris Bowen
HIPAA Privacy Officer
Central Florida Family Health Center
2400 SR 415A
Sanford, FL 32771
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
407-322-8645, ext. 1010

Effective Date
This Notice is effective on or after April 14, 2003.