Internal Medicine Associates of Lee County, M.D., P.A.
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.
Our Commitment to Your Privacy
Our practice is dedicated to maintaining the privacy of your protected health information. Protected health information is information about you that may identify you and relates to your past, present or future physical or mental health or condition. In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the privacy of your protected health information. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your protected health information.
This Notice of Privacy Practices describes how we may use and disclose your protected health information. It also describes your privacy rights in regard to your protected health information. The terms of this notice apply to all records containing your protected health information that are created or retained by our practice. We reserve the right to amend this Notice of Privacy Practices, at any time. Any revision or amendment to this notice will be effective for all of your records that our practice maintains at that time. Our practice will post a copy of our current notice in our offices in a visible location at all times.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information for Treatment, Payment and Healthcare Operations Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of our practice.
Following are examples of the types of uses and disclosures of your protected health information that our practice is permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our practice.
Treatment: Our practice may use your protected health information to treat you. We may disclose your protected health information to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment. For example, we may ask you to have x-rays or laboratory tests done in order to diagnosis or treat you. Also, many of the people who work for our practice, including but not limited to our doctors, nurses, and medical assistants may use or disclose your protected health information to treat you or to assist others in your treatment. For example, we may disclose your protected health information to other physicians who may be treating you or to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, we may use your protected health information in order to write a prescription for you, or we may disclose your protected health information to a pharmacy when we order a prescription for you. In certain situations, we may also disclose your protected health information to another health care provider for their treatment activities.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. We may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for your treatment. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as; making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital admission may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission. We also may use and disclose your protected health information to obtain payment from third parties, such as family members, that may be responsible for your bills. Also, we may use your protected health information to bill you directly for health care services. In certain situations, we may also disclose your protected health information to another health care provider or health plan for their payment activities.
Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of Internal Medicine Associates. These activities include, but are not limited to, quality assessment activities, employee review activities, training of students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to students that see patients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name. We may also call you by name in the waiting room when we are ready to see you. We may use or disclose your protected health information, as necessary, to contact you by mail or phone. For example, we may call you to confirm an appointment or inform you of test results. If we are unable to reach you by phone we may try to reach you by mail. We may contact you to inform you of healthcare treatment options or other health services that may be of interest to you. We may also contact you to obtain your opinion about our practice’s services. In certain situations, we may also disclose your protected health information to another health care provider or health plan for their health care operations.
We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services, copying of medical records) for our practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or
Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Marketing: We will only use your protected health information for marketing if we have your written authorization.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or
Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and State laws.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of Internal Medicine Associates, and (6) medical emergency (not on Internal Medicine Associate’s premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
Criminal Activity: Consistent with applicable federal and State laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Workers’ Compensation: Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally-established programs.
Inmates: We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.
Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the Privacy Rule.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described above. You may revoke an authorization at any time, in writing, except to the extent that action has already been taken in reliance to the use and disclosure indicated in the authorization. All requests must be made by using our “revocation of authorization to release protected health information” form. All requests must be submitted to our Privacy Officer in writing.
2. Your Rights.
The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
You have the right to access your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that your physician and the practice use for making decisions about you. Please note: There may be a fee for copying your records. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewed. All requests must be made by using our “request to access protected health information” form. All requests must be submitted in writing to the office where you are seen.
You have the right to request a restriction of the use and disclosure of your protected health information. You have the right to request a restriction in our use or disclosure of your protected health information for treatment, payment, or healthcare operations. Additionally, you have the right to request that we restrict our disclosure of your protected health information to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your protected health information you must use our “request for restrictions of the use and disclosure of protected health information” form. All requests must be submitted to our Privacy Officer in writing.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location. For instance you may ask that we contact you at home, rather than work. Our practice will accommodate reasonable requests. You do not need to give a reason for your request. To request confidential communications you must use our “request for confidential communications of protected health information” form. All requests must be submitted to our Privacy Officer in writing.
You may have the right to have your physician amend/correct your protected health information. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. You must provide us with a reason that supports your request for amendment. In certain circumstances we may deny the amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting) in writing. Also, we may deny your request if you ask us to amend information that in our opinion: (a) is accurate and complete; (b) is not part of the protected health information kept by or for our practice; (c) is not part of the protected health information which you would be permitted to inspect or copy; or (d) is not created by our practice, unless the individual or entity that created the information is not available to amend the information. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. All requests must be made using our “request for correction/amendment of protected health information” form. All requests must be submitted to our Privacy Officer in writing.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. You have the right to request an ‘accounting of disclosures’. An ‘accounting of disclosures’ is a list of certain disclosures our practice has made of your protected health information for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes, or in response to an authorization for the use or disclosure of protected health information signed by you. All requests must state a time period, which may not be longer than 6 years from the date of disclosure and may not include dates before
You have the right to obtain a paper copy of this notice from us. You are entitled to receive a paper copy of our Notice of Privacy Practices. You may ask us to give you a copy at any time. To obtain a paper copy of this notice please contact our Privacy Officer or pick one up at any of our offices.
If you believe your privacy rights have been violated you may file a complaint with our Privacy Officer or with the Secretary of the Department of Health and Human Services. You may complain to our Privacy Officer verbally or in writing, using the contact information below. There will be no retaliation for filing a complaint with either our Privacy Officer or the Secretary of the Department of Health and Human Services.
4. Contact Person
Our practice’s contact person for all issues regarding patient privacy and your rights under the Federal privacy standards is our Privacy Officer. Information regarding matters covered by this notice can be requested by contacting our Privacy Officer. If you have any questions regarding this notice or to request any of the following forms: “request to access protected health information”, “request for restrictions of the use and disclosure of protected health information”, “request for confidential communications”, “request for correction/amendment of protected health information”, “revocation of an authorization to release protected health information” or “request for an accounting of disclosures of protected health information” please contact our Privacy Officer. You may contact our Privacy Officer by calling 239-418-2507 or by writing to our Privacy Officer in C/O Internal Medicine Associates at
This notice was published and becomes effective on