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.
ClareMedica Health Partners, LLC creates records about you and the treatment and services we provide to you. The information we collect is called Protected Health Information (“PHI”). We take our obligation to keep your PHI secure and confidential very seriously. We are required by federal and state law to protect the privacy of your PHI, to provide you with this Notice about how we safeguard and use it, and to notify you promptly following a breach of your unsecured PHI. When we use or disclose your PHI, we are bound by the terms of this Notice. This Notice applies to all electronic or paper records we create, obtain, and/or maintain that contain your PHI.
This notice takes effect immediately and will remain in effect until we replace it. We must follow the privacy practices described in this notice while it is in effect. We may change the terms of this Notice at any time, and we may, at our discretion, make the new terms effective for all PHI in our possession, including any PHI we created or received before we issued the new Notice. If we change this Notice, we will update the Notice on our website, and copies will be available, upon request, at our Centers. In addition, you can request a copy of the Notice by calling our ClareMedica Corporate office at 786-485-1005 or by writing to ClareMedica at 14750 N.W. 77th Court, Suite 100, Miami Lakes, Florida 33016. We will post any new Notice in a prominent location at each facility.
HOW WE USE AND DISCLOSE YOUR PHI
We may use and disclose your PHI without your written authorization for the following purposes (Treatment,
Payment, Operations (TPO) Exception):
To share with nurses, doctors, pharmacists, and other health care professionals so they can determine your plan of care.
To help you obtain services and treatment you may need for example, ordering lab tests and using the results.
To coordinate your health care and related services for example, to remind you of an appointment or to encourage you to receive preventive screenings or immunizations.
• To obtain payment from a third party that may be responsible for payment for example, health plan or pharmaceutical assistance programs.
For Operations and Research. We may disclose your PHI for operations and research purposes, but only as allowed by law.
• Where required by law. We may disclose your PHI:
• To state or federal agencies to ensure we are following the law.
• In response to a court order or a subpoena, provided that certain requirements are met.
• To law enforcement agencies or officials, when required by a court order.
• For judicial and administrative proceedings when asked to do so by a court order, subpoena or other request.
• For certain government functions such as disclosures to the US military, national security, and presidential protective services.
• When necessary to comply with Workers’ Compensation laws related to a work-related illness or injury.
• Organ Donation. We may share information when responding to organ and tissue donation requests.
• Medical Examiner or Funeral Director. We may share information with a coroner, medical examiner, or funeral director when an individual becomes deceased.
USES AND DISCLOSURES OF PHI THAT REQUIRE YOUR AUTHORIZATION
We will obtain your written permission or authorization before we use or disclose your PHI for any other purpose not stated in this Notice. For example, your permission is required to:
• Use and disclose PHI for marketing communications when we receive direct or indirect payment for making the communications from a third party whose product or service is being marketed;
• Disclose PHI for purposes that constitute a sale of PHI; or
• Use and disclose genetic information of you or your dependents for underwriting purposes.
For certain kinds of PHI, federal and state law may require enhanced privacy protection and we can only disclose such information with your written permission except when specifically permitted or required by law. This includes PHI that is:
• Maintained in psychotherapy notes and mental health notes.
• About alcohol and drug abuse prevention, treatment and referral.
• About HIV/ AIDS testing, diagnosis or treatment.
• About venereal and/or communicable disease(s).
• About genetic testing.
You may revoke this permission in writing at any time. We will then stop using your PHI for that purpose, but we cannot undo any actions taken prior to your revoking your permission.
YOUR INDIVIDUAL RIGHTS
To exercise the rights below, you may be asked to complete and submit the applicable form, which is available by calling the ClareMedica Corporate Office at 786-485-1005 and speaking to our compliance department or writing to our Compliance Department at 14750 N.W. 77th Court, Suite 100, Miami Lakes, Florida 33016.
You have the right to:
• Request restrictions in how your PHI may be used or shared for TPO. We are not legally required to agree to your request but if we do, that agreement will be binding and we will honor your request, to the extent permitted by law, not to disclose information to us or an insurer about a medical visit, service or prescription for which you pay the full amount out of your pocket at the time of service.
• Inspect and obtain a copy of your PHI that is included in certain paper or electronic records we maintain. Copies will be provided in a form and format that is readily producible, which means we are reasonably able to produce the records in a readable form.
• Request confidential communications whereby communications with PHI will be sent to an alternate location or by alternative means. We will accommodate reasonable requests whenever feasible.
• Request an amendment of your PHI created and maintained by us if you believe it is incorrect. If we do not agree to your request, we will keep your request and our reason for the denial in your record and will inform you of the reason for the decision within 60 days.
• Request an accounting of the disclosures we have made of your PHI for the past six years from the date of your request.
• Request a paper copy of this Notice by contacting us at the address below.
• Receive notice of a breach in the event of a breach of your information.
If you have questions about your privacy rights, believe that we may have violated your privacy rights, or disagree with a decision that we made about your PHI, you may contact us at the following address or telephone number:
HIPAA PRIVACY OFFICER
14750 NW 77th Court
Miami, Florida 33016
Monday-Friday, 8 a.m. to 5 pm., workdays
You may also contact the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. Your complaint can be sent by email, fax, or mail to the Office of Civil Rights. U.S. Dept. of Health, OCR, 200 Independence Avenue SW, Washington, D.C., 20201. For more information, see their website at: http://www.hhs.gov/ocr/privacy/hipaa/complaints/.
No action will be taken against you for filing a complaint.