NEFEDA Privacy Statement

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Northeast Florida Endocrine and Diabetes

PRIVACY NOTICE TO PATIENTS

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED BY NORTHEAST FLORIDA ENDOCRINE
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE READ IT CAREFULLY.

Effective Date: April 14, 2003

Under the HIPAA Privacy regulations, Northeast Florida Endocrine and all similar health care providers are required by federal law to maintain the privacy of your protected health information (PHI) and will abide by the terms in this Privacy Notice.

Please be advised that Northeast Florida Endocrine may use your PHI in rendering treatment to you. For example, we are permitted to use your PHI in providing you with medical care/treatment when you visit our office or when we treat you in a hospital or nursing facility. Under federal law, we may disclose your PHI to you or we can disclose your PHI to third parties for treatment. For example if we refer you to a specialist, we will forward your medical information to such specialist. We can disclose your PHI for payment purposes. For example, we will disclose your PHI to your insurance provider, employer, Medicare, Medicaid or other party responsible for providing you with health insurance coverage in order for Northeast Florida Endocrine to be reimbursed for our services rendered to you. We will also use or disclose your PHI for health care operations. For example, we may use your PHI when we engage in quality assurance and medical chart reviews, which are part of our health care operations. We may also disclose your PHI, when required by the Secretary of The US Department of Health & Human Services .

Unless disclosure is required under federal, state law, or certain other exceptions, including law enforcement, we are prohibited from disclosing your PHI without your authorization. Our practice may use or disclose your PHI in accordance with the specific requirements of the HIPAA rules without Northeast Florida Endocrine needing to obtain your authorization if the information is:

required by law
required for public health purposes
required disclosures about victims of abuse, neglect or domestic violence
required by a health oversight agency for oversight activities authorized by law
required in the course of any judicial or administrative proceeding
required for a law enforcement purpose to a law enforcement official
required by a coroner or medical examiner
required by an organ procurement organization for research, and,
if disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.

Additionally, if you are a member of the armed forces, Northeast Florida Endocrine is permitted to disclose your PHI without your consent if deemed necessary by appropriate military command authorities to assure an appropriate military mission.

We may also contact you via mail or phone to remind you of appointments with our office or to discuss treatment alternatives.[2]

In the event our practice wishes to disclose your PHI to another entity besides those referenced above, we are required to obtain your authorization. We would seek to obtain your authorization in Northeast Florida Endocrine’s desired to release your PHI for reasons other than treatment, payment, or for our practice’s operations. For example, if we desired to participate in outside research or a drug study, we would need your written authorization prior to being permitted to release your PHI to such outside research facility or drug manufacturer. If you provide us with an authorization, you have the ability to revoke such authorization at any time by sending Northeast Florida Endocrine a written revocation. However, if we have already released such information pursuant to your prior authorization, the revocation will be effective for all future disclosures.

Please be further advised that you have the ability to access, copy, and inspect and amend your medical information that we maintain. Additionally, if you desire, Northeast Florida Endocrine can provide you with an accounting of all disclosures for treatment, payment or healthcare operations and pursuant to authorization.

If you have a dispute with our practice regarding our use of your PHI or a disclosure by Northeast Florida Endocrine and believe that your primary rights have been violated, please contact David Wilson, Northeast Florida Endocrine’s Privacy Officer to file a dispute or you may contact the Secretary of Health and Human Services.

Lastly, please be advised that you have the right to request restrictions on certain use and disclosures of your PHI to carry out treatment, payment or healthcare operations or disclosures by Northeast Florida Endocrine of your PHI to a family member, relative, or a close personal friend. However, we are not required by federal law to agree to your requested restriction. If you request a copy of your PHI, you also have the ability to request that we send it to an alternative location (different address) ad by alternative means. Northeast Florida Endocrine reserves the right to amend this Notice as revised. Notices will be provided to you upon your visit.

Thank you.

Source: Arnall, Golden & Gregory, LLP. Atlanta, GA

[1] Note, if a state law limits the ways in which a Covered Entity may disclose PHI in such a way that the state law is more stringent than the disclosure rules of HIPAA, then the notice given to individuals must reflect the more stringent law. 42 CFR Section 164.520 (b)(1)(c). “More stringent is defined in the privacy rules and in general terms means that a state law is more stringent if the disclosure under state law would not be permissible even though disclosure would be permissible under the HIPAA rules, or state law grants greater rights of access or amount of information to PHI by the individual, state law requires the consent to have a narrow scope of duration, state law requires more detailed information regarding disclosures, reporting or requiring a longer duration to be maintained, or state law provides greater privacy protection. 42 CFR Section 160.202 (December 28, 2002.)

[2] If the entity is charitable, it probably should include a provision that allows the entity to contact the individual in order to raise funds for the entity.