This notice describes how medical information about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.

Protected health information (PHI), about you, is maintained as a written and/or electronic record of your contacts or visits for healthcare services with our practice. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present or future physical or mental health condition and related healthcare services.

Our practice is required to follow specific rules on maintaining the confidentiality of your PHI, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your PHI. It also describes how we follow applicable rules and use and disclose your PHI to provide your treatment, obtain payment for services you receive, manage our healthcare operations and for other purposes that are permitted or required by law.

Following is a statement of your rights, under the Privacy Rule, in reference to your PHI. Please feel free to discuss any questions with our staff.

• Right to receive a copy of this Notice: You have the right to receive, and we are required to provide you with, a copy of this Notice of Privacy Practices. We reserve the right to change the terms of our notice at any time. Upon your request, we will provide a revised copy either by mail or at your next appointment. It will also be posted in a conspicuous location within the practice and, if maintained, on our website.

• Right to authorize other uses and disclosures: You may authorize any use or disclosure of PHI not specified in this notice, including marketing purposes, psychotherapy notes, or sale of PHI. You may revoke an authorization in writing, except to the extent action has already been taken based on it.

• Right to request alternative communication: You may request to be contacted via alternative methods or at an alternative location (email, phone, alternative address, etc.) by informing us in writing.

• Right to inspect and copy PHI: You may inspect and obtain a copy of your complete health record. Electronic copies are available if maintained electronically. Fees may apply according to professional, state, or federal guidelines.

• Right to request restriction of PHI: You may request in writing that we do not use or disclose certain PHI for treatment, payment, or healthcare operations. We may deny some requests but are required to honor requests for restrictions paid fully out-of-pocket.

• Right to request amendment: You may request an amendment to your PHI while we maintain it, though some requests may be denied.

• Right to request disclosure accounting: You may request a listing of disclosures made of your PHI outside our office.

• Right to receive a privacy breach notice: You will receive written notice if a breach of your unsecured PHI occurs and notification is required by risk assessment.

If you have questions regarding your privacy rights, please contact our Privacy Manager. Contact information is provided below under Privacy Complaints.

Examples of uses and disclosures of PHI include:

• Treatment: Coordination or management of your healthcare and services with third parties involved in your care.
• Special Notices: Appointment reminders, exam results, treatment alternatives, health-related benefits, fund-raising, or group health plan disclosures. You may opt out.
• Payment: Activities to obtain payment from insurance or other sources for your healthcare services.
• Healthcare Operations: Business planning, quality assessment, medical review, legal services, auditing, and patient safety activities.
• Health Information Organization: Facilitating electronic exchange of PHI for treatment, payment, or operations.
• To Others Involved in Your Healthcare: Disclosures to family, friends, or others involved in your care if you do not object.
• Other Permitted Uses: As required by law, public health, abuse/neglect, FDA compliance, research, legal proceedings, law enforcement, coroners, organ donation, military activity, national security, worker’s compensation, or DHHS requests.

You may file a complaint if you believe your privacy rights have been violated. You may contact our Privacy Manager at:

Address: 1770 W 68 ST
City: Hialeah
State: FL
Zip Code: 33014

We will not retaliate against you for filing a complaint.