4450 E Fletcher Avenue, Suite C, Tampa, Florida 33613
Phone: (813) 975-2800 Fax: (813) 977-7924
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Understanding Your Health Record/Information: Each time you visit a physician or other healthcare provider, a record of your visit is made. Typically this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
Basis for planning your care and treatment
Means of communication among the many health professionals who contribute to your care
Legal document describing the care you received
Means by which you or a third party payer can verify that services billed were actually provided
Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
Understanding what is in your record and how your health information is used helps you to:
Ensure its accuracy
Better understand who, what, when, where and why others may access your health information
Make more informed decisions when authorizing disclosure to others.
YOUR HEALTH INFORMATION RIGHTS: Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:
Request a restriction on certain uses and disclosures of your information
Obtain a paper copy of the notice of information practices upon request
Inspect and copy your health record as provided for in 45 CFR 164.524
Amend your health record as provided in 45 CFR 164.526
Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
OUR RESPONSIBILITIES: This organization is required to:
Maintain the privacy of your health information
Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
Abide by the terms of this notice
Notify you if we are unable to agree to a requested restriction
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you supplied us. We will not use or disclose your health information without your authorization, except as described in this notice.
EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH OPERATIONS: We will use your health information for treatment. For example: Information obtained by a nurse, physician or other member of your healthcare team will be recorded in your record and used to determine your course of treatment. Your physician will document in your record his expectations of the members of your healthcare team. Members of your healthcare team will record the actions they took and their observations. We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him/her in treating you.
We will use your health information for payment. For example: A bill may be sent to you or a third party payer. The information on or accompanying the bill may include information that identifies you as well as your diagnosis, procedures, and supplies used.
Examples of some but not all of the ways your health information may be disclosed:
Business Associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the Emergency Department and Radiology and certain laboratory tests. When these services are contracted, we may disclose your health information so that they can perform the job we have asked them to do and bill you or your third party payer for services rendered. So that your health information is protected, however, we require the business associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition.
Communication with Family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.
Research: We may disclose information to researchers when their research has been approved by an Institutional Review Board that has review the research proposal and established protocols to ensure the privacy of your health information.
Funeral Directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.
Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Patient Contact: We may contact you to provide appointment reminders or information about treatment alternatives or other health related information.
Food and Drug Administration: We may disclose to the FDA health information relative to adverse events with respect to supplements, product and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.
Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
It is illegal and a violation of patient privacy for anyone to take unauthorized pictures of any patient or anyone in our office without that person's express written consent. Use of cell phones to take pictures or live stream while in the office of Tampa Cardiovascular Associates, P.A. is expressly prohibited.
