The notice of Privacy practices is required by a law called the Health Insurance Portability and Accountability Act of 1996 (HIPAA). ClearMedica Medical Centers has been committed to patient privacy and confidentiality, but compliance with HIPAA will make our privacy programs and information technology even better. This Notice describes how “protected health information” about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.
“Protected health information” is your health information or other individually identifiable information, such as demographic data, that may identify you. Protected health information relates to your past, present or future physical or mental health or condition related to healthcare services. This Notice of Privacy Practices describes how ClearMedica Medical Centers may use and disclose your protected health information to carry out treatment, for payment, for healthcare operations and for other purposes permitted or required by law. This Notice also describes certain rights that you may have to access your protected health information. ClearMedica Medical Centers is required to abide by the terms of this Notice of Privacy Practices. The terms of this Notice may change at any time. The new Notice will apply to all protected health information acquired after it goes into effect. Upon your request, we will provide you with any historical Notice of Privacy Practices or you may obtain the most current copy by visiting the ClearMedica Medical Centers website.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION THAT DO NOT REQUIRE YOUR AUTHORIZATION
Your protected health information may be used and disclosed by ClearMedica Medical Centers, our staff and others outside of our offices who are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and to support the operations of ClearMedica Medical Centers. The following list, by way of example rather than limitation, explains certain uses and disclosures of your protected health information that ClearMedica Medical Centers is permitted to make.
TREATMENT
ClearMedica Medical Centers will use and disclose your protected health information to provide, coordinate or manage your healthcare and any related services. This includes the coordination or management of your healthcare with another provider. For example, ClearMedica Medical Centers may disclose your protected health information, as minimally necessary, to a home health agency that provides care to you. ClearMedica Medical Centers will also disclose health information to physicians or other healthcare providers who may be treating you. For example, your protected health information may be provided 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 disclose your protected health information from time-to-time to another physician or healthcare provider (e.g., specialist or laboratory) who, at the request of your physician becomes involved in your care by providing assistance with your healthcare diagnosis or treatment. As another example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. ClearMedica Medical Centers participates in certain Health Information Exchanges or Organizations (HIEs or HIOs), which help to make your protected health information available to other healthcare providers who may need access to it in order to provide care or treatment to you.
PAYMENT
ClearMedica Medical Centers may use and disclose your protected health information as necessary to obtain payment for healthcare services. This may include providing it to your health insurance plan before it approves or pays for recommended healthcare services so that it may make a determination of eligibility or coverage for insurance benefits. It may also include supplying the information to review services provided to you for medical necessity and to undertake utilization-review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health insurance plan to obtain prior plan approval.
HEALTHCARE OPERATIONS
ClearMedica Medical Centers may use or disclose your protected health information in order to support our business activities. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, fundraising activities, and conducting or arranging for other business activities. ClearMedica Medical Centers may share your protected health information with “business associates,” or third-party organizations which perform services such as billing or transcription services on behalf of ClearMedica Medical Centers. ClearMedica Medical Centers has written contracts with our business associates to protect the privacy of your protected health information, and business associates are also required by law to comply with the same privacy and security requirements that apply to ClearMedica Medical Centers. ClearMedica Medical Centers may use and disclose your protected health information to tell you about appointments and other matters related to your care. We may contact you by mail, telephone or e-mail. We may leave voice messages at the telephone number you provide to us, and we may respond to your e-mails. ClearMedica Medical Centers may use and disclose medical information to tell you about possible treatment options, new services or alternatives that may be relevant to your healthcare.
INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE
Unless you indicate otherwise, ClearMedica Medical Centers may disclose to a relative, a close friend or any other person you identify, the portion of your protected health information which directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary for your healthcare, if, based on our professional judgment, we determine that it is in your best interest. We may disclose protected health information to notify or assist in notifying a family member, personal representative or any other person who 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.
TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY
ClearMedica Medical Centers may use and disclose protected health information about you when necessary to prevent a serious threat to your health and safety, or the health and safety of another person or the public. However, any disclosure would only be to someone who is able to help prevent the threat.
ORGAN AND TISSUE DONATION
If you are an organ donor, ClearMedica Medical Centers may release protected health information to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ- donation bank as necessary to facilitate organ or tissue donation and transplantation.
WORKERS’ COMPENSATION
ClearMedica Medical Centers may release protected health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
PUBLIC HEALTH RISKS AND PATIENT SAFETY ISSUES
ClearMedica Medical Centers may disclose protected health information about you for public health activities and purposes to a public health authority that is permitted by law to receive the information. For example, disclosures may be made for the purposes of preventing or controlling disease, injury or disability; to report births and deaths; to report reactions to medications or problems with products; and to notify people of recalls of products that they may be using.
COMMUNICABLE DISEASES
ClearMedica Medical Centers may disclose or use your protected health information to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and to comply with state mandatory-disease reporting, such as cancer registries.
ABUSE OR NEGLECT
ClearMedica Medical Centers may disclose your protected health information to a public health authority authorized by law to receive reports of child or elder abuse or neglect, and to notify the appropriate government authority if IU Health believes a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure when required or authorized by law.
HEALTH OVERSIGHT ACTIVITIES
ClearMedica Medical Centers may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the healthcare system, government benefit programs and compliance with civil-rights laws.
FOOD AND DRUG ADMINISTRATION (FDA)
ClearMedica Medical Centers may disclose your protected health information to a person or company required by the Food and Drug Administration for the purpose of quality, safety or effectiveness of FDA-regulated products or activities, which include: to report adverse events, product defects or problems, biologic product deviations; to track products; to enable product recalls; to make repairs or replacements; or to conduct post-marketing surveillance, as required.
LEGAL PROCEEDINGS
ClearMedica Medical Centers 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) or in certain conditions in response to a subpoena, discovery request or other lawful process.
LAW ENFORCEMENT
ClearMedica Medical Centers may disclose protected health information for certain law-enforcement purposes, such as: in response to a court order, subpoena, warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness or missing person; about the victim of a crime, if under certain limited circumstances, we are unable to obtain the person’s agreement; about a death we believe may be the result of criminal conduct; about criminal conduct at the hospital; and, in emergency circumstances, to report a crime, the location of the crime or victim, or the identity, description or location of the person who committed the crime.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS
ClearMedica Medical Centers may release protected health information to a coroner or medical examiner, for example, to identify a deceased person or determine the cause of death. We may also release protected health information about patients of the hospital to funeral directors as necessary to carry out their duties.
MILITARY ACTIVITY AND NATIONAL SECURITY
ClearMedica Medical Centers may use or disclose the protected health information of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military-command authorities, for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits or to foreign military authority if you are a member of that foreign military service. 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.
INMATES
If you are an inmate of a correctional institution or under the custody of a law enforcement official, ClearMedica Medical Centers may release protected health information about you to the correctional institution or law enforcement official. This release would be necessary for the institution to provide you with healthcare, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION THAT DO REQUIRE YOUR AUTHORIZATION
As described above, ClearMedica Medical Centers will use your protected health information and disclose it outside of ClearMedica Medical Centers for treatment, payment, healthcare operations and when permitted or required by law. ClearMedica Medical Centers will not disclose your protected health information for other purposes without your prior written authorization. These types of uses and disclosures will be made only with your written authorization. In addition, certain disclosures of your psychotherapy notes, mental health records, and drug and alcohol abuse treatment records may require your prior written authorization.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the right to inspect and obtain an electronic or paper copy of your protected health information that may be used to make decisions about your care. This includes medical and billing records but does not include psychotherapy notes. To inspect and obtain a copy of your protected health information, you must submit your request in writing to the ClearMedica Medical Centers. If you request a copy of the information, ClearMedica Medical Centers may charge a fee for the cost of copying, mailing or other supplies associated with your request.
RIGHT TO INSPECT AND COPY
ClearMedica Medical Centers may deny your request to inspect and copy in some limited circumstances. If you are denied access to protected health information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by ClearMedica Medical Centers will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
RIGHT TO AMEND
You have a right to request an amendment of the health information that in our records. Your request for an amendment must be made in writing, including a reason for the request and submitted to the ClearMedica Medical Centers. ClearMedica Medical Centers may deny a request for an amendment if it is not in writing and does not include a reason to support the request or requests for amendment of information that: was not created by ClearMedica Medical Centers; is not part of the protected health information kept by ClearMedica Medical Centers; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete.
RIGHT TO AN ACCOUNTING OF DISCLOSURES
You have the right to request an accounting of disclosures. This is a list of disclosures ClearMedica Medical Centers has made of your protected health information, excluding disclosures for treatment, payment, healthcare operations or disclosures you authorized in writing. To request an accounting of disclosures, submit your request in writing and include the specific time to ClearMedica Medical Centers Billing department. The first accounting of disclosure in a 12-month period is free. Additional accounting of disclosures may cost a fee; you will be notified in advance of any cost involved so that you may choose to withdraw or modify your request before incurring a cost.
RIGHT TO REQUEST RESTRICTIONS
You have the right to request a restriction on the ways your protected health information is used or disclosed. To request a restriction, submit your request in writing to the ClearMedica Medical Centers. The request should include what information you want to limit, whether you want to limit use or disclosure, or both, and to whom you want the limits to apply – for example, disclosures to your spouse. ClearMedica Medical Centers is not required to agree to your request. If we do agree, we will comply with your restriction unless the information is needed to provide emergency medical treatment. ClearMedica Medical Centers will agree to restrict disclosures of your health information to your health insurance plan for payment and healthcare operations purposes (not for treatment) if the disclosure pertains solely to a healthcare item or service for which you paid in full.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATION
You have the right to request that ClearMedica Medical Centers communicate with you about healthcare matters in a certain way or at a certain location. For example, you can request that you are only contacted at work or at a specific address. Such requests should be made in writing to ClearMedica Medical Centers and should specify how or where you wish to be contacted. ClearMedica Medical Centers will accommodate all reasonable requests.
RIGHT TO A PAPER COPY OF THIS NOTICE
You have the right to a paper copy of this Notice of Privacy Practices, even if you have agreed to receive this Notice electronically. You may also find a copy of this Notice on the ClearMedica Medical Centers website.
OTHER USES OF PROTECTED HEALTH INFORMATION
Other uses and disclosures of your protected health information not covered by this Notice or allowed by law will be made only with your written permission. If you provide permission to use or disclose protected health information, you may revoke that permission, in writing, at any time. If you revoke your permission, ClearMedica Medical Centers will no longer use or disclose protected health information about you for the reasons covered by your written authorization. ClearMedica Medical Centers a is unable to take back any disclosures it may have already made with your permission.
CHANGES TO THIS PRIVACY NOTICE
ClearMedica Medical Centers reserves the right to change this Notice and to make the revised or changed Notice effective for protected health information we already have about you, as well as any information we receive in the future. The revised Notice of Privacy Practices will be posted on our website at ClearMedicaMedicalCenters.com; you may also request that a revised copy be sent to you in the mail or obtain one at the time of an appointment at ClearMedica Medical Centers.
QUESTIONS OR COMPLAINTS
If you believe ClearMedica Medical Centers has violated your privacy rights, you may file a complaint with ClearMedica Medical Centers or with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. To file a complaint with ClearMedica Medical Centers, please submit a complaint in writing to ClearMedica Medical Centers. If you have further questions about this Notice of Privacy Practices, please contact ClearMedica Medical Centers’ Center Manager Christina Gilileo at 813-588-5123.
If you believe your privacy rights have been violated, you may file a written complaint at ClearMedica Medical Centers, 675 South Kings Avenue, Brandon, Florida, 33511. If we cannot resolve your concerns, you also have the right to file a written complaint with the Secretary of the Department of Health and Human Services, Office for Civil Rights US DHHS, 200 Independence Avenue SW, Washington, DO 20201.
