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Privacy Statement
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. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO
US.
OUR LEGAL DUTY
We are required by applicable federal and state law to
maintain the privacy of your health information. We are
also required to give you this Notice about our privacy
practices, our legal duties, and your rights concerning
your health information. We must follow the privacy
practices that are described in this Notice while it is in
effect. This notice takes effect April 14, 2003 and will
remain in effect until we replace it.
We reserve the right to change our privacy practices and
the terms of this Notice at any time, provided such
changes are permitted by applicable law. We reserve the
right to make the changes in our privacy practices and the
new terms of our Notice effective for all health
information that we maintain, including health information
we created or received before we made the changes. Before
we make a significant change in our privacy practices, we
will change this Notice and make the new notice available
upon request.
You may request a copy of our Notice at any time. For more
information about our privacy practices, or for additional
copies of this Notice, please contact us by using the
information listed at the end of this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION
We use and disclose health information about you for
treatment, payment and health care operations. For
example:
Treatment: We may use or disclose your health
information to a physician or other health care provider
providing treatment to you.
Payment: We may use and disclose your health
information to obtain payment for services we provide to
you.
Health Care Operations: We may use and disclose
your health information in connection with our health care
operations. Health care operations include quality
assessment and improvement activities, reviewing the
competence or qualifications of health care professionals,
evaluating practitioner and provider performance,
conducting training programs, accreditation,
certification, licensing or credentialing activities.
Your Authorization: In addition to our use of your
health information for treatment, payment or health care
operations, you may give us written authorization to use
your health information or to disclose it to anyone for
any purpose. If you give us an authorization, you may
revoke it in writing at any time. Your revocation will not
affect any use or disclosure permitted by your
authorization while it was in effect. Unless you give us a
written authorization, we cannot use or disclose your
health information for any reason except those described
in this notice.
Notice of Privacy Practices
Clinical Research Programs: We will contact patients to inform them of clinical drug studies we have available for specific medical conditions.
To Your Family and Friends:
We must disclose your health information to you, as
described in the Patient Rights section of this Notice. We
may disclose your health information to a family member,
friend or other person to the extent necessary to help
with your health care or with payment of your health care,
but only if you agree that we may do so.
Persons Involved in Care: We may use or disclose
health information to notify, or assist in the
notification of (including identifying or locating) a
family member, your personal representative or another
person responsible for your care, of your location, your
general condition or death. If you are present, then prior
to use or disclosure of your health information, we will
provide you with an opportunity to object to such uses or
disclosures. In the event of your incapacity or emergency
circumstances, we will disclose health information based
on a determination using our professional judgment
disclosing only health information that is directly
relevant to the person's involvement in your health care.
We will also use our professional judgment and our
experience with common practice to make reasonable
inferences of your best interest in allowing a person to
pick up filled prescriptions, medical supplies, x-rays, or
other forms of health information.
Marketing Health-Related Services: We will not use
your health information for marketing communications with
outside vendors without your written authorization.
Required by Law: We may use or disclose your health
information when we are required to do so by law.
Abuse or Neglect: We may disclose your health
information to appropriate authorities if we reasonably
believe that you are a possible victim of abuse, neglect
or domestic violence or the possible victim of other
crimes. We may disclose your health information to the
extent necessary to avert a serious threat to your health
or safety or the health or safety of others.
National Security: We may disclose to military
authorities the health information of Armed Forces
personnel under certain circumstances. We may disclose to
authorized federal officials health information required
for lawful intelligence, counterintelligence and other
national security activities. We may disclose to a
correctional institution or law enforcement official
having lawful custody of protected health information of
an inmate or patient under certain circumstances.
Appointment Reminders: We may use or disclose your
health information to provide you with reminders (such as
voicemail messages, postcards or letters).
PATIENT RIGHTS
Access: You have the right to look at or get
copies of your health information, with limited
exceptions. You may request that we provide copies in a
format other than photocopies. We will use the format
you request unless we cannot practicably do so. You must
make a request in writing to obtain access to your
health information. You may obtain a form to request
access by using the contact information listed at the
end of this Notice. We will charge you a reasonable
cost-based fee for expenses such as copies and staff
time. You may also request access by sending us a letter
to the address at the end of this Notice. If you request
copies, we will charge you $(TBD) for each page, $(TBD)
per hour for staff time to locate and copy your health
information, and postage if you want the copies mailed
to you. If you prefer, we will prepare a summary or an
explanation of your health information for a fee.
Contact us using the information listed at the end of
this Notice for a full explanation of our fee structure.
Disclosure Accounting: You have the right to
receive a list of instances in which we or our business
associates disclosed your health information for purposes
other than treatment, payment, health care operations and
certain other activities, for the last 6 years, but not
before April 14, 2003. If you request this accounting more
than once in a 12-month period, we may charge you a
reasonable cost-based fee for responding to these
additional requests.
Restriction: You have the right to request that we
place a restriction on our use or disclosure of your
health information. We are not required to agree to these
additional restrictions, but if we do, we will abide by
our agreement (except in an emergency).
Alternative Communication: You have the right to
request that we communicate with you about your health
information by alternative means or to alternative
locations. (You must make your request in writing.) Your
request must specify the alternative means or location,
and provide a satisfactory explanation how payments will
be handled under the alternative means or location you
request.
Amendment: You have the right to request that we
amend your health information. (Your request must be in
writing, and it must explain why the information should be
amended.) We may deny your request under certain
circumstances.
Electronic Notice: If you receive this Notice on
our web site or by electronic mail, you are entitled to
receive this Notice in written form.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices
or have questions or concerns, please contact us.
If you are concerned that we may have violated your
privacy rights, or you disagree with a decision we made
about access to your health information or in response to
a request you made to amend or restrict the use of
disclosure of your health information or to have us
communicate with you by alternative means or at
alternative locations, you may communicate to us using the
contact information listed at the end of this Notice. You
also may submit a written complaint to the U.S. Department
of Health and Human Services. We will provide you with the
address to file your complaint with the U.S. Department of
Health and Human Services upon request.
We support your right to the privacy of your health
information. We will not retaliate in any way if you
choose to file a complaint with us or with the U.S.
Department of Health and Human Services.
Contact Officer:
Administrator
FLEI
7800 West Oakland Park Blvd.
Suite 206
Sunrise, FL 33351
Telephone: (954) 741-5555
Facsimile: (954) 572-6958
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