Michael F Sheehan HIPAA NOTICE OF PRIVACY PRACTICES Effective Date THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE READ THIS DOCUMENT CAREFULLY.
Dr Sheehan and his staff are dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. "Protected Health Information" is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. North Tampa Psychiatric Associates is required by law to abide by the terms of this Notice.
HOW YOUR MEDICAL INFORMATION WILL BE USED AND DISCLOSED:
On your first visit, you will be asked to sign a consent form. Once you have consented to the use and disclosure of your protected health information, we will use your medical information responsibly to provide optimal patient care. This includes treatment, payment and health care operations For example, your medical information may be used by the doctor treating you, by the business office to process your payment for the services rendered and by administrative personnel reviewing the quality of the care you receive. Using or disclosing health information for treatment would include an assistant taking a phone message, recording it in the medical record, and informing your doctor, or informing a laboratory about your diagnosis, calling in a prescription to your pharmacy, or discussing your treatment with your family doctor. An example of using or disclosing health information for payment would be as follows: We submit a bill to your health insurer to receive payment for your care; the insurer requests health information (for example, your diagnosis and what care we provided) in order to pay us. In such situations, we will disclose only the minimum amount of information necessary for this purpose. An example of using or disclosing health information for health care operations would be as follows: In the course of providing treatment to patients, we perform certain important functions such as quality assessment, training programs, credentialing, medical review, etc. In performing such functions, we may rely on certain business associates to assist us. We will share with our business associates only the minimum amount of personal health information necessary for them to assist us.
We may also use and/or disclose your information in accordance with federal and state laws for the following purposes:
Appointment Reminders. * We may contact you to provide appointment reminders.
Treatment Information. * We may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Disclosure to Department of Health and Human Services. * We may disclose medical information when required by the United States Department of Health and Human Services as part of an investigation or determination of our compliance with relevant laws.
Family and Friends. * Unless you object, we may disclose your medical information to family members, other relatives or close personal friends when the medical information is directly relevant to that person?s involvement with your care.
Notification. * Unless you object, we may use or disclose your medical information to notify a family member, a personal representative or another person responsible for your care of your location, general condition or death.
Disaster Relief. * We may disclose your medical information to a public or private entity, such as the American Red Cross, for the purpose of coordinating with that entity to assist in disaster relief efforts.
Health Oversight Activities. * We may use or disclose your medical information for public health activities, including the reporting of disease, injury, vital events and the conduct of public health surveillance, investigation and/or intervention. We may disclose your medical information to a health oversight agency for oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings.
Abuse or Neglect. * We may disclose your medical information when it concerns abuse, neglect or violence to you in accordance with federal and state law.
Legal Proceedings. * We may disclose your medical information in the course of certain judicial or administrative proceedings.
Law Enforcement. * We may disclose your medical information for law enforcement purposes or other specialized governmental functions.
Coroners, Medical Examiners and Funeral Directors. * We may disclose your medical information to a coroner, medical examiner or a funeral director.
Organ Donation. * If you are an organ donor, we may disclose your medical information to an organ donation and procurement organization.
Research. * We may use or disclose your medical information for certain research purposes if an Institutional Review Board or a privacy board has altered or waived individual authorization, the review is preparatory to research or the research is on only decedent's information.
Public Safety. * We may use or disclose your medical information to prevent or lessen a serious threat to the health or safety of another person or to the public.
Workers' Compensation. * We may disclose your medical information as authorized by laws relating to workers? compensation or similar programs.
Business Associates. * We may disclose your health information to a business associate with whom we contract to provide services on our behalf. To protect your health information, we require our business associates to appropriately safeguard the health information of our patients.
We will not use or disclose your medical information for any other purpose without your written authorization. Once given, you may revoke your authorization in writing at any time. To request a Revocation of Authorization form, you may contact: North Tampa Psychiatric Associates, tel 813 968 7188
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:
You have the following rights with respect to your medical information:
* You may ask us to restrict certain uses and disclosures of your medical information. We are not required to agree to your request, but if we do, we will honor it. * You have the right to receive communications from us in a confidential manner. * Generally, you may inspect and copy your medical information. This right is subject to certain specific exceptions, and you may be charged a reasonable fee for any copies of your records. * You may ask us to amend your medical information. Please ask for the Request for Amendment/Correction of Protected Information Form. We may deny your request for certain specific reasons. If we deny your request, we will provide you with a written explanation for the denial and information regarding further rights you may have at that point. * You have the right to receive an accounting of the disclosures of your medical information made by North Tampa Psychiatric Associates during the last six years (or following April 14, 2003), except for disclosures for treatment, payment or healthcare operations, disclosures which you authorized and certain other specific disclosure types. Please ask for the Request for an Accounting of Disclosures form. * You may request a paper copy of this Notice of Privacy Practices for Protected Health Information. * You have the right to complain to us and/or to the United States Department of Health and Human Services if you believe that we have violated your privacy rights. If you believe your privacy rights have been violated, you may file the written complaint report form by mailing it or delivering it to our contact person at North Tampa Psychiatric Associates, telephone 813-968 7188. You may complain to the Secretary of Health and Human Services (HHS) by writing to Office for Civil Rights, U.S.Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201; by calling 1-800-368-1019; or by sending an email to OCRprivacy@hhs.gov. We cannot, and will not, make you waive your right to file a complaint with HHS as a condition of receiving care from us, or penalize you for filing a complaint with HHS. * If you would like further information regarding your rights or regarding the uses and disclosures of your medical information, or require any of the above mentioned forms, please contact North Tampa Psychiatric Associates, telephone 813-968 7188, and ask for the privacy contact
THIS NOTICE IS EFFECTIVE AS OF 4/14/2003
REVISION OF NOTICE OF PRIVACY PRACTICES
We reserve the right to change the terms of this Notice, making any revision applicable to all the protected health information we maintain. If we revise the terms of this Notice, we will post a revised notice at North Tampa Psychiatric Associates, and will make paper copies of the revised Notice of Privacy Practices available upon request.
*The Proposed rule issued 3/02 eliminated the consent requirement for uses and disclosures for treatment, payment and health care operations and replaced it with a requirement that health care providers with a direct treatment relationship with the patient make a good faith effort to obtain an acknowledgment that the patient received the provider's Notice of Privacy Practices. Use of this site means you agree to Medem's Terms of Service.