NOTICE OF PRIVACY PRACTICES
BRAIN AND SPINE CENTER LLC
2202 STATE AVENUE, SUITE 201
PANAMA CITY, FL 32405
PHONE: (850) 785-0029
FAX: (850) 785-7600
2011 N. HARRISON AVENUE
PANAMA CITY, FL 32405
PHONE: (850) 769-3261
FAX: (850) 785-6388
2011 N. HARRISON AVENUE
PANAMA CITY, FL 32405
PHONE: (850) 769-3261 EXT. 107
FAX: (850) 522-0444
401 NORTHSIDE DRIVE
PANAMA CITY, FL 32405
PHONE: (850) 913-7040
FAX: (850) 913-0290
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 CAFEFULLY.
Understanding Your Health Record
The Brain and Spine Center’s mission is to provide the highest quality medical services possible. In keeping with this philosophy, we strive to protect your privacy and keep secure all health information we maintain about you. Each time you visit the Brain and Spine Center, a record is made that contains information such as your diagnosis, symptoms, examination and test results, and the treatment you were given. This record allows the many health care professionals who contribute to your care to communicate. It is also a legal document describing your care and is the means by which you or your insurance company can verify that you received the services you were billed for. Your record may also be used as a tool to improve our services, to market our facility, or to supply information to public health officials charged with improving the health of our nation.
Knowing and understanding what is in your medical record helps you to ensure that the information is accurate. Understanding how the information in your record is used for treatment and payment purposes helps you to better understand who and why others may access your health information, thus allowing you to make a more informed decision when authorizing others to have access to your private health information.
Your Health Information Rights
Although your health record is the physical property of the Brain and Spine Center, the information in it belongs to you. You have the right to request a restriction on certain uses of your health information. You may request, for example, that family members not be included in discussions about your health or condition. Any use or disclosure of your medical information for purposes other than treatment, payment, or routine operational functions that improve our services will be made ONLY with your written, revocable authorization. This authorization form is available to you upon request from the receptionist. For example, you may wish your record to be sent to your attorney. We must have written authorization from you to disclose anything about you to any one or for any purpose other than treatment, payment or routine facility management.
You have the right to inspect and obtain a copy of your health record. We may deny request to inspect your protected health information if, in our professional judgment, we determine that the access requested is likely to endanger your life or safety or that of another person. You have the right to have a decision to deny access reviewed by on outside person. To obtain and copy your medical information, you must submit a written request to the Privacy Officer whose contact information is listed on the last page of this Privacy Notice. If you request a copy of your information, we may charge you a fee for the costs of copying, mailing or other costs incurred by us in complying with your request. Please contact our Privacy Officer if you have questions about access to your medical record.
You may request an amendment or correction to your health information for as long as we maintain the information. In certain cases, we may deny your request for an amendment. If we deny your request for an amendment, you have a right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Requests for amendment must be in writing and must be directed to our Privacy Officer. In this written request, you must also provide a reason to support the requested amendment.
You have the right to obtain an accounting of any disclosures of your health information, beyond those routine disclosures made for treatment, payment or routine healthcare facility management. We are not required to account for disclosures that you requested, disclosures that you agreed to by signing an authorization form, disclosures to friends or family members involved in your care, or certain other disclosures we are permitted to make without your authorization. The request for accounting must be made in writing to our Privacy Officer. The request should specify the time period sought for the accounting. Accounting request may not be made for periods of time in excess of six years. We will provide the fist accounting you request during any 12-month period without charge. Subsequent accounting request may be subject to a reasonable cost-based fee.
You have the right to request that we communicate with you in certain ways. We will accommodate reasonable requests. For example, we can communicate with you by fax instead of phone call or we can communicate with you at alternative locations (for example, to your office phone instead of your home phone). Requests must be made in writing to our Privacy Officer.
You may also revoke your authorization to use or disclose health information except to the extent that action has already taken place. This type of request must be made in writing to our Privacy Officer.
Upon request, you have a right to receive this Notice of Privacy Practices even if you have already received a copy of this notice.
The Brain and Spine Center is required to maintain the privacy and security of your health information, provide you with this notice describing our privacy practices with respect to the information we collect and maintain about you, abide by the terms of this notice, notify you if we are unable to agree to requested restrictions, and to accommodate reasonable requests you may have made to us to communicate health information by alternative means or locations. We reserve the right to change our privacy practices and to make new provisions effective for all protected health information we maintain about you. If revisions are made to this Notice, a revised Notice will be posted in the lobby of all Brain and Spine Center offices.
For More Information or To Report a Problem
If you have questions or would like additional information, you may contact our Privacy Officer whose contact information is listed on the last page of this notice. You have the right to express complaints to the Brain and Spine Center or with the Secretary of Health and Human Services if you believe that your privacy rights have been violated. You may file a complaint in writing to our Privacy Officer. We encourage you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
Examples of Uses and Disclosures of Your Health Information for Treatment, Payment and Health Care Operation
The Brain and Spine Center may use your personal health information for purposes of providing treatment, obtaining payment for treatment, and conduction healthcare operations. Your protected health information may be used or disclosed only for these purposes unless Brain and Spine Center has obtained your authorization or if federal regulations or state law otherwise permits the use of disclosure. Disclosures of your health information may be made in writing, orally, or by fax.
We may use your health information for treatment purposes:
For example, information such as your medical history, blood pressure, and weight will be recorded in your record and used to determine the course of treatment that will ensure your safety during your course of treatment. Our physicians may document a procedure they may perform and their expectations and instruction for recovery. Test results, such as MRI or x-rays, may be maintained in your records.
We may use your health information for payment:
For example, a bill may be sent to your insurance carrier. The information on, or accompanying the bill, may include information that identifies you, as well as your diagnosis, procedures and supplies used.
We may use your health information for routine healthcare facility management:
For example, members of our infection control committee may use information in your health record to assess the effectiveness of our sterilization procedures. This information will then be used to continually improve the quality and effectiveness of the services we provide.
Notification/Communication with Family Members or Significant Others
Unless you object in writing, we may discuss your health information with a family member, a friend designated by you, or any other person responsible for your care. Again, unless you object in writing, we may discuss scheduling or give appointment reminders to a family member by phone or leave the appointment information on your answering machine. Health professionals, using their best judgment, may communicate with a family member, other relative, close personal friend or any other person you identify, health information that is relevant to the that person’s involvement in your care or payment related to your care. For example, we may discuss with your spouse the need for you to rest for the remainder of the day or we may review the proper dosage for medication. Should you wish any of the above named persons to be unauthorized to receive such information about you, you must request this in writing prior to receiving services at Brain and Spine Center. Please contact our Privacy Officer to request any restrictions you would like to make in sharing your health information with your family members or significant others.
Communications Between Physician and Those Responsible for Your Care