North Point Physicians, LLC – Notice of Privacy Practices

Revised: September 2013

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY.

A.  OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your Protected Health Information (PHI).  In conducting our business, we will create records regarding you and the treatment and services we provide to you.  We are required by law to maintain the confidentiality of health information that identifies you.  We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your PHI.  We also are required by Law to notify affected individuals if we determined there has been a breach of unsecured PHI.  By law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

The terms of this notice apply to all records containing medical information created or retained by our practice.  We reserve the right to revise or amend this Notice of Privacy Practices.  Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future.  Our practice will post a copy of our Notice of Privacy Practices in our office. You may also request a copy of our Notice of Privacy Practices at any time. 

B.  IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

North Point Physicians, LLC

Privacy Officer

1395 N. Courtenay Pkwy, Suite 107

Merritt Island, Florida  32953

(321) 453-1955

C.  HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION ABOUT YOU.

The following categories describe examples of the way we use and disclose health information.

1. Treatment. Our practice may use your health information to treat you.  For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis.  We might use your health information in order to write a prescription for you, or we might disclose your health information to a pharmacy when we order a prescription for you.  Many of the people who work for our practice – including, but not limited to, our doctors and nurses – may use or disclose your PHI in order to treat you or to assist others in your treatment. Finally, we may also disclose your PHI to other health care providers for purposes related to your treatment.
2. Payment. Our practice may use and disclose your PHI in order to bill and collect payment for the services and items you may receive from us.  For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.  We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members.  Also, we may use your PHI to bill you directly for services and items.  We may disclose your PHI to other health care providers and entities to assist in their billing and collection efforts.
3. Health Care Operations. Our practice may use and disclose your PHI to operate our business.  As examples of the ways in which we may use and disclose your information for our operations, our practice may use your PHI to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our practice.  We may disclose your PHI to other health care providers and entities to assist in their health care operations.
4. Appointment Reminders. Our practice may use and disclose your PHI to contact you and remind you of an appointment.
5. Treatment Options. Our practice may use and disclose your health information to inform you of potential treatment options or alternatives.
6. Health-Related Benefits and Services. We may use and disclose your medical information to tell you about health-related benefits or services that may be of interest to you. However, the practice does not receive any compensation in connection with communication with patients about its products and services.
7. Release of Information to Family/Friends. We will disclose your medical information to you or someone who has legal rights to act on your behalf. We may disclose your information to a family member, a friend or any other person(s) you identify if you direct us to do so or if we exercise professional judgment and determine that they are involved in your care or payment for your treatment.  In addition, we may disclose your medical information about you to an entity assisting in a disaster relief situation, unless you object to it in writing.
8. Disclosures Required By Law. Our practice will use and disclose your health information when we are required to do so by federal, state or local law.
9. Business Associates. We may disclose PHI to our business associate who performs functions on our behalf or provide us with services if the PHI is necessary for those functions or services. All of our business associates are obligated, under contract with us, to protect the privacy and ensure the security of your PHI.

D.  USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your health information: 

1. Public Health Risks. Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:
   • maintaining vital records, such as births and deaths
   • reporting child abuse or neglect
   • preventing or controlling disease, injury or disability
   • notifying a person regarding potential exposure to a communicable disease
   • notifying a person regarding a potential risk for spreading or contracting a disease or condition
   • reporting reactions to drugs or problems with products or devices
   • notifying individuals if a product or device they may be using has been recalled
   • notifying appropriate government agency(ices) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information

2. Health Oversight Activities. Our practice may disclose your PHI to a health oversight agency for activities authorized by law.  Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings. Our practice may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  We also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.  We may also use or disclose your PHI to defend ourselves in the event of a lawsuit.
4. Law Enforcement. We may release PHI if asked to do so by a law enforcement official:
   • Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
   • Concerning a death we believe has resulted from criminal conduct
   • Regarding criminal conduct at our offices
   • In response to a warrant, summons, court order, subpoena or similar legal process
   • To identify/locate a suspect, material witness, fugitive or missing person
   • In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

5. Deceased Patients. Our practice may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death.  If necessary, we also may release health information in order for funeral directors to perform their jobs.
6. Organ and Tissue Donation. Our practice may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
7. Research. Our practice may use and disclose your PHI for research purposes in certain limited circumstances.  We will obtain your written authorization to use your PHI for research purposes except when an Institutional Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following:  (i) the use or disclosure involves no more than a minimal risk to your privacy based on the following:  (A) an adequate plan to protect the identifiers from improper use and disclosure; (B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (C) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the PHI.
8. Serious Threats to Health or Safety. Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.  Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
9. Military. Our practice may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
10. National Security. Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law.  We also may disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
11. Inmates. Our practice may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.  Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
12. Workers’ Compensation. Our practice may release your PHI for workers’ compensation and similar programs.
13. Data Breach Notification. We will notify, in writing, in the event that the privacy of your medical information has been breached.  We may use or disclose your PHI to provide legally required notices of unauthorized access to or disclosure of your medical information.

 E.  USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION 

1. Psychotherapy Notes. Any use or disclosure of psychotherapy notes, unless the notes are being used for treatment, payment or health care operation or as part of legal defense
2. Marketing. Any use or discourse for marketing purpose.
3. Sales of medical information. Any sale of your protected medical information to a third party.

F.  YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION

You have the following rights regarding PHI we maintain about you:

1. Confidential Communications. You have the right to request that our practice communicate with you about your health and related issues in a particular manner or at a certain location.  For instance, you may ask that we contact you at home, rather than work.  In order to request a type of confidential communication, you must make a written request to specify the requested method of contact, or the location where you wish to be contacted.  Our practice will accommodate reasonable requests.  You do not need to give a reason for your request.
2. Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations.  Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends.   To request a restriction on who may have access to your PHI, you must submit a written request to our Privacy Officer.  Your request must state the specific restrictions requested and to whom you want the restriction to apply. We are not required to agree to your request unless the disclosure is to a health plan for purpose of payment for healthcare services or healthcare operations. In this case we must agree to your request; however, you must have paid us in full “out of pocket” in order for us to grant the disclosure. We are not required to agree to this request if it relates to your treatment.  However, if we do agree to any of your restriction requests, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.
3. Inspection and Copies. You have the right to inspect and obtain a copy of your medical information that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes.  You must submit your request in writing to obtain access to your medical information. If you request a copy of your medical information, we may charge a fee for costs of copying, mailing, and other supplies associated with your request.  Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct the review.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice.  To request an amendment, your request must be made in writing and submitted to our Privacy Officer. You must provide us with a reason that supports your request for the amendment.   Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing.  Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice.
5. Accounting of Disclosures.  All of our patients have the right to request an accounting of disclosures made.  All requests for an accounting of disclosures must be submitted in writing (the appropriate form can be requested from our office staff). The first list you request within a 12-month period is free of charge. We may charge you for any additional lists requested within the same 12-momth period. We will notify of the costs involved with any additional request prior to their completion, allowing you to withdraw your request before you incur any costs.
6. Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices.  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
7. Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.  To file a complaint with our practice, contact North Point Physicians, LLC, Attn: Privacy Officer, 1395 N. Courtenay Pkwy., Suite 107, Merritt Island, Florida 32953.  All complaints must be submitted in writing. You will not be penalized for filing a complaint.
8. Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.  Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization.  But discourses that we made in reliance on your authorization before you revoked it will not be affected by the revocation.

Again, if you have any questions regarding this notice or our health information privacy policies, please contact:

North Point Physicians, LLC

Attn: Privacy Officer

1395 N. Courtenay Pkwy., Suite 107

Merritt Island, Florida 32953