NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Please read it carefully.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
Protected health information includes demographic and medical information that concerns the past, present, or future physical or mental health of an individual. Demographic information could include your name, address, telephone number, Social Security number and any other means of identifying you as a specific person. Protected health information contains specific information that identifies a person or can be used to identify a person.
Protected health information is health information created or received by a health care provider, health plan, employer, or health care clearinghouse. The B & B Holding Enterprises, Inc., Affiliates and Lines of Business (Provider) can act as each of the above business types. This medical information is used by the Provider in many ways while performing normal business activities.
Your protected health information may be used or disclosed by the Provider for purposes of treatment, payment, and health care operations. Health care professionals use medical information in the clinics or hospital to take care of you. Your protected health information may be shared, with or without your consent, with another health care provider for purposes of your treatment. The Provider may use or disclose your health information for case management and services. The Provider may send the medical information to insurance companies, Medicare, Medicaid, or community agencies to pay for the services provided to you.
Your information may be used by certain Provider personnel to improve the Provider’s health care operations. The Provider also may send you appointment reminders, information about treatment options or other health-related benefits and services.
Some protected health information can be disclosed without your written authorization as allowed by law. Those circumstances include:
Other uses and disclosures of your protected health information by the Provider will require your written authorization. These uses and disclosures may be for marketing or research purposes, certain uses and disclosure of psychotherapist notes, and the sale of protected health information resulting in compensation to the Provider,
This authorization will have an expiration date that can be revoked by you in writing.
INDIVIDUAL RIGHTS
You have the right to request that the Provider restrict the use and disclosure of your protected health information to carry out treatment, payment, or health care operations. You may also limit disclosures to individuals involved with your care. The Provider is not required to agree to any restriction.
You have the right to be assured that your information will be kept confidential. The Provider will contact you in the manner and at the address or phone number you select. You may be asked to put your request in writing. If you are responsible to pay for services, you may provide an address other than your residence where you can receive mail and where the Provider may contact you.
You have the right to inspect and receive a copy of your protected health information that is maintained by the Provider within 30 days of the Provider’s receipt of your request to obtain a copy of your protected health information. You must complete the Provider’s Authorization to Disclose Confidential Information form. If there are delays in the Provider’s ability to provide the information to you within 30 days, you will be told the reason for the delay and the anticipated date your request can be fulfilled.
Your inspection of the information will be supervised at an appointed time and place. You may be denied access to some records as specified by federal or state law.
If you choose to receive a copy of your protected health information, you have the right to receive the information in the form or format you request. If the Provider cannot produce it in that form or format, you will be given the information in a readable hard copy form or another form or format that you and the Provider agree to.
The Provider cannot give you access to psychotherapy notes or certain information being used in a legal proceeding. Records are maintained for specified periods of time in accordance with the law. If your request covers information beyond that time, the Provider is not required to keep the record and the information may no longer be available.
If access is denied, you have the right to request a review by a licensed health care professional who was not involved in the decision to deny access. This licensed health care professional will be designated by the Provider.
You have the right to correct your protected health information. A request to correct your protected health information must be in writing and provide a reason to support your requested correction.
The Provider may deny your request, in whole or part, if the protected health information:
If your correction is accepted, the Provider will make the correction and inform you and others who need to know about the correction. If your request is denied, you may send a letter detailing the reason you disagree with the decision. The Provider may respond to your letter in writing. You also may file a complaint, as described below in the section titled Complaints.
You have the right to receive a summary of certain disclosures the Provider may have made of your protected health information. This summary does not include:
This summary does include disclosures made for:
You may request a summary for not more than a 6-year period from the date of your request.
If you received this Notice of Privacy Practices electronically, you have the right to a paper copy upon request.
The Provider may send health care appointment reminders to you by postal mail, or by a telephone text or call.
As part of the Provider’s legal duties, this Notice of Privacy Practices must be given to you. The Provider is required to follow the terms of the Notice of Privacy Practices currently in effect.
COMPLAINTS
If you believe your privacy health rights have been violated, you may file a complaint with the:
Department of Health’s Inspector General at 4052 Bald Cypress Way, BIN A03/ Tallahassee, FL 32399-1704/ telephone 850-245-4141 and with the Secretary of the U.S. Department of Health and Human Services at 200 Independence Avenue, S.W./ Washington, D.C. 20201/ telephone 202-619-0257 or toll free 877-696-6775.
The complaint must be in writing, describe the acts or omissions that you believe violate your privacy rights, and be filed within 180 days of when you knew or should have known that the act or omission occurred. The Provider will not retaliate against you for filing a complaint.