THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
1. HOSF is permitted to make uses and disclosures of protected health information (PHI) for treatment, payment and health care operations, as described in the following examples:
a. For treatment‚ for example: (PHI is disclosed to our pharmacy business associate when medications are ordered.)
b. For payment‚ for example: (PHI is disclosed to Health Insurance Companies when authorization for payment is requested.)
c. For health care operations‚ for example: (PHI is disclosed to members of HOSF’s interdisciplinary team for determining the Plan of Care.)
2. HOSF is permitted or required, under specific circumstances, to use or disclose protected health information without the individual’s written authorization, for example: (for national
security or intelligence purposes.)
3. Other uses and disclosures will be made only with the individual’s written authorization, and the individual may revoke such authorization.
4. HOSF intends to engage in (n)one or more of the following activities:
a. HOSF may contact the individual to provide appointment reminders or information about treatment alternatives or other heath-related benefits and services that may be of interest to the individual or patient.
b. HOSF may contact the individual/patient to raise funds for HOSF; or
c. A group health plan, or a health insurance issuer or HMO with respect to a group health plan, may disclose protected health information to the sponsor of the plan.
5. The individual has the following rights regarding protected health information:
a. The right to request restrictions on certain uses and disclosures of protected health information. HOSF is not required to agree to a requested restriction, however.
b. The right to receive confidential communications of protected health information, as applicable.
c. The right to inspect and copy protected health information, as provided in the Privacy Regulation.
d. The right to amend protected health information, as provided in the Privacy Regulation.
e. The right to receive an accounting of disclosures of protected health information.
f. The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically.
6. HOSF is required by law to maintain the privacy of protected health information and to provide individuals with Notice of its legal duties and Privacy Practices with respect to protected health information.
7. HOSF is required to abide by the terms of the Notice currently in effect.
8. HOSF reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains.
9. HOSF will provide individuals/patients with a revised Notice by paper copy.
10. Individuals may complain to HOSF and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint follows: 1) complaint must be in writing 2) name the entity subject to the complaint and the violation 3) filed within 180 days that complainant knew of violation.
11. HOSF’s contact person for matters relating to complaints is:
Bruce Wolters, Executive Director
1250-B Grumman Place
Titusville, Florida 32780
12. This Notice is first in effect on April 14th, 2003.