Privacy Policy
NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION
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
CAREFULLY.
Effective date: April 14, 2003
If you consent, Miami Counseling & Resource Center is permitted by
federal privacy laws to make uses and disclosures of your health
information for purposes of treatment, payment, and health care
operations. Protected health information is the information we create and
obtain in providing our services to you. Such information may include
documenting your symptoms, examination, test results, diagnosis,
treatment, and applying for future care or treatment. It also includes
billing documents for those services.
Examples of uses of your health information for treatment
purposes are:
- An employee of the provider's office obtains treatment information
about you and records it in a health record
- During the course of your treatment, the provider determines that
he/she will need to consult with another specialist in the area. He/She
will share the information with such specialists and obtain his/her
input.
An example of use of your health information for payment
purposes:
- We submit a request for payment to your health insurance company.
The health insurance company requests information from us regarding
services rendered. We will provide that information to them about you
and the care you receive.
- We verify insurance coverage prior to your first appointment and
obtain prior authorization and pre-certification when required to do so
by your policy coverage.
An example of use of your health information for health care
operations:
- The state licensing authority wants to review records to assure that
we have acted consistent with state law regarding your care. In doing
so, it wants to take a sampling which includes review of your chart. At
the licensing authority's request, we will provide it with a copy of
your chart.
Your health information rights:
The health record and billing records we maintain are the physical
property of this office. The information in it, however, belongs to you.
You have a right to:
- Request a restriction on certain uses and disclosures of your
protected health information by delivering the request in writing to our
office. We are not required to grant the request, but we will comply
with any request granted.
- Obtain a paper copy of the Notice of Privacy Practices for Protected
Health Information by making a request at our office.
- Request that you be allowed to inspect and receive a copy of your
health record and billing record. You may exercise this right by
delivering the request in writing to our office using the form we
provide to you upon request.
- Appeal a denial of access to your protected health information
except in certain circumstances.
- Request that your health care record be amended to correct
incomplete or incorrect information by delivering a written request to
our office using the form we provide to you upon request
- File a statement of disagreement if your amendment is denied, and
require that the request for amendment and any denial be attached in all
future disclosures of your protected health information.
- Obtain an accounting of disclosures of your health information as
required to be maintained by law by delivering a written request to our
office using the form we provide to you upon request. The accounting
will not include internal uses of information for treatment, payment, or
operations, disclosures made to you or made at your request.
- Request that communication of your health information be made by
alternative means or at an alternative location by delivering the
request in writing to our office using the form we provide to you upon
request.
- Revoke any authorizations that you made previously to use or
disclose information except to the extent information or action has
already been taken by delivering a written revocation to our office.
You have the right to review this Notice before signing the consent
authorizing use and disclosure of your protected health information for
treatment, payment, and health care operations purposes.
If you want to exercise any of the above rights, please contact: Dr.
Paula Levine, Ph.D., Compliance Officer, at 111 Majorca Ave, Suite B,
Coral Gables, FL 33134, (305) 448-8325 in person, or in writing, during
normal business hours. She will provide you with assistance on the steps
to take to exercise your rights. In addition, The Secretary of Health and
Human Services may also be contacted.
Our Responsibilities
Miami Counseling & Resource Center is required to:
- Maintain the privacy of your health information as required by law
- Provide you with a notice as to our duties and privacy practices as
to the information we collect and maintain about you
- Abide by the terms of this Notice
- Notify you if we cannot accommodate a requested restriction or
request
- Accommodate your reasonable requests regarding methods to
communicate health information to you.
We reserve the right to amend, change, or eliminate provisions in our
privacy practices and access practices and to enact new provisions
regarding the protected health information we maintain. If our information
practices change, we will amend our Notice to reflect these changes. You
are entitled to receive a revised copy of the Notice by calling or
requesting a copy of our Notice or by visiting the office to obtain a
copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to
report a problem regarding the handling of your information, you may
contact the following person:
Paula Levine, Ph.D., Compliance Officer
111 Majorca Avenue, Suite B, Coral Gables, Florida 33134
PH: (305) 448-8325 FAX: (305) 448-0687
Additionally, if you believe your privacy rights have been violated,
you may file a written complaint at our office by delivering the written
complaint to the following person:
Paula Levine, Ph.D., Compliance Officer
@ The address and phone numbers listed above
You may also file a complaint by mailing or e-mailing it to the
Secretary of Health and Human Services.
We cannot, and will not, require you to waive the right to file a
complaint with the Secretary of Health and Human Services (HHS) as a
condition of receiving treatment from our office.
We cannot, and will not, retaliate against you for filing a complaint
with the Secretary.
Other Uses and Disclosures
- We have Business Associates with whom we may share your protected
health information.
- For example, in preparing our annual financial statement, auditors
may need to review samples of medical care given. We may disclose your
health information to the accounting firm to prepare this material.
- For example, during our routine health care operations, we may need
to hire computer technicians and software vendors. We may disclose your
health information to these vendors to maintain daily functioning in our
health care operations.
Notification
Unless you object, we may use or disclose your protected health
information to notify, or assist in notifying, a family member, personal
representative, or other persons responsible for your care, about your
location, about your general condition, or your death.
Communication with Family
Using our best judgment, we may disclose to a family member, other
relative, close personal friend, or any other person you identify, health
information relevant to that person's involvement in your care or in
payment for such care if you do not object or in an emergency.
Disaster Relief
We may use and disclose your protected health information to assist in
disaster relief efforts.
Funeral Directors/Coroners
We may disclose your protected health information to funeral directors or
coroners consistent with applicable law to allow them to carry out their
duties.
Marketing
We may contact you to provide you with appointment reminders, with
information about treatment alternatives, or with information about other
health-related benefits or services that may be of interest to you.
Fund Raising
We may contact you as part of a fund raising effort.
Workers Compensation
If you are seeking compensation through Workers Compensation, we may
disclose your protected health information to the extent necessary to
comply with laws relating to Workers Compensation.
Public Health
As required by law, we may disclose your protected health information to
public health or legal authorities charged with preventing or controlling
disease, injury, or disability.
Abuse and Neglect
We may disclose your protected health information to public authorities as
allowed by law to report abuse or neglect.
Correctional Institutions
If you are an inmate of a correctional institution, we may disclose to the
institution or agents there of your protected health information necessary
for your health and the health and safety of other individuals.
Law enforcement
We may disclose your protected health information for law enforcement
purposes as required by law, such as when required by a court order, or in
cases involving felony prosecutions, or to the extent an individual is in
the custody of law enforcement.
Health oversight
Federal law allows us to release your protected health information to
appropriate health oversight agencies or for health oversight activities.
Judicial/Administrative Proceedings
We may disclose your protected health information in the course of any
judicial or administrative proceeding as allowed or required by law, with
your consent, or as directed by a proper court order.
To avert a serious threat or health or safety, we may disclose your
protected health information consistent with applicable law to prevent or
lessen a serious, imminent threat to the health or safety of a person or
the public.
For Specialized Governmental Functions
We may disclose your protected health information for specialized
government functions as authorized by law such as to Armed Forces
personnel, for national security purposes, or to public assistance program
personnel.
Other uses
Other uses and disclosures in addition to those identified in this Notice
will be made only as otherwise authorized by law or with your written
authorization and you may revoke that authorization as previously stated.
Website
We maintain a website that provides information about our business. This
Notice is on the website. |
