 JACKSONVILLE SPINE CENTER
Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS THIS INFORMATION. PLEASE READ AND REVIEW IT CAREFULLY. Recently the United States government established new rules concerning the use and protection of medical and health information. This initiative was part of the Health Insurance Portability and Accountability Act (HIPPA) of 1996. The rules are intended to provide standard privacy protections for your medical information. Jacksonville Spine Center is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices at Jacksonville Spine Center please contact:
Privacy Officer: Karen Wansley or Medical Records Department I. Jacksonville Spine Center may Use or Disclose Your Health Information for Treatment, Payment and Health Care Operations Jacksonville Spine Center collects health information from you and stores it in your electronic chart on our computer. This is your medical record. The medical record is the property of Jacksonville Spine Center, but the information in the medical record belongs to you. Jacksonville Spine Center protects the privacy of your health information. The law permits Jacksonville Spine Center to use or disclose your health information without your authorization for the following purposes: 1. Treatment. Jacksonville Spine Center may use your health information to determine a course of treatment, to coordinate care within the office or to other healthcare professionals outside of Jacksonville Spine Center involved in your care. For example, a Jacksonville Spine Center office might disclose your health information to others outside our practice including a designated personal representative (as long as they are approved by you), another specialist, a hospital, a pharmacist, medical equipment supplier or any other healthcare professional (in the opinion of the physician or physician’s representative) who needs your information to continue your care. 2. Payment. Jacksonville Spine Center may use your health information to seek approval for certain services, bill for those services and collect payment from third party payers. For example, our office will send an invoice to your health insurance company to provide them with the necessary information for payment for our services or our office might contact your insurance company to seek approval for tests we deem necessary to determine a course of treatment for which the insurance company requires us to disclose your personal health information. 3. Regular Health Care Operations. Jacksonville Spine Center may use and disclose health information for its own operations to facilitate the function of our practice as necessary to provide quality care to all of our patients. Jacksonville Spine Centers’ healthcare operations include such activities as:
5. Notification and communication with family. We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others. II. Jacksonville Spine Center may Use or Disclose Your Health Information for Other Legal or Health Related Purposes 1. Public health. As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure. 2. Health oversight activities. We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings. 3. Judicial and administrative proceedings. We may disclose your health information in the course of any administrative or judicial proceeding. 4. Law enforcement. We may disclose your health information to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes. 5. Deceased person information. We may disclose your health information to coroners, medical examiners and funeral directors. 6. Organ donation. We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues. 7. Research. We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board or Jacksonville Spine Centers’ privacy board. 8. Public safety. We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public. 9. Worker’s compensation. We may disclose your health information as necessary to comply with worker’s compensation laws. 10. Change of Ownership. In the event that Jacksonville Spine Center is sold or merged with another organization, your health information/record will become the property of the new owner. III. When Jacksonville Spine Center May Not Use or Disclose Your Health Information Except as described in this Notice of Privacy Practices, Jacksonville Spine Center will not use or disclose your health information without your written authorization. If you do authorize Jacksonville Spine Center to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. 1. You have the right to request restrictions on certain uses and disclosures of your health information. Jacksonville Spine Center is not required to agree to the restriction that you requested. 2. You have the right to receive your health information through a reasonable alternative means or at an alternative location. For example, you might not wish us to discuss your health condition or other health information in private with no family members present. You can request that we not leave messages on your answering machine. Jacksonville Spine Center will make every effort to comply with your reasonable requests for confidential communications. 3. You have the right to inspect and copy your health information including billing records. If you make a request for copies of your records a nominal fee may be charged for copying and assembling costs associated with your requests. 4. You have a right to request that Jacksonville Spine Center amend your health information that is incorrect or incomplete. Jacksonville Spine Center is not required to change your health information and will provide you with information about Jacksonville Spine Centers’ denial and how you can disagree with the denial. Jacksonville Spine Center may deny your request if your health information was not created by us, if the records you are requesting are not part of our records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if in the opinion of Jacksonville Spine Center the records containing your health information are accurate and complete. 5. You have a right to receive an accounting of disclosures of your health information made by Jacksonville Spine Center, except that Jacksonville Spine Center does not have to account for the disclosures described in parts 1 (treatment), 2 (payment), 3 (health care operations) and 4 (information provided to you) of section I of this Notice of Privacy Practices. 6. You have a right to a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, contact Jacksonville Spine Centers’ Medical Record Department at (904) 223-3321. V. Changes to this Notice of Privacy Practices Jacksonville Spine Center reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment. Until such amendment is made, Jacksonville Spine Center is required by law to comply with this Notice. Any amendments to this Notice of Privacy Practices will be posted in our centers and on our website (www.jaxspine.com) within twenty business days of the change. VI. Complaints If you want to file a concern or complaint about Jacksonville Spine Center use or disclosure of protected health information please contact the privacy officer at: Jacksonville Spine Center If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to: Region IV, Office for Civil Rights, U.S. Department of Health and Human Services Voice Phone (404) 562-7886 |
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