Heart & Family Health Institute
1700 S. E. Hillmoor Drive
Port St. Lucie, Florida 34952
772-335-9600

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 REVIEW IT CAREFULLY

WHO WILL FOLLOW THESE PRIVACY PRACTICES

This Notice describes information about privacy practices followed by our physicians, employees and other office personnel. The practices described in this Privacy Notice will also be followed by healthcare providers you consult with by telephone who provide "call coverage" for your healthcare provider when your healthcare provider is not available.

YOUR HEALTH INFORMATION

This Notice applies to the Protected Health Information (PHI) and records we have about your health, health status, and the healthcare and services received at the Heart & Family Health Institute (HFHI).

We are required by law to maintain the privacy of your protected health information and to give you this Notice. It will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

We may use and disclose Protected Health Information (PHI) about you without your consent for the following purposes:

For Treatment. We may use health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, office staff or other personnel who are involved in taking care of you and your health services.

For example, your doctor may be treating you for a heart condition and may need to know if you have other health problems that could complicate your treatment. The doctor may use your current and past medical history to decide what treatment is best for you. The doctor may also tell another doctor about your condition so that doctor can help determine the most appropriate care for you.

Different personnel in our office may share information about you and disclose information to people who do not work in our office in order to coordinate your care, such as phoning in prescriptions to your pharmacy, scheduling lab work or ordering X-rays. Family members and other healthcare providers may be part of your medical care outside this office and may also require information about you that we have.

For Payment. We may use and disclose health information about you so that the treatment and services you receive at HFHI may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about a service you received at HFHI so your health plan will pay us or reimburse you for the service. We may also tell your health plan about a treatment you are going to receive to obtain prior approval, or to determine whether your plan will cover the treatment.

For Healthcare Operations. We may use and disclose health information about you in order to run the practice and make sure that you and our other patients receive quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you. We may also use health information about all or many of our patients to help us decide what additional services we should offer, how we can become more efficient, or whether certain new treatments are effective.

A.Business Associates Certain of our business operations may be performed for or on our behalf by other businesses. We refer to these as "business associates." For example, we may use a billing service to mail out your statements. For those services to be performed by a business associate, disclosure of individual identifiable information about you may be required. In any such instance we will have entered into a formal agreement with the business associate that requires them to maintain the confidentiality of any patient information received.

Appointment Reminders We may contact you as a reminder that you have an appointment for treatment or medical care at the Heart & Family Health Institute (HFHI). This reminder may be left on your answering machine/service.

Test Results We may contact you to report test results for services rendered at the Heart & Family Health Institute (HFHI) or at another facility. Actual test results or a message to call your doctor's office may be left on your answering machine/service.

Treatment Alternatives We may tell you about or recommend possible treatment options or alternatives that may be of interest to you. This information may be left on your answering machine/service.

Health-Related Products and Services We may tell you about health-related products or services that may be of interest to you. This information may be left on your answering machine/service.

Please notify us if you do not wish to be contacted for appointment reminders, test results or if you do not wish to receive communications about treatment alternatives or health-related products and services. You will need to put your request not to be contacted in writing and mail it to the address listed at the top of this Notice.

SPECIAL SITUATIONS

We may use or disclose health information about you without your authorization for the following purposes, subject to all applicable legal requirements and limitations:

To Avert a Serious Threat to Home or Safety We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

Required by Law We will disclose health information about you when required to do so by federal, state or local law.

Organ and Tissue Donation. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate such donation and transplant.

Military, Veterans, National Security and Intelligence. If you are or were a member of the armed forces, or part of the national security or intelligence communities, we may be required by military command or other government authorities to release health information about you. We may also release information about foreign military personnel to the appropriate foreign military authority.

Workman's Compensation We may release health information about you for workman's compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

Public Health Risks We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products.

Health Oversight Activities. We may disclose health information about you to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the healthcare system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. Subject to all applicable legal requirements, we may also disclose health information about you in response to a subpoena.

Law Enforcement We may release health information about you if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process, subject to all applicable legal requirements.

Coroners, Medical Examiners and Funeral Directors We may release health information about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine a cause of death.

Information Not Personally Identifiable We may use or disclose health information about you in a way that does not personally identify you or reveal who you are.

Family and Friends. We may disclose health information about you to your family members or friends if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection. We may also disclose health information to your family or friends if we can infer from the circumstances, based on our professional judgment, that you would not object. For example, we may assume you agree to our disclosure of your Protected Health Information (PHI) to your spouse, parent or friend when you bring your spouse, parent or friend with you into the exam room during treatment or while treatment is discussed.

In situations where you are not capable of giving consent (because you are not present or due to your incapacity or a medical emergency), we may, using professional judgment, determine that a disclosure to your family member or friend is in your best interest. In that situation, we will disclose only health information relevant to the person's involvement in your care. For example, we may inform the person who accompanied you to the Heart & Family Health Institute (HFHI) of what your health status is and provide updates on your progress and prognosis. We may also use our professional judgment and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up items or information from HFHI. For example, prescriptions, medical supplies, test results or X-rays.

OTHER USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION (PHI)

We will not use or disclose your Protected Health Information (PHI) for any purposes other than those identified in the previous sections without your specific, written Authorization. If you give us Authorization to use or disclose Protected Health Information (PHI) about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose information about you for the reasons covered by your written Authorization, but we cannot take back any uses or disclosures already made with your permission.

If we have HIV or substance abuse information about you, we cannot release that information without a special signed, written authorization from you. This is different from the Authorization mentioned above. In order to disclose these types of records, we will have to have a special authorization that complies with the law governing HIV or substance abuse records.

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU

You have the following rights regarding the Protected Health Information (PHI) we maintain about you:

Right to Inspect and Copy. You have the right to inspect and have your health information copied. This includes medical and billing records that we use to make decisions about your care. You must submit a written request to the Regulatory Affairs Department in order to have your health information copied. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other associated supplies. We may deny your request for a copy in certain limited circumstances. If you are denied access to your Protected Health Information (PHI), you may ask that the denial be reviewed. If such a review is required by law, we will select a licensed healthcare professional to review your request and our denial. The person conducting the review will not be the person who denied your request, and we will comply with the outcome of the review.

Right to Amend If you believe Protected Health Information (PHI) we have about you is incorrect or incomplete, you may submit a written request for us to amend the information.

To request an amendment to your Protected Health Information (PHI), complete and submit a Medical Record Amendment/Correction Form to the Regulatory Affairs Department at the address listed at the top of the Privacy Notice. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.

In addition, we may deny your request if you ask us to amend PHI if:

Right to an Accounting of Disclosures You have the right to request an "accounting of disclosures" of your health information. This is a list of the disclosures HFHI made of Protected Health Information (PHI) about you for purposes other than treatment, payment and healthcare operations. To obtain this list, you must submit your request in writing to the Regulatory Affairs Department. It must state the dates for the information you are requesting. The time period can not be longer than seven (7) years back and may not include dates before April 14, 2003. Your request should indicate how we are to provide the information to you (mail, fax, etc.). We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions You have the right to request a restriction or limitation on the Protected Health Information (PHI) we use or disclose about you to someone who is involved in your care or the payment for it, like a family member or friend. For example, you could ask that we not use or disclose PHI about a surgery you had.

We are Not Required to Agree to Your Restriction Request If we do agree, we will comply with your request unless the PHI is needed to provide you emergency treatment.

To request restrictions, you may complete and submit the Request For Restriction Of Use / Disclosure of Protected Health Information to the Privacy Officer, Regulatory Affairs Department.

Right to Request Confidential Communications You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you may complete and submit the Restriction Agreement to the Privacy Officer, Regulatory Affairs Department. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted or receive mail.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may obtain a copy at any reception desk at the Heart & Family Health Institute, or you may contact the Privacy Officer, Regulatory Affairs Department, to request a copy.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice, and to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a summary of the current Notice in the patient areas of HFHI with its effective date in the top right hand corner. You are entitled to a copy of the entire Notice currently in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the Regulatory Affairs Department or with the Secretary of the U.S. Department of Health & Human Services. To file a complaint with our office, contact the Privacy Officer at 772-398-7998. You will not be penalized for filing a complaint.

If you have any questions about the information in this Notice, please contact our Privacy Officer at
772-398-7998 in the Regulatory Affairs Department.