HIPAA Notice of Privacy Practices

Experience Health & Wellness Center, 2307 Sandoval Blvd, Suite 3, Cape Coral, FL 33991
Privacy Officer: Omar Clark, D.C. · (239) 205-3700

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.

We understand the importance of privacy and are committed to maintaining the confidentiality of your medical information. We make a record of the medical care we provide and may receive such records from others. We use these records to provide or enable other health care providers to provide quality medical care, to obtain payment for services provided to you as allowed by your health plan, and to enable us to meet our professional and legal obligations to operate this medical practice properly. We are required by law to maintain the privacy of protected health information, to provide individuals with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. This notice describes how we may use and disclose your medical information. It also describes your rights and our legal obligations with respect to your medical information. If you have any questions about this Notice, please contact our Privacy Officer listed above.

A. How This Medical Practice May Use or Disclose Your Health Information

This medical practice collects health information about you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of this medical practice, but the information in the medical record belongs to you. The law permits us to use or disclose your health information for the following purposes:

Treatment

We use medical information about you to provide your medical care. We disclose medical information to our employees and others who are involved in providing the care you need. For example, we may share your medical information with other physicians or health care providers who will provide services we do not provide, or with a pharmacist or laboratory. We may also disclose medical information to members of your family or others who can help you when you are sick or injured.

Payment

We use and disclose medical information about you to obtain payment for the services we provide. For example, we give your health plan the information it requires before it will pay us. We may also disclose information to other health care providers to assist them in obtaining payment for services they have provided to you.

Health Care Operations

We may use and disclose medical information about you to operate this medical practice. For example, we may use and disclose this information to review and improve the quality of care we provide, or the competence and qualifications of our professional staff. We may also use and disclose this information as necessary for medical reviews, legal services and audits, including fraud and abuse detection and compliance programs, and business planning and management. We may share your medical information with our "business associates," such as our billing service, that perform administrative services for us. We have a written contract with each of these business associates that requires them and their subcontractors to protect the confidentiality and security of your protected health information.

Appointment Reminders

We may use and disclose medical information to contact and remind you about appointments. If you are not home, we may leave this information on your answering machine or in a message left with the person answering the phone.

Sign In Sheet

We may use and disclose medical information about you by having you sign in when you arrive at our office. We may also call out your name when we are ready to see you.

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 and general condition. If you are able and available to agree or object, we will give you the opportunity to object prior to making these disclosures. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communicating with your family and others.

Marketing

Provided we do not receive payment for making these communications, we may contact you to give you information about products or services related to your treatment, case management, or care coordination, or to recommend other treatments or providers that may be of interest to you. We will not otherwise use or disclose your medical information for marketing purposes, or accept any payment for other marketing communications, without your prior written authorization, which you may revoke at any time.

Sale of Health Information

We will not sell your health information without your prior written authorization, which you may revoke at any time.

Required by Law

As required by law, we will use and disclose your health information, but we will limit our use or disclosure to the relevant requirements of the law.

Public Health, Oversight, and Legal Proceedings

We may, and are sometimes required by law, to disclose your health information to public health authorities, health oversight agencies, and in the course of judicial and administrative proceedings, and to law enforcement officials, subject to the limitations imposed by law. We may also disclose information for coroners, organ or tissue donation, public safety, proof of immunization, specialized government functions, and workers' compensation, as permitted or required by law.

Change of Ownership

In the event that this medical practice is sold or merged with another organization, your health information will become the property of the new owner, although you will maintain the right to request that copies be transferred to another physician or medical group.

Breach Notification

In the case of a breach of unsecured protected health information, we will notify you as required by law. If you have provided us with a current email address, we may use email to communicate information related to the breach.

B. When This Medical Practice May Not Use or Disclose Your Health Information

Except as described in this Notice, this medical practice will not use or disclose your health information without your prior written authorization. Most uses and disclosures of psychotherapy notes, uses and disclosures for marketing that involve payment, and the sale of your health information require your written authorization. If you authorize us to use or disclose your health information, you may revoke that authorization, in writing, at any time, except to the extent we have already acted in reliance on it.

C. Your Health Information Rights

Right to Request Special Privacy Protections

You have the right to request restrictions on certain uses and disclosures of your health information by a written request specifying what information you want to limit. If you tell us not to disclose information to your commercial health plan concerning care for which you paid in full out of pocket, we will abide by your request, unless we must disclose the information for treatment or legal reasons.

Right to Request Confidential Communications

You have the right to request that you receive your health information in a specific way or at a specific location. We will comply with all reasonable requests submitted in writing that specify how or where you wish to receive these communications.

Right to Inspect and Copy

You have the right to inspect and copy your health information, with limited exceptions. To access your medical information, you must submit a written request detailing what information you want access to, whether you want to inspect it or get a copy of it, and your preferred form and format. We may charge a reasonable fee that covers our costs for labor, supplies, and postage.

Right to Amend or Supplement

You have the right to request that we amend health information you believe is incorrect or incomplete. You must make your request in writing and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information and will provide you with information about any denial and how you can disagree with it.

Right to an Accounting of Disclosures

You have the right to receive an accounting of certain disclosures of your health information made by this medical practice, subject to the exceptions described by law.

Right to a Paper or Electronic Copy of this Notice

You have the right to a paper copy of this Notice of Privacy Practices, even if you have previously requested its receipt by email. To exercise any of these rights, please contact our Privacy Officer listed at the top of this Notice.

D. Changes to this Notice of Privacy Practices

We reserve the right to amend this Notice at any time in the future, and to make the new provisions effective for all information that we maintain, including information created or received prior to the effective date of the change. Until such an amendment is made, we are required by law to comply with this Notice. We will post any revised Notice in our office, and a copy will be available upon request.

E. Complaints

Complaints about this Notice of Privacy Practices, or about how this medical practice handles your health information, should be directed to our Privacy Officer listed at the top of this Notice. You will not be penalized or retaliated against for filing a complaint. You may also file a complaint with the U.S. Department of Health and Human Services.