Effective Date: 09/23/2013

Publication Date: 09/23/2013

Click here to view the Notice of Privacy Practices in Spanish

This notice describes how medical information about you may be used and disclosed, and how you can gain access to this information. Please review it carefully.

ZION FAMILY HEALTHCARE, LLC

Protected health information (PHI), about you, is maintained as a written and/or electronic record of your contacts or visits for healthcare services with our practice. Specifically, PHI is information about you, including demographic information (i.e., name, address, phone, etc.), that may identify you and relates to your past, present or future physical or mental health condition and related healthcare services.

Our practice is required to follow specific rules on maintaining the confidentiality of your PHI, using your information, and disclosing or sharing this information with other healthcare professionals involved in your care and treatment. This Notice describes your rights to access and control your PHI. It also describes how we follow applicable rules and use and disclose your PHI to provide your treatment, obtain payment for services you receive, manage our healthcare operations, and for other purposes that are permitted or required by law.

Your Rights Under The Privacy Rule

    •    Right to receive this Notice: You are entitled to a copy of this Notice of Privacy Practices. We must follow the terms of this notice but reserve

          the right to change them at any time.

    •    Right to authorize other uses and disclosures: Any use of PHI not listed in this Notice requires your written authorization (e.g., marketing, sale

          of PHI, most psychotherapy notes). You may revoke authorization at any time in writing.

    •    Right to request alternative confidential communication: You can ask us to contact you by alternative means (e.g., email, phone) or at

          another address/number. Requests must be in writing.

    •    Right to inspect and copy your PHI: You may review or request a copy of your medical record, including in electronic format. Reasonable

          fees may apply.

    •    Right to request restrictions: You may request in writing that we not use or disclose your PHI for treatment, payment, or operations. While we

          may deny most requests, if you pay in full out-of-pocket for a service, we must honor your request not to share it with your health plan.

    •    Right to request amendments: You may request changes to your PHI while we maintain it. We may deny requests in certain cases.

    •    Right to request an accounting of disclosures: You may ask for a list of disclosures of your PHI made outside of our office.

    •    Right to receive a breach notice: You will receive written notification if your unsecured PHI is breached and notification is required by law.

How We May Use or Disclose PHI

Treatment – We may use/disclose PHI to coordinate/manage your healthcare with third parties involved in your treatment (e.g., pharmacies, other providers).

Special Notices – We may contact you with appointment reminders, test results, treatment alternatives, health-related benefits, or fundraising information. You can opt out of such notices.

Payment – We may use/disclose PHI to obtain payment from your health plan, including pre-authorization or coverage determinations.

Healthcare Operations – We may use/disclose PHI to support business activities like planning, quality improvement, legal services, auditing, or patient safety.

Health Information Organizations – We may use electronic exchange networks to share PHI for treatment, payment, or operations.

To others involved in your care – Unless you object, we may disclose PHI to family, friends, or others identified as involved in your care. If you cannot agree or object, we may disclose what we deem in your best interest.

Other Permitted/Required Uses and Disclosures

We may use or disclose your PHI without authorization for:

    •    As required by law

    •    Public health activities

    •    Health oversight activities

    •    Abuse or neglect cases

    •    FDA compliance

    •    Research purposes

    •    Legal proceedings

    •    Law enforcement

    •    Coroners, funeral directors, organ donation

    •    Criminal activity

    •    Military or national security activities

    •    Worker’s compensation

    •    When you are an inmate in a correctional facility

    •    To the Department of Health and Human Services (HHS) for compliance investigations

Privacy Complaints

You may complain to us or directly to the Secretary of HHS if you believe your privacy rights have been violated. To file with us, contact our Privacy Manager.

We will not retaliate against you for filing a complaint.

Address: 13135 W Linebaugh Ave

Suite: 101

City: Tampa

State: Florida

Zip Code: 33626