Effective Date: November 19th, 2023
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS SUCH INFORMATION. PLEASE REVIEW IT CAREFULLY.
Each time you receive care or treatment at a medical office or other healthcare facility, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment information, a plan for future care or treatment, identifying information and billing-related information, as recorded by your attending physician(s) and other healthcare providers. This Notice is provided to inform you regarding (i) how Garrett Internal Medicine and its healthcare providers (collectively, “GIM”) may use or disclose medical information about you, (ii) with whom medical information about you may be shared, (iii) the safeguards GIM has in place to protect medical information about you and (iv) your rights to access and amend medical information about you. For purposes of this Notice, “medical information about you” includes sexually-transmissible disease-related information (including HIV and AIDS), genetic information, alcohol and/or substance abuse information, mental health information and other specially protected health information that may be subject to additional confidentiality protections under applicable State and federal law.
GIM is required to maintain the privacy of medical information about you and abide by the terms of this Notice (or the version currently in effect). GIM reserves the right to change this Notice in the future. Its effective date is noted at the top of this page. GIM reserves the right to make the revised or changed notice effective for health information it already has about you as well as any information it receives in the future. You may obtain a copy of the current version of this Notice at any time in the future by accessing the GIM website at www.garrettinternalmedicine.com, contacting the GIM Privacy Officer and requesting a copy be mailed to you, or asking for a copy at your next visit to GIM. You will be asked to provide a signed acknowledgment of receipt of this Notice. Since GIM’s intent is to make you aware of the possible uses and disclosures of medical information about you and your privacy rights, the delivery of your health care services will in no way be conditioned upon your signed acknowledgment of this Notice. If you decline to provide a signed acknowledgment, GIM will continue to provide your treatment and will use and disclose medical information about you to the extent permitted by applicable law.
USE AND DISCLOSURE OF MEDICAL INFORMATION ABOUT YOU
For Treatment: GIM may use medical information about you, as needed, to provide treatment or services to you. GIM may disclose medical information about you to, and obtain your medical information from, doctors, nurses, technicians, or other individuals, who are involved in taking care of you. For example, a doctor treating you at another hospital for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. GIM may also disclose medical information about you to, and obtain your medical information from the Event Notification Service through the Florida Health Information Exchange, and other health information exchanges in which you participate or for which you qualify for the purpose of its and the other participating providers’ treatment, payment and healthcare operations. Health information exchanges (commonly referred to as HIEs) are electronic health information networks in which community healthcare providers (such as GIM) may participate to facilitate the provision of care to patients. Information contained in HIEs may also be analyzed by the participating healthcare providers to improve their respective healthcare operations. GIM may also obtain information about you from, or transmit information about you through, electronic equipment and systems, such as medical devices used in your care, video cameras/monitors on GIM premises, GIM’s computer systems and any other applicable technology.
For Payment: GIM may use and disclose medical information about you, as needed, to bill and collect payment from you, your insurance company or a third party payer for care or treatment rendered to you. For example, GIM may need to give your insurance company information about you so that it will pay GIM or reimburse you for treatment provided by GIM. GIM may also tell your health plan about treatment you are going to receive to determine whether your plan will cover the cost of it. For Healthcare Operations: GIM may use and disclose medical information about you, as needed, to support the daily activities related to its healthcare services. These activities include, but are not limited to, quality assessment activities; investigations; oversight of staff performance; healthcare education; licensing; communications about a product or service, patient satisfaction surveys and focus groups, and conducting or arranging for other healthcare-related activities. GIM may share medical information about you, as needed, with independent “business associates” who perform various activities (for example, billing services, transcriptionists and survey entities) for GIM. GIM’s business associates will also be required to protect any medical information GIM provides about you. GIM may also use or disclose medical information about you, as needed, to provide you with information about treatment alternatives or other health-related benefits and services that might be of interest to you. For example, your name and address may be used to send you a newsletter about GIM and the services it offers or to send you information about products or services that GIM believes might benefit you. If you do not wish your information to be shared for these purposes, please contact the GIM Privacy Officer as set forth at the end of this Notice. GIM may disclose to a member of your family, a relative, a close friend or any other person you identify, medical information about you that directly relates to that person’s involvement in your care. GIM may also disclose information to someone who helps pay for your care. GIM may use or disclose medical information about you to notify or assist in notifying a family member, personal representative or any other person who is responsible for your care, of your location, general condition or death. GIM may use or disclose medical information about you to an authorized public or private entity to assist in disaster relief efforts and coordinate uses and disclosures to family or other individuals involved in your care.
As Permitted or Required by Law: GIM may use or disclose medical information about you to the extent permitted or required by applicable law, including but not limited to:
For Public Health: GIM may disclose medical information about you to a public health authority, who is permitted by law to collect or receive such information. Such disclosure may be necessary to do the following: Prevent or control disease, injury, or disability; Report births and deaths; Report child abuse or neglect; Report reactions to medications or problems with products; Notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; or Notify the appropriate government authority if GIM believes a patient has been the victim of abuse, neglect, or domestic violence.
Regarding Communicable Disease: GIM may disclose medical information about you, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or condition.
For Health Oversight: GIM may disclose medical information about you to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. These health oversight agencies may include State and federal government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
For Product Tracking: GIM may disclose medical information about you to a person or company required by the Food and Drug Administration (FDA) to do the following: Report adverse events, product defects, or problems and biologic product deviations; Track products; Enable product recalls; Make repairs or replacements; or Conduct required post-marketing surveillance.
In Legal Proceedings: GIM may disclose medical information about you during any judicial or administrative proceeding, in response to a court order or administrative tribunal (if such a disclosure is expressly authorized) and, in certain conditions, in response to a subpoena, discovery request, or other lawful process.
For Law Enforcement: GIM may disclose medical information about you for law enforcement purposes, including the following: Responses to legal proceedings; Information requests for identification and location; Circumstances pertaining to victims of a crime; Deaths suspected from criminal conduct; Crimes occurring at GIM; or Medical emergencies believed to result from criminal conduct.
To Coroners, Funeral Directors and Organ Procurement Organizations: GIM may, if applicable, disclose medical information about you to coroners or medical examiners for identification, to determine the cause of death or for the performance of other duties authorized by law. GIM may also disclose medical information about you to funeral directors, and to organ procurement organizations to facilitate cadaveric organ, eye, or tissue donations.
For Research: GIM may use medical information about you or disclose medical information about you to researchers when authorized by law. For example, GIM may disclose information about you to a researcher pursuant to an institutional review board (IRB) or privacy board approved protocol or retrospective review request that has been determined to pose minimal risk to your privacy.
For Health, Safety and National Security: GIM may disclose medical information about you, in accordance with State and/or federal law, if it believes that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. GIM may disclose medical information about you if it is necessary for law enforcement authorities to identify or apprehend an individual. GIM may also disclose medical information about you to authorized federal officials for conducting national security and intelligence activities.
Regarding Workers’ Compensation: GIM may disclose medical information about you to comply with workers’ compensation laws and other similar legally-established programs.
Regarding Inmates: If you are an inmate of a correctional facility, GIM may use or disclose medical information about you to such facility.
Other Uses: Uses and disclosures of your health information not covered by the Notice or otherwise permitted by applicable federal or state laws will be made only with your written authorization.
In addition, GIM must have your authorization to release psychotherapy notes, to release your information for marketing purposes or to sell your personal information for any purpose. If you authorize GIM to use or disclose your health information, you may revoke that permission, in writing, at any time by contacting Health Information Management at the hospital you visited or at your physician or other healthcare provider’s office.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You may exercise the following rights by submitting a written request to the GIM Privacy Officer. Please be aware, however, that GIM might deny your request, when legally permitted to do so.
Right to Inspect and Copy: For as long as GIM maintains medical information about you, you may inspect and obtain (for a reasonable, cost-based fee) a copy of medical information about you contained in certain medical and billing records maintained by GIM. This right does not include inspection and copying of the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and medical information about you that is subject to a law that prohibits access to medical information about you.
Right to Request Restrictions: You may ask GIM not to use or disclose medical information about you for treatment, payment, or health care operations (as described in this Notice). Your request must be submitted in writing to the GIM Privacy Officer. In your request, you must specifically state (i) what information you want restricted; (ii) whether you want to restrict GIM’s use, disclosure, or both; (iii) to whom you want the restriction to apply, for example, disclosures to your spouse; and (iv) an expiration date. If GIM believes that the restriction is not in the best interest of either party, or GIM cannot reasonably accommodate your request, GIM is not required to agree. If the restriction is agreed to by GIM, GIM will not use or disclose medical information about you in violation of that restriction, unless it is needed to provide emergency treatment. You may revoke a previously agreed upon restriction, at any time, in writing. Contact Health Information Management at the hospital you visited or the office manager at your physician or other healthcare provider’s office to request a restriction.
Right to Restrict Certain Health Information: You may ask GIM not to disclose information about you for payment purposes if: (i) the restriction is not otherwise prohibited by law, (ii) the disclosure is to a health plan for purposes of carrying out payment or healthcare operations, (iii) the information pertains solely to a service or healthcare item for which you paid out of pocket in full, and (iv) you made the request in writing prior to the information being released. Contact GIM at (386) 225-4900 to exercise this right.
Right to Request Confidential Communications: You may request that GIM communicate with you using alternative means (e.g., e-mail) or at an alternative location (e.g., post office box). GIM will not ask you the reason for your request, and will accommodate reasonable requests, when possible. If you request communication via unencrypted e-mail, please be aware that receiving or forwarding unencrypted e-mail could make that communication vulnerable to third party interference.
Right to Request Amendment: If you believe that the information GIM maintains about you is incorrect or incomplete, you may request an amendment to such information. While GIM will accept requests for amendment, GIM is not legally required to agree to an amendment.
Right to an Accounting of Certain Disclosures: You may request that GIM provide you with an account of disclosures it has made of medical information about you. This right applies to disclosures made for purposes other than treatment, payment or health care operations (as described in this Notice). To be accountable, the disclosure must have been made no more than 6 years from the date of your request. This right excludes disclosures made to you, to family members or friends involved in your care, or for notifications required by law (including disclosures for law enforcement, national security or intelligence purposes). The right to receive this information is subject to additional exceptions, restrictions, and limitations as described earlier in this Notice.
Right to Obtain a Copy of this Notice: You may obtain a paper copy of this Notice (or the version currently in effect) from GIM or view it electronically via the GIM website at www.GarrettInternalMedicine.com.
PRIVACY LAWS
This Notice is provided to you as a requirement of the rules created under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). There are several other State and federal privacy laws that also apply to medical information about you including the Freedom of Information Act, the Privacy Act and the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act. To the extent not preempted by HIPAA, GIM has taken such laws into consideration in developing its privacy policies and this Notice.
COMPLAINTS
If you believe GIM has failed to comply with this Notice or that GIM has violated these privacy rights, you may file a written complaint with the GIM Privacy Officer or the Department of Health and Human Services. GIM will not retaliate against you for filing a complaint. If GIM determines that your privacy rights have been violated, you will be notified by the GIM Privacy Officer.
CONTACT INFORMATION
You may contact the GIM Privacy Officer for further information about the complaint process or for further explanation of this document.
The GIM Privacy Officer may be contacted at:
Garrett Internal Medicine
50 Leanni Way
Suite A3-4
Palm Coast, Florida 32137
(386) 225-4900 telephone (anonymous reporting)
(386) 225-4748 facsimile
COVERED ENTITIES
All GIM healthcare providers and staff are covered by this Notice