Patient Privacy

Notice of Privacy Practices For Heart Specialists of Sarasota

This notice describes how medical information about you may be used and disclosed, how you can get access to this information, and your rights and our responsibilities. Please review it carefully.

Each time you visit our physicians or receive treatment from us, a record of your visit is made. This record may contain your symptoms, examination and test results, diagnoses, treatment, your future treatment plan, and your billing information. This notice applies to all of the records that are generated by our physicians.

Our Responsibilities

At Heart Specialists of Sarasota (HSS) we are committed to maintaining the privacy of your protected health information. We are required by law to provide you with this notice of our legal duties and privacy practices. Additionally, we are required to notify affected individuals if there is ever a breach of any unsecured protected health information. We will abide by the notice that is currently in effect. This notice is effective 7/1/13.

Uses and Disclosures – How we may use and disclose protected health information about you.

For Treatment: We may use protected health information about you, in paper or electronic form, to provide you with treatment or services. We may disclose protected health information about you to other health care providers. For example, we may need to communicate with your primary care physician (PCP) concerning your treatment plan and follow up care.

For Payment: We may use and disclose protected health information about your treatment and services to our billing office, to seek payment from your insurance company or other third party payer or family member who assumes financial responsibility for your care. For example, we may need to give your insurance company information about your diagnosis in order to obtain an authorization so services will be paid.

For Healthcare Operations: We may use and disclose your protected health information in order to improve our practice. For example, medical staff and/or others involved in quality improvement may review your care and treatment outcome as a basis for continually improving quality of care for all.

We also use and disclose protected health information: • To business associates we contract with to perform services related to your care; • To remind you that you have an appointment, give you test results or tell you of treatment alternatives; • To assess your satisfaction with the services we provide to you; • To discuss care coordination or prescription refills with you or your pharmacy; • When conducting training programs for healthcare professionals.

Individuals Involved in Your Care or Payment for Your Care: Unless you object, we may release protected health information about you to family members, friends or others involved in your care.

Research: We may disclose information to researchers when they offer services that may be beneficial to you based on your diagnoses, as long as there is no payment made to us for the disclosure.

Future Communications:

As Required by Law, for example, we may disclose your protected health information to the following: • Government agencies, such as Public Health, or legal or federal authorities responsible for preventing or controlling disease, injury, disability, or other threat to health, safety or national security. • Workers compensation agents • Law enforcement for purposes as required by law or in response to a valid subpoena or court order • Correctional institutions if you are in custody of a correctional institution or law enforcement officer. Other Uses of Your Protected Health Information That Require Your Authorization • Psychotherapy notes, if any, may not be released without your authorization. • Release of your protected health information for marketing purposes requires your authorization. • The sale of any of your protected health information is prohibited without your authorization. • You may opt out of any fund raising activities on a per solicitation basis. • Any other use or disclosure not described in this notice would require your authorization.

If you provide authorization for any of the above, you may revoke that permission at any point in time and from that day forward, we will no long use or disclose your protected health information for the reasons covered by your authorization. You understand that we are not able to take back any disclosures that were already made with your permission.

Your Health Information Rights Although your health record is the physical property of Heart Specialists of Sarasota, you have the right to: • Inspect and copy your protected health information. You may request access to your records on paper or in electronic form, by contacting us. You may also ask that we send your health information directly to another individual with your signed, written instructions. We reserve the right to charge you a reasonable fee to cover the cost of providing you with a copy of your records. We may deny your request to inspect and/or copy in certain limited circumstances, and if we do this, you may ask that the denial be reviewed. • Request an amendment to your protected health information, in writing with a detailed explanation, if you believe that the information we have is incorrect or incomplete. If for some reason your request is denied, you will be notified in writing of the reason for the denial. • Request an accounting of disclosures. This is a list of certain disclosures we make of your protected health information other than treatment, payment, healthcare operations, or other permitted uses. • Notification of a breach of unsecured protected health information, as required following a risk assessment, including any steps that you need to take in order to protect yourself against harm due to the breach. • Request, in writing, that we restrict communication to your health plan regarding a specific treatment or service, as long as is it not required by law, and you, or someone you know, has paid for the service in full. Effective March 26, 2013, The Omnibus Rule requires that we honor this restriction. • Request confidential communications. You have the right to alternative means of communication as long as it is reasonable and made in writing, with the alternative means listed. For example, you may ask that we contact you at work or by US postal service. The request should include an address where you would like to receive bills and related correspondence regarding payment for services. • A paper copy of this notice. You may ask for a copy of this notice at any point in time. You may obtain a copy of this notice on our website: www.heartspecialistsofsarasota.com. Changes to This Notice: We reserve the right to change this notice. The current notice will always be posted in our office and will include the new effective date. Copies of any revised notices will be available on our website. You may also receive a copy from our office upon request.

Complaints If you believe your privacy rights have been violated, you may file a complaint with us by contacting our Privacy Officer, Christine Archambault at 941-225-6006, or by contacting the Office for Civil Rights as noted below:

Office for Civil Rights US Department of Health and Human Services 200 Independence Avenue, S.W. Room 509F, HHH Building Washington, D.C. 20201

There will be no retaliation for filing a complaint with either the Privacy Officer or the Office for Civil Rights.