NOTICE OF PRIVACY PRACTICES EFFECTIVE 1/1/2016
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.

OUR PLEDGE REGARDING HEALTH INFORMATION (HI):

We, understand that medical information about you and your health is personal. We are committed to protecting medical information about you. Health Information (HI) in this notice means information related to your health or health services that can be used to identify you. We collect and keep HI to provide you with quality care and to comply with certain legal requirements. HI may be oral, written or electronic. We limit access to all types of your HI to our employees and service providers who manage your coverage and provide services. We have physical, electronic and procedural safeguards, per federal standards to guard your HI.

This notice tells you

  • How we may use your HI.
  • When we can share your HI with others.
  • What other rights you have to your HI.

We MUST, by law:

  • make sure that health information that identifies you is kept private;
  • use and share your HI if asked for by you or your legal representative;
  • use and share your HI if asked for by Secretary of the Department of Health and Human Services to make sure your privacy is protected;
  • give you this notice of our legal duties and privacy practices concerning health information about you;
  • notify you following a breach of unsecured protected health information; and
  • follow the terms of the notice that is currently in effect.

WE ARE PERMITTED TO:

To provide for your treatment, payment of your care and to run our business, we are permitted to use and share your HI as follows.

  • For Treatment. We are allowed to use and share health information about you to provide you with medical treatment or services. We may disclose health information about you to personnel who are involved in taking care of you. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for nutritional counseling. We also may share health information about you in order to coordinate the different things you need, such as prescriptions, lab work and diagnostic testing.
    • To Distribute Reminders. We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or medical care. For example, we may mail postcard reminders about appointments.
    • To Identify Treatment Alternatives. We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. For example, we may speak to providers about other ways to treat someone in your situation to provide you with best options.
    • For Health Related Benefits and Services. We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you. For example we can suggest a disease management or wellness program to improve your health.
  • For Payment. We are permitted to use and share health information about you so that the treatment and services you receive may be billed for and payment may be collected. For example, we may talk to your insurer about a treatment you are going to receive to determine whether your insurance plan will cover the treatment.
    • To Communicate with Plan Sponsors. We may give enrollment and summary HI to an employer plan sponsor. We may give them other HI if they agree to limit its use per federal law.
    • To Inform Individuals Involved in Providing your Care or Involved in Payment for Your Care. We may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you have been seen in our office. In addition, we may disclose health information about you to a friend or family member should an emergency situation arise.
  • For Health Care Operations. We are allowed to use and share health information about you to run our business. For example we may use HI to make sure that all of our patients receive quality care and to monitor the performance of our staff in caring for you. We may also combine and study health information about many patients.

IN ADDITION, WE MAY USE HI:

  • To Comply with Laws. We will disclose health information about you when required to do so by federal, state or local law.
  • For Public Health Activities. We may disclose health information about you for public health activities, such as preventing disease outbreak.
  • About victims of abuse, neglect or domestic violence. We may share information about an individual believed to be a victim of abuse, neglect or domestic violence to an authorized government entity, including social service or protective services agency.
  • To Support Health Oversight Activities. We may disclose health information to an agency that is allowed by law to receive HI. These agencies may perform audits, fraud and abuse investigations, inspections, or licensure activities.
  • In Response to Lawsuits and Disputes. We may disclose health information about you in response to court order, subpoena, warrant, summons or similar process.
  • To Law Enforcement. We may release health information to a law enforcement official for example, to find a missing person or to report a crime
  • To Coroners, Medical Examiners and Funeral Directors. We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to funeral directors as necessary to carry out their duties.
  • For Organ and Tissue Donation. To help get, store or transplant organs, eyes or tissue. For example, if you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
  • For Research. To study disease or disability, as allowed by law.
  • To Avoid a Serious Threat to Health 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. Any disclosure, however, would only be to someone able to help prevent the threat.
  • For Government Functions. This may be for military and veteran use, national security, Intelligence Activities or the Protective Services. For example, if you are a member of the armed forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority. For persons in the custody of a law enforcement official(s) we may release health information to (1) provide you with health care; (2) protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
  • For Workers' Compensation. We may release health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

OTHER USES OF HI:

  • Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission.
  • If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

YOU HAVE THE FOLLOWING RIGHTS REGARDING HI:

  • Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to our Compliance Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
  • Right to Request Confidential Communication. 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 must make your request in writing to our Compliance Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must tell us how or where you wish to be contacted. If you do not tell us how or where you wish to be contacted, we do not have to follow your request.
  • Right to Inspect and Copy. You have the right to inspect and obtain a copy of HI that may be used to make decisions about your care. Usually, this includes medical and billing records. This does not include psychotherapy notes. To inspect and copy health information that may be used to make decisions about you, please submit your request in writing to the Compliance Officer at the address on the last page of this notice. If you request a copy of the Information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request, in writing, that the denial be reviewed. A licensed health care professional will then review your request and the denial. The person conducting the review will not be the person who previously denied your request. We will comply with the outcome of the review. You have the right to access the information in the form and format you request, or in hard copy. We may provide a designee with the requested information, if such a request is in writing.
  • Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to include additional information in your medical record. You have the right to request an amendment for as long as all of the health information is maintained by us. To request an amendment, your request must be made in writing, include the reason that supports your request and be submitted to our Compliance Officer. 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 information that: o Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; o Is not part of the HI kept by us; o Is not part of the HI which you would be permitted to inspect and copy; or o Is accurate and complete.
  • Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of health information about you, excluding disclosures for the purpose of treatment, payment and healthcare operations. To request this list or accounting of disclosures, you must submit your request in writing to the Compliance Officer. Your request must state a time period, which may not be more than six. Your request should indicate in what form you want the list (for example, on paper, or electronically). The first list you request within a 12- month period will be free. For additional lists, 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 Restrict Release of Information For Certain Services- You have the right to restrict the disclosure of information regarding services for which you have paid in full or on an out of pocket basis. This information can be released only upon your written authorization.
  • Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy, please submit your written request to the Compliance Officer at the address noted below.
  • Right To Breach Notification You have the right to be notified of any breach of your unsecured healthcare information.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our offices and on the website. The notice will contain on the first page, the effective date. In addition, each time you are seen for treatment or health care services at our office, we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint.

  • To file a complaint please contact:
    Nancy DiGioacchino, Compliance Officer
    (866)255-1154 
    compliance@chsamerica.com
    KGHealth Partners
    TheCampus at Icot Center
    13360Icot Blvd
    Clearwater FL 33760
  • You will not be penalized for filing a complaint.
Notificación de Practicas Privadas, Efectivo desde 1/1/2016
Esta notificación describe cómo puede utilizarse y divulgarse su información médica, y cómo puede acceder usted a esta información. Revísela con cuidado.

Sus derechos

Usted cuenta con los siguientes derechos:

  • Obtener una copia de su historial médico y de reclamos.
  • Corregir en papel o en formato electrónico su historial médico.
  • Solicitar comunicación confidencial.
  • Pedirnos que limitemos la información que compartimos.
  • Recibir una lista de aquellos con quienes hemos compartido su información.
  • Obtener una copia de esta notificación de privacidad.
  • Elegir a alguien que actúe en su nombre.
  • Presentar una queja si considera que se violaron sus derechos de privacidad.

Sus opciones

Tiene algunas opciones con respecto a la manera en que utilizamos y compartimos información cuando:

  • Respondemos las preguntas de cobertura de su familia y amigos.
  • Proporcionamos alivio en caso de una catástrofe.
  • Comercializamos nuestros servicios y vendemos su información.

Nuestros usos y divulgaciones

Podemos utilizar y compartir su información cuando:

  • Ayudamos a administrar el tratamiento de atención médica que usted recibe.
  • Dirigimos nuestra organización.
  • Pagamos por sus servicios médicos.
  • Administramos su plan médico.
  • Ayudamos con asuntos de seguridad y salud pública.
  • Realizamos investigaciones médicas.
  • Cumplimos con la ley.
  • Respondemos a las solicitudes de donación de órganos y tejidos y trabajamos con un médico forense o director funerario.
  • Tratamos la compensación de trabajadores, el cumplimiento de la ley y otras solicitudes gubernamentales.
  • Respondemos a demandas y acciones legales.
  • No creamos o mantenemos las notas de psicoterapia en esta oficina

Sus derechos

Cuando se trata de su información médica, usted tiene ciertos derechos.

Esta sección explica sus derechos y algunas de nuestras responsabilidades para ayudarlo.

Recibir una copia de su historial médico y de reclamos

  • Puede solicitar que le muestren o le entreguen una copia de su historial médico y reclamos y otra información médica que tengamos de usted. Pregúntenos cómo hacerlo.
  • Le entregaremos una copia o un resumen de su historial médico y de reclamos, generalmente dentro de 30 días de su solicitud. Podemos cobrar un cargo razonable en base al costo.

Solicitarnos que corrijamos el historial médico y de reclamos

  • Puede solicitarnos que corrijamos su historial médico y de reclamos si piensa que dichos historiales son incorrectos o están incompletos. Pregúntenos cómo hacerlo.
  • Podemos decir “no” a su solicitud, pero le daremos una razón por escrito dentro de 60 días.

Solicitar comunicaciones confidenciales

  • Puede solicitarnos que nos comuniquemos con usted de una manera específica (por ejemplo, por teléfono particular o laboral) o que enviemos la correspondencia a una dirección diferente.
  • Consideraremos todas las solicitudes razonables y debemos decir“sí” si nos dice que estaría en peligro si no lo hacemos.

Solicitarnos que limitemos lo que utilizamos o compartimos

  • Puede solicitarnos que no utilicemos ni compartamos determinada información médica para el tratamiento, pago o para nuestras operaciones.
  • No estamos obligados a aceptar su solicitud, y podemos decir “no”si esto afectara su atención.

Recibir una lista de aquellos con quienes hemos compartido información

  • Puede solicitar una lista (informe) de las veces que hemos compartido su información médica durante los seis años previos a la fecha de su solicitud, con quién la hemos compartido y por qué.
  • Incluiremos todas las divulgaciones excepto aquellas sobre el tratamiento, pago y operaciones de atención médica, y otras divulgaciones determinadas (como cualquiera de las que usted nos haya solicitado hacer). Le proporcionaremos un informe gratis por año pero cobraremos un cargo razonable en base al costo si usted solicita otro dentro de los 12 meses.

Obtener una copia de esta notificación de privacidad

  • Puede solicitar una copia en papel de esta notificación en cualquier momento, incluso si acordó recibir la notificación de forma electrónica. Le proporcionaremos una copia en papel de inmediato.

Elegir a alguien para que actúe en su nombre

  • Si usted le ha otorgado a alguien la representación médica o si alguien es su tutor legal, aquella persona puede ejercer sus derechos y tomar decisiones sobre su información médica.
  • Nos aseguraremos de que la persona tenga esta autoridad y pueda actuar en su nombre antes de tomar cualquier medida.

Presentar una queja si considera que se violaron sus derechos

  • Si considera que hemos violado sus derechos, puede presentar un aqueja comunicándose con nosotros por medio de la información de la página 1.
  • Puede presentar una queja en la Oficina de Derechos Civiles del Departamento de Salud y Servicios Humanos enviando una carta a: Department ofHealth and Human
  • Services, 200 Independence Avenue, S.W., Washington,D.C. 20201, llamando al
  • 1-800-368-1019 o visitando www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/factsheets_spanish.html, los últimos dos disponibles en español.
  • No tomaremos represalias en su contra por la presentación de un aqueja.

Sus opciones

Para determinada información médica, puede decirnos sus decisiones sobre qué compartimos.

Si tiene una preferencia clara de cómo compartimos su información en las situaciones descritas debajo, comuníquese con nosotros. Díganos qué quiere que hagamos, y seguiremos sus instrucciones.

En estos casos, tiene tanto el derecho como la opción de pedirnos que:

  • Compartamos información con su familia, amigos cercanos u otras personas involucradas en el pago de su atención.
  • Compartamos información en una situación de alivio en caso de una catástrofe.
Si no puede decirnos su preferencia, por ejemplo, si se encuentra inconsciente, podemos seguir adelante y compartir su información si creemos que es para beneficio propio. También podemos compartir su información cuando sea necesario para reducir una amenaza grave e inminente a la salud o seguridad.

En estos casos, nunca compartiremos su información a menos que nos entregue un permiso por escrito:

  • Propósitos de mercadeo.
  • Venta de su información.

Nuestros usos y divulgaciones

Por lo general, ¿cómo utilizamos o compartimos su información médica?

Por lo general, utilizamos o compartimos su información médica de las siguientes maneras.

Ayudar a administrar el tratamiento de atención médica que usted recibe

  • Podemos utilizar su información médica y compartirla con otros profesionales que lo estén tratando.
    Ejemplo: Un médico nos envía información sobre su diagnóstico y plan de tratamiento para que podamos organizar los servicios adicionales.

Dirigir nuestra organización

  • Podemos utilizar y divulgar su información para dirigir nuestra organización y comunicarnos con usted cuando sea necesario.
  • No se nos permite utilizar información genética para decidir si le proveemos cobertura y el precio de dicha cobertura. Esto no se aplica a los planes de atención a largo plazo.
    Ejemplo:Utilizamos su información médica para ofrecerle mejores servicios.

Pagar por sus servicios médicos

  • Podemos utilizar y divulgar su información médica cuando pagamos por sus servicios médicos.
    Ejemplo:Compartimos su información con su plan médico para coordinar el pago por su trabajo médico.

Administrar su plan

  • Podemos divulgar su información médica a su patrocinador del plan médico para la administración del plan.
    Ejemplo:Su compañía nos contrata para proveer un plan médico, y nosotros le proporcionamos a su compañía determinadas estadísticas para explicar las primas que cobramos.

¿De qué otra manera podemos utilizar o compartir su información médica?

Se nos permite o exige compartir su información de otras maneras (por lo general, de maneras que contribuyan al bien público, como la salud pública e investigaciones médicas).

Tenemos que reunir muchas condiciones legales antes de poder compartir su información con dichos propósitos. Para más información, visite: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/factsheets_spanish.html, disponible en español.

Ayudar con asuntos de salud pública y seguridad

  • Podemos compartir su información médica en determinadas situaciones, como:
  • Prevención de enfermedades.
  • Ayuda con el retiro de productos del mercado.
  • Informe de reacciones adversas a los medicamentos.
  • Informe de sospecha de abuso, negligencia o violencia doméstica.
  • Prevención o reducción de amenaza grave hacia la salud o seguridad de alguien.

Realizar investigaciones médicas

  • Podemos utilizar o compartir su información para investigación de salud.

Cumplir con la ley

  • Podemos compartir su información si las leyes federales o estatales lo requieren, incluyendo compartir la información con el Departamento de Salud y Servicios Humanos si éste quiere comprobar que cumplimos con la Ley de Privacidad Federal.

Responder alas solicitudes de donación de órganos y tejidos y trabajar con un médico forense o director funerario

  • Podemos compartir su información médica con las organizaciones de procuración de órganos.
  • Podemos compartir información médica con un oficial de investigación forense, médico forense o director funerario cuando un individuo fallece.

Tratar la compensación de trabajadores, el cumplimiento de la ley y otras solicitudes gubernamentales

  • Podemos utilizar o compartir su información médica:
    • En reclamos de compensación de trabajadores.
    • A los fines de cumplir con la ley o con un personal de las fuerzas de seguridad.
    • Con agencias de supervisión sanitaria para las actividades autorizadas por ley.
    • En el caso de funciones gubernamentales especiales, como los servicios de protección presidencial, seguridad nacional y servicios militares.

Responder a demandas y acciones legales

  • Podemos compartir su información médica en respuesta a una orden administrativa o de un tribunal o en respuesta a una citación.

Nuestras responsabilidades

  • Estamos obligados por ley a mantener la privacidad y seguridad de su información médica protegida.
  • Le haremos saber de inmediato si ocurre un incumplimiento que pueda haber comprometido la privacidad o seguridad de su información.
  • Debemos seguir los deberes y prácticas de privacidad descritas en esta notificación y entregarle una copia de la misma.
  • No utilizaremos ni compartiremos su información de otra manera distinta a la aquí descrita, a menos que usted nos diga por escrito que podemos hacerlo. Si nos dice que podemos, puede cambiar de parecer en cualquier momento. Háganos saber por escrito si usted cambia de parecer.

Cambios a los términos de esta notificación

Podemos modificar los términos de esta notificación, y los cambios se aplicarán a toda la información que tenemos sobre usted. La nueva notificación estará disponible según se solicite, en nuestro sitio web, y le enviaremos una copia por correo.

Cuestiones

Si usted cree que sus derechos han sido violados, puede comunicarse con :

Nancy DiGioacchino, Compliance Officer
(866)255-1154 
compliance@chsamerica.com
KGHealth Partners
TheCampus at Icot Center
13360Icot Blvd
Clearwater FL 33760

Paramayor información, visite:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/factsheets_spanish.html ,disponible en español.