NOTICE OF PRIVACY PRACTICES
Planned Parenthood of North Florida, Inc.
914 NW 13th Street, Gainesville, FL 32601
Phone (352)377-0881 Fax (352)374-6823
2121 W Pensacola Street STE B-2 Tallahassee, FL 32304
Phone (850)574-7455 Fax (850)575-4335
Jacksonville Beach Clinic:
2370-1 South Third Street Jacksonville, FL 32250
Phone (904)249-2378 Fax (904)249-0910
Jacksonville Central Clinic:
3850 Beach Blvd Jacksonville, FL 32207
Phone (904)399-2800 Fax (904)399-2333
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.
In this Notice, Planned Parenthood of NorthFlorida, Inc. may be referred to as we, our, or us.
We understand that your health information is personal. We may obtain information about your health from exams, tests, or from others who have provided you with care. We are committed to protecting your health information. This Notice will explain our privacy practices. It will describe:
1. How Your Health Information Will Be Used and Disclosed
2. Your Rights Related to Your Health Information
3. The Contact Person for More Information or for Complaints
This Notice is required by law. However, we may change our Notice at any time. Any of the changes that we make may apply to the information we already have and to new information. We will provide you with any new notice upon request. The new notice will also be posted at our clinics and other locations.
OUR CURRENT NOTICE " Effective April 14, 2003
1. How Your Health Information Will Be Used and Disclosed
We may use or disclose your health information for a number of reasons. This Notice explains those reasons. It also gives some examples of the uses and disclosures. The examples do not list every use or disclosure that may occur. However, any time that we use your information, or disclose it to someone else without your express authorization, it will fit one of the reasons listed here.
Treatment. We may use health information about you to provide you with healthcare treatment and services. We may disclose health information about you to doctors, nurses, technicians, health students, volunteers or other personnel who are involved in taking care of you. They may work at our offices, at a hospital if you are hospitalized under our supervision, or at another doctor's office, lab, pharmacy, or other healthcare provider to whom we may refer you for consultation, to take x-rays, to perform lab tests, to have prescriptions filled, or for other treatment purposes. For example, a doctor treating you may need to know if you have diabetes because diabetes may slow the healing process. We may provide that information to a physician treating you at another institution.
Payment. We may use and disclose health information about you to bill and collect payment from you, an insurance company, a state Medicaid agency or a third party. For example, we may need to give your health insurance plan information about your office visit so your health plan will pay us or reimburse you for the visit. Alternatively, we may need to give your health information to the state Medicaid agency so that we may be reimbursed for providing services to you. In some instances, we may need to tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
Healthcare Operations. We may use and disclose health information about you to operate our healthcare practice. These uses and disclosures are necessary to run our practice and make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, whether certain new treatments are effective, or to compare how we are doing with others and to see whether we can make improvements. We may remove information that identifies you from this set of health information so others may use it to study healthcare delivery without learning who our specific patients are. Also, we may share your health information with third parties who provide services or functions that are essential to our business. These third parties are called "business associates," and they may include billing agents or transcriptions services. We will make sure that all business associates have signed a written contract that will protect the privacy of your health information.
Appointment Reminders. We may use and disclose health information to contact you as a reminder that you have an appointment. Please let us know if you do not wish us to contact you concerning your appointment, or if you wish to have us use a different telephone number or address to contact you for this purpose.]
Fundraising Activities: We may use health information about you to contact you in an effort to raise money for our not-for-profit operations. Please let us know if you do not want us to contact you for such fundraising efforts.]
As Required by Law. We will disclose health information about you when required to do so by federal, state, or local law.
To Avert 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. The disclosure would only be made to someone able to help prevent the threat.
Military and Veterans. If you are a current or former member of the armed forces, we may release health information about you as required by military command authorities or the Department of Veterans Affairs as may be applicable. We may also release health information about foreign military personnel to the appropriate foreign military authorities.
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.
Public Health Risks. We may disclose health information about you for public health activities. These activities generally include the following:
To prevent or control disease, injury or disability;
To report births and deaths;
To report child abuse or neglect;
To report reactions to medications or problems with products;
To notify people of recalls of products they may be using;
To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to an order issued by a court or administrative tribunal. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only after efforts have been made to tell you about the request and you have time to obtain an order protecting the information requested.
Law Enforcement. We may release health information if asked to do so by a law enforcement official:
In response to a court order, court-ordered subpoena, warrant or summons or similar process;
To identify or locate a suspect, fugitive, material witness, or missing person;
If you are the victim of a crime and we are unable to obtain your consent;
About a death we believe may be the result of criminal conduct;
In an instance of criminal conduct at our facility; and
In emergency circumstances to report a crime; the location of the crime or victims or the identity, description, or location of the person who committed the crime.
Coroners, Health Examiners and Funeral Directors. We may release health information to a coroner or health 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.
Inmates. If you are an inmate of a correctional institute or under the custody of a law enforcement official, we may release health information about you the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with healthcare; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Other Uses of Health Information Based upon Your Written Authorization.
Other uses and disclosures of your health information will be made only with your written authorization. You may provide, amend, or revoke your authorization, in writing, at any time. We are unable to take back any disclosures we have already made. You may not revoke an authorization to the extent that we have already taken action in reliance on it. For more information about authorizations, please contact the Privacy Official.
2. Your Rights Related to Your Health Information
You have the following rights regarding the health information we maintain about you:
Right to Inspect and Copy. You have certain rights to inspect and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records. This does not include psychotherapy notes.
If you want to review or receive a copy of these records, you must make the request in writing on a form provided by us. You should send the signed form to the Privacy Official at the address listed on page 1.
If your request is accepted, we may charge a fee for the costs of locating, copying, mailing or processing your request. If your request is denied, you have the right to have this decision reviewed. The request and the denial will be reviewed by a licensed healthcare professional who did not conduct the original review. We will comply with the outcome of the review. Please contact the Privacy Official if you have questions about inspecting or copying your information.
Right to Amend. If you feel that your health information is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we keep the information. All requests must be made in writing on a form provided by us. You should send the signed form to the Privacy Official at the address listed on page 1.
In certain cases, we may deny your request for an amendment. For example, we may deny your request if it is not the form provided by us or if the request is not signed. We may also deny your request if: (1) we did not create the information, (2) it is not part of the health information kept by or for our practice; (3) the information is something that you would not be permitted to inspect and copy; or (4) the information is accurate and complete.
Amendments to your health information may be disclosed to those with whom we disclose information as previously specified.
Right to an Accounting of Disclosures. You have the right to request a list (accounting) of certain disclosures that we have made. This right applies to disclosures for purposes other than treatment, payment, and health care operations as described in this Notice. It also excludes disclosures you have authorized, disclosures made directly to you, disclosures to family members or friends involved in your care, and disclosures for national security or law enforcement officials.
You must request this list of disclosures on a form that we will provide to you. Your request must state a time period or the disclosures. The time period may not be longer than 6 years and it may not begin before April 14, 2003.
The first list of disclosures within a 12-month period will be free. We may charge you for the costs of additional lists. We will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred. Your right to receive the list may be subject to certain conditions, restrictions, and limitations. Please contact the Privacy Official for more information about accountings.
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 may also ask us not to disclose health information about you to family members or friends who are involved in your care or the payment for your care. For example, you could ask that access to your health information be denied to a particular member of our workforce who is known to you personally.
We are not required to agree to a restriction that you may request. We will review your request and decide whether it is in your best interests to allow the use and disclosure of your health information. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. We cannot agree to restrict disclosures that are required by law.
You may request a restriction by completing a form that we will provide to you. In your request, you must tell us what information you want to limit and to whom you want the limits to apply. The request must be signed.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain manner or at a certain location. For example, you can ask that we only contact you at work, or you may ask us to send your mail to a post office box. Please make this request in writing to our Privacy Official. We may condition your request. We will accommodate all reasonable requests.
Right to a Paper Copy of this Notice. We will send you a paper copy of this Notice at any time upon request.
3. The Contact Person for More Information or for Complaints
If you need more information or if you believe your privacy rights have been violated, we encourage you to contact our Privacy Official. To submit a complaint or for more information about the complaint process, contact the Privacy Official using the information found on page 1. You will not be penalized for filing a complaint.
You may also complain to the Secretary of the Department of Health and Human Services if you believe your privacy rights have been violated.
Special Section for Minors and Persons with Guardians
This Notice of Privacy Practices also applies to minors and incapacitated adults. Minors and incapacitated adults enjoy the same basic privacy protections as those listed above for their health information. However, because by law minors and incapacitated adults cannot make health care decisions for themselves, either a parent or a guardian must make medical decisions on their behalf. Consequently, because parents or guardians make health care decisions on behalf of minors or incapacitated adults, parents or guardians can authorize the use and disclosure of minors or incapacitated adults health information as if the parents or guardians were in the minors or incapacitated adults shoes. When making health care decisions on behalf of minors or incapacitated adults, parents or guardians also hold all of the rights listed in this Notice related to the protection of such health information, including the right to inspect and copy and the right to amend.
While oftentimes a minors health care decisions are made by a parent or guardian, there are certain situations where minors can make their own healthcare decisions independent of parental or guardian knowledge or consent. Such situations are heavily regulated by law and include minors who have become emancipated, minors who are donating blood or tissue samples and minors who are independently seeking examination and treatment for a sexually transmissible disease. It is important to note that when making such an independent health care decision, only the minor can authorize the use and disclosure of the minors health information with respect to the independent health care decision. Moreover, the minor holds all of the rights listed in this Notice related to the protection of health information concerning such an independent health care decision. However, if the minor elects to inform the parent or guardian and obtain parental or guardian consent for the independent health care decision, then all of the privacy rights regarding the health information for the independent health care decision may revert back to the parent or guardian.
There are also certain situations where adults other than the parent or guardian can access, use and/or disclose a minors health information without the consent of the parent or guardian. These situations usually occur where the law recognizes that the health or safety of the minor is in danger and access to or use and disclosure of health information without appropriate authorization is necessary to appropriately protect the minor. Such situations include minors who are suffering from emergency medical conditions, minors who have independently sought contraceptive information and services, and minors who are victims of child abuse, abuse.
2121 W. Pensacola, Tallahassee, FL 32304
(850) 574-7455 Fax: (850) 575-4355