The Bob Rauschenberg Center for Living

Notice of Privacy Practices

(In compliance with HIPPA regulations)

The purpose of this policy is to ensure that our practice, physicians, and staff have the necessary medical and individually identifiable health information to provide the highest quality medical care possible while protecting the confidentiality of the individually identifiable health information of our patients to the highest degree possible.
A patient should not be afraid to provide information to our practice and its physicians and staff for the purpose of treatment, payment, and healthcare operations. To that end, our practice and its physicians and staff will:

• Adhere to the standards set forth in the Notice of Privacy Practices.
• Collect, use, and disclose individually identifiable health information only in conformance with state and federal laws and current patient covenants and/or authorizations, as appropriate. Our practice and its physicians will not use or disclose individually identifiable health information for uses outside of the practice’s scope of treatment, payment, and healthcare operations, for example. marketing, employment, life insurance applications, without the written authorization from the patient.
• Use and disclose individually identifiable health information to remind patients of their appointments, unless they instruct us not to. This includes telephone contact number.
• Recognize that individually identifiable health information collected about patients must be accurate, timely, complete, and available when needed. Our practice and its physicians and staff will implement reasonable measures to protect the integrity of all individually identifiable health information maintained about our patients.
• Recognize that patients have a right to privacy. Our practice and its physicians and staff respect the patient’s individual dignity at all times. Our practice and its physicians and staff will respect patients’ privacy to the extent consistent with providing the highest quality medical care possible and with the efficient administration of the facility.
• Act as responsible information stewards and treat all individually identifiable health information as sensitive and confidential. Consequently, our practice and its physicians and staff will:
• Treat all individually identifiable health information data as confidential in accordance with professional ethics, accreditation standards, and legal requirements.
• Not disclose individually identifiable health information data unless the patient (or is or her authorized representative) has properly authorized the release or the release is otherwise authorized by law.

1. OUR COMMITMENT TO YOUR PRIVACY

Our practice is dedicated to maintaining the privacy of your individually identifiable health information. In conducting our business, we will create records regarding you, the treatment and services that we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning you individually identifiable health information. By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

• How we may use and disclose your individually identifiable health information
• Your privacy rights in your individually identifiable health information
• Our obligation concerning the use and disclosure of you individually identifiable health information

The terms of this notice apply to all records containing your individually identifiable health information that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that we may create or maintain in the future. Our practice will post a copy of our most current Notice at any time.

2. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

AIDS RESOURCE COUNCIL OF SOUTHWEST FLORIDA, INC AT (239) 278-4272

3. WE MAY USE AND DISCLOSE YOU INDIVIDUALLY IDENTIFIABLE HEATH INFORMATION IN THE FOLLOWING WAYS:

The following categories describe the different ways in which we may use and disclose you individually identifiable health information.

1. Treatment: Our Practice may use your individually identifiable information to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests) and we may use the results to help us reach a diagnosis, We might use your individually identifiable health information in order to write a prescription for you, or we might disclose you individually identifiable health information to a pharmacy when we order a prescription for you. Many of the people who work for our practice—including , but not limited to, our doctors, and nurses—may disclose you individually identifiable health information to others who may assist in your care, such as your spouse, children, or parents.

Finally, we may also provide your individually identifiable health information to other health care providers related to you treatment.

2. Payment: Our practice may use and disclose you individually identifiable health information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if you insurer will cover, or pay for, your treatment. We also may use and disclose your individually identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your individually identifiable health information to bill you directly for services and items. We may disclose you individually identifiable health information to other providers and entities to assist in their billing and collection efforts.
3. Health Care Operations: Our practice may use and disclose your individually identifiable health information to operate our business. As examples of the ways in which we, may use and disclose your information for our operations, our practice may use your individually identifiable health information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities of our practice. We may disclose your individually identifiable health information to other health care providers and entities to assist in their health care operations
4. Appointment Reminders: Our practice may use and disclose your individually identifiable health information to contact you and remind you of an appointment.
5. Treatment Options: Our practice may use and disclose you individually identifiable health information to inform you of potential treatment options or alternatives.
6. Health-Related Benefits and Services: Our practice may use and disclose your individually identifiable health information to inform you of health related benefits or services that may be of interest to you.
7. Release of Information to Family/Guardians/Friend: Our practice may release your individually identifiable health information to a family member, guardian, or friend that is involved in your care, or who assists in taking care of you. For example, a parent or guardian may ask that a babysitter take their child to the pediatrician’s office for treatment of a cold. In this example, the babysitter may have access to this child’s medical information.
8. Disclosures Required by Law: Our practice will use and disclose your individually identifiable health information when we are required to do so by federal, state and or local law.

4. USE AND DISCLOSURE OF YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose you identifiable health information:

1. Public Health Risks. Our practice may disclose your individually identifiable health information to public health authorities that are authorized by law to collect information for the purpose of:

• Maintaining vital records, such as births and deaths
• Reporting Child abuse or neglect
• Preventing or controlling disease, injury or disability
• Notifying individuals regarding potential exposure to a communicable disease
• Notifying individuals  regarding a potential risk for spreading or contracting a disease or condition
• Reporting reactions to drugs or problems with products or devices
• Notifying individuals if a product or device they may be using has been recalled
• Notifying a appropriate government agency (ies) and authority (ies) regarding the potential abuse or neglect of an adult patient (including domestic violence)
• However, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
• Notifying your employer under limited circumstance related primarily to workplace injury or illness or medical surveillance.
• Health Oversight Activities. Our practice may disclose individually identifiable health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigation, inspections, audits, surveys, licensures, and disciplinary actions, civil, administrative and criminal procedures or actions or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
• Lawsuits and Similar Proceedings. Our practice may use and disclose your individually identifiable health information in response to a court or administrative order, if you are involved in a lawsuit of similar proceeding. We also may disclose your individually identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
• Law Enforcement: We may release individually identifiable health information if asked to do so by a laws enforcement official:
• Regarding a crime victim in certain situations, if we are unable to obtain the person’ agreement
• Concerning a death we believe has resulted from criminal conduct
• Regarding criminal conduct at our offices
• In response to a warrant, summons, court order, subpoena, or other similar legal process
• To identify/locate a suspect, material witness, fugitive, or missing person
• In an emergency, to report a crime (including the location or victim (s) of the crime, or the description, identity, or location of the perpetrator
• Deceased Patients. Our practice may release individually identifiable health information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
• Organ and Tissue Donation. Our practice may release your individually identifiable health information to organizations that handle organ, eye, or tissue procurement or transplantation if you are an organ donor.
• Research. Our office may use and disclose you individually identifiable health information for research purposes in certain limited circumstances. We will obtain your written authorization to use your individually identifiable health information for research purposes except when an Internal Review Board or Privacy Board has determining that the waiver of you authorization satisfies the following:
1. The use or disclosure involves no more that minimal risk to your privacy based on the following:
1. an adequate plan to protect the identifiers from improper uses and disclosure;
2. an adequate plan to destroy the identifies at the earliest opportunity with the research (unless there is a health or research justification for  retaining the identifiers or such retention is otherwise required by law); and
3. adequate written assurances that the individually identifiable health information will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the disclosure would otherwise be permitted.
2. The research could not be practicable conducted without the waiver, and
3. The research could not practicable be conducted without the access to and use of the individually identifiable health information.
• Rights to Provide an Authorization for other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the uses and disclosure of your individually identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your individually identifiable health information for the reasons described in the authorization. Please note we are required to retain records of your care.

If you have a complaint or grievance with our practice, it physicians or staff, it is requested that you utilize our established patient grievance process. If your grievance/complaint is regarding your individually identifiable health information, and our established patient grievance process has been utilized without satisfaction, you may contact the Secretary of the Department of Health and Human Services. You will not be penalized for filing a grievance/complaint.

If you have any questions regarding this notice of our health information privacy policies, please contact:

AIDS RESOURCE COUNCIL OF SOUTHWEST FLORIDA, INC,

3677 CENTRAL AVENUE

SUITE B

FORT MYERS, FLORDA 33901